A chief information officer in the NHS has said the amount of work involved in implementing an important cross-organisational child health system in London was underestimated.
David Welbourn, chief information officer at the North East London Strategic Health Authority, identified problems with data migration and differences in working practices across the capital as key issues in the troubled implementation of a child health system.
Welbourn summarised the difficulties with the Child Health Interim Application, supplied by BT as part of the NHS's National Programme for IT (NPfIT), in a briefing for his board before it was subsumed into the new NHS London organisation.
Welbourn's critique came as the website for Connecting for Health, which runs the NPfIT, continued to carry assurances about the system.
The child health application is used to collate data on immunisations and vaccination, as well as issue reminders to parents. It also issues recalls if necessary.
The system went live in July 2005, about three months late, and had only a limited set of key features, some of which are still missing, and are not due to be delivered until this month.
"Primary care trusts have reverted to manual processes which are clearly less efficient and have a higher risk of error," said Welbourn in his paper.
"There are differing views about the level of clinical risk arising from this unfortunate position, even among the experts, although some of the more mobile and disadvantaged families are likely to have missed elements of the immunisation and vaccination schedule."
Trusts will "seek to ensure that any missed jabs are identified and appropriate action taken", the report added.
Connecting for Health has issued a "reassurance that the new computer system will not have put individual children at any increased risk of missing their vaccinations". It has not published detailed lessons from the system's implementation.
Welbourn, however, noted that there is "considerable learning to be drawn from the child health programme, not least because it is the first system to be deployed as a common system across multiple organisations".
He added, "Two key aspects of data migration were underestimated - the impact of differences in clinical practice between the primary care trusts, and the impact of a highly mobile population leaving episodes of care records in different locations."
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