Government plans for London NHS IT in tatters

Health officials in London are working with BT, Cerner and IT specialists to rescue plans for integrated e-health records in the capital amid signs that the government's one-size-fits-all approach is disintegrating

Health officials in London are working with BT, Cerner and IT specialists to rescue plans for integrated e-health records in the capital amid signs that the government's one-size-fits-all approach is disintegrating, Computer Weekly has learned.

The original plan which was announced in 2002, in a document "Delivering 21st Century IT Support for the NHS", was for the National Programme for IT [NPfIT] in the NHS to deliver "ruthless standardisation". In London a single database to support electronic health records for eight million people was to be rolled out to all trusts and other NHS sites.

That plan turned out to be too ambitious - and was watered down when officials and the NPfIT local service provider in the capital, BT, decided to install different releases of the US-based Cerner "Millennium" system to support e-recordsin NHS trusts.

Now that plan, too, has run into trouble, Computer Weekly has learned. BT, NHS IT specialists and Cerner have ended up customising the standardised smartcard-based Cerner system for one London trust, the Royal Free, after it ran into serious problems.

In June 2008 the Royal Free Hampstead NHS Trust became the first trust to install the London Configuration Release 1 [LC1] of Cerner Millennium Care Records Service. It was the first installed Cerner system in England where users had smartcard access to electronic records. Three other London trusts are using the earlier LC0 of the Cerner system.

But because of continued problems with the LC1 installation, the Royal Free Hampstead NHS Trust, BT, Cerner and the London Programme for IT have put in place a 90-day rescue plan of the trust's systems, which began on 6 October. The plan involves setting up on site what the Royal Free calls a "full systems and support team".

The trust says the team is working on a software build directly for the Royal Free and is "thus changing the London programme model of one build appropriate for all trusts".

Health officials and BT had hoped to start rolling out LC1 to other trusts and NHS sites in London - but work has been halted. It is unclear when - and if - it will restart given the Royal Free's problems and the customisation of its software.

The Royal Free's staff have had to cope with system crashes, delays in booking patient appointments and data missing in records. 

Some health IT experts say the problems at the Royal Free and other London trusts could end up with BT delivering a non-standard system to NHS sites in the capital. This would wipe out some of the cost savings of having standard software which could be upgraded easily across NHS sites in the capital. It would also mean an end to the NPfIT vision of fully integrated IT systems across England.

The government announced in 2002 that there would be a "full National Health Record Service, with core data and reference links to local Electronic Patient Record systems for full record access" by the end of December 2007. That promise now appears years away from being fulfilled.

The government had also promised standardisation. It said in Delivering 21st Century IT Support for the IT, "We will improve the leadership and direction given to IT, and combine it with national and local implementation that are based on ruthless standardisation."

But a switch to non-standard systems in London could benefit some trusts by reducing delays in the installations of reliable replacements for legacy systems. And BT, NHS IT specialists and health officials in London still hope to achieve the exchange of health records across trusts with different and customised versions of Cerner, or other systems.

A spokesman for BT has told Computer Weekly that it is discussing with London trusts, Cerner and the London for IT the best way to strike a balance between "tailoring the system to reflect the working practices of a trust" while seeking to share patient information across the programme.

The spokesman said, "The aim of the discussions is to agree a more flexible, efficient and effective way of achieving the original aims of the programme [the sharing of electronic health records] and taking account of the changing NHS needs and structures."

A spokeswoman for the Royal Free said, "Although we are currently facing challenges with the [Cerner LC1] system we believe that once these have been resolved, other trusts will benefit significantly from the changes that are made as a result."

But the delivery of non-standard systems to London's trusts raises questions about whether the Department of Health ever needed to sign £6.2bn worth of contracts with local service providers.

Before the advent of the National Programme for IT [NPfIT] in 2002, healthcare IT companies were already supplying non-standard systems to NHS trusts.

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