Success of NHS IT rests on doctors' buy-in

Encouraging doctors to support the £2.3bn overhaul of IT systems in the NHS is fast emerging as the biggest hurdle confronting...

Encouraging doctors to support the £2.3bn overhaul of IT systems in the NHS is fast emerging as the biggest hurdle confronting those charged with implementing it.

As the biggest IT project ever undertaken in the UK starts to get under way, former health minister Lord Hunt and Frank Burns, chief executive of Wirral Hospital NHS Trust, are just two of the high-profile figures who have expressed concern about winning the support of doctors.

Hunt, who was in charge of the national IT programme until he resigned from the government last month, highlighted his concerns in a recent issue of Health Service Journal. "My greatest fear is that we will not get doctors on board," he said.

The former minister's comments came just a week after Burns expressed his own fears about getting clinicians' involvement in the strategy.

Burns, who supports the national IT programme, nonetheless identified clinical ownership as "potentially the biggest risk factor" for the strategy, Delivering 21st Century IT Support for the NHS, which underpins it.

"The issue needs a lot more attention than it is currently getting. Success for the IT strategy should not be measured by how many clinicians have desktop access to a clinical system, but by how many clinicians are using their Pin codes on a daily basis," Burns added.

If anyone should know about the potential pitfalls for large-scale health service technology projects it is Burns, who ran IT in the NHS in the 1990s and oversaw the Information for Health strategy, the predecessor of the current national programme. Burns is now chief executive at what is widely regarded as one of the most technologically advanced NHS trusts in the country.

Doctors' leaders have warned that little is being done to get the majority of the medical profession to change working practice to fit the new systems.

Dr Grant Kelly, chairman of the British Medical Association's IT committee, said, "Clinical ownership is something that we all go on about. The government needs to focus very closely on the requirements that the clinicians have to improve patient care."

Kelly, a practising GP, said the national IT programme should design and build systems around clinicians' needs. "The national IT programme was designed by Downing Street, not doctors. We need to have closer dialogue with the government," he said.

The national programme, which is overseen by the NHS IT tsar Richard Granger, works with NHS clinicians and managers on a number of fronts, a spokesman said. However, it is likely that the NHS Modernisation Agency, an organisation set up to help local staff deal with cultural change, will handle the new working practices required by the national programme.

A core team of clinicians in the National Design Authority is working on the outline specification for the integrated care records service.

Kelly said that a recent advertisement for clinicians to advise on the design of the IT systems underpinning the national programme was a step in the right direction.

"There is a project to employ clinicians to advise on the design of national systems that could be significant," he said.

But he warned that there are few examples of IT systems reducing doctors' workloads in a clinical environment, with the sole exception of electronic data interchange for the likes of pathology messaging. One of the key features of the pathology system, according to Kelly, is the fact that it was built following years of clinicians spelling out to the government exactly what they needed.

"This is the type of thing that the government needs to look at to see how IT systems should work," he said. EDI enables the transfer of patients' pathology results, which are then automatically inserted into clinical databases, providing doctors with up-to-the-minute information.

Designing common IT systems to deal with data like electronic patient records and e-booking of hospital appointments is no small undertaking, with about 9,000 GP practices in England alone.

Although Kelly agrees that electronic patient records will eventually serve clinicians' needs, he has reservations about national e-bookings.

"For those hospitals that can bring their internal booking systems up to speed to feed e-booking, the project could be good," he said. "But there is no need for such a national structure, there is only a need for a standard e-booking format that is web-browsable," he added.

If the government struggles to win the hearts and minds of doctors it could face an uphill struggle to sell the strategy to the rest of the NHS.

The stakes, for the government, the taxpayer, and most importantly, the patients who depend on the health service, are high.

For Kelly, getting clinicians to back the changes is key to the success of the strategy. "If they do not get clinician buy-in then it will be yet another public sector IT failure, but bigger than the ones before."

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