The main suppliers to the £12.7bn National Programme for IT have until the end of November to make important progress in installing e-record systems in big acute hospitals.
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If the seven-month deadline is not met, "we will look at alternative approaches", Christine Connelly, the Department of Health's chief information officer, told the Financial Times.
Asked whether that could involve termination of the billions of pounds' worth of important contracts held by BT and CSC she said: "At this point, we are not ruling anything out."
She added that "it is in all our interests to make the systems and solutions we currently have a success".
She said that hospitals will be given greater freedom to configure the system to their local needs and that there would be a "library" of such adaptations. Trusts will be able to choose which version is closest to their requirements and modify it if necessary.
In the south, a nine-month competition is to be held to let additional suppliers bid alongside CSC and BT to install and run e-record systems in about 30 trusts where progress was halted after Fujitsu had its contract terminated last year.
The FT also reports that there will be an approach modelled on Apple's iPhone "apps store", which will allow any supplier to provide additional functions. That will mean earlier adopters of the BT and CSC systems will be able to exploit what is installed without having to wait "months or years" for the next software release.
"The key thing we have communicated to our suppliers is significant progress by the end of November," she said. By then, "if there is a suggestion that everything is just going to slip and slip, that's the point where we will draw the line" and "start to look at alternative approaches".
Specific deadlines have been set to get the Lorenzo system running across a big acute hospital by the end of November and working smoothly across it by next March.
It's unclear whether the new deadlines will lead to trusts installing systems before they are properly tested and safe. Several go-lives of the NPfIT Cerner Millennium Care Records Service have led to hundreds of patient apointments being lost in systems, which has caused delays in treatments, and breaches of Government targets.