NHS IT pioneers see risks of over-optimism materialise

When a group of pioneering hospitals in London went live with a major e-records system under the government's £12.7bn NHS IT scheme, a headline in The Sun set the scene for the next 18 months.

When a group of pioneering hospitals in London went live with a major e-records system under the government's £12.7bn NHS IT scheme, a headline in The Sun set the scene for the next 18 months.

"Data Woe at 2 London Hospitals," it said, pointing out that doctors had been forced to write notes on slips of paper when a new Care Records Service system crashed.

Barts and The London NHS Trust and BT, the main IT contractor for London under the National Programme for IT (NPfIT), denied the story.

The trust said, "The new patient administration system - also known as the Care Record Service (CRS) - did not crash A period of adjustment was anticipated with contingencies in place to support staff who experienced any problems, with the majority of issues being resolved within 24 hours."

The statement proved optimistic. Difficulties at the trust have escalated, almost month by month, since the Care Records Service system went live in April last year.

Backlogs of patients who were not seen or treated within government waiting-time standards grew at first to hundreds.

Now, 18 months after the go-live, Computer Weekly has revealed that at least 14,000 patients are on a backlog for treatment. Barts has lost track of their appointments - though the system was installed to keep track of the healthcare "pathways" of patients.

No one should wait more than 18 weeks for treatment after being referred by a GP, under government guidelines. But hospital executives have no idea how many of the 14,000 patients are outside of the 18-week limit.

Doctors at the hospital made electronic requests for their patients to be treated, but found much later, or never discovered at all, that the appointments had not been made. Doctors or their staff pressed the wrong keys, or the requests did not end up at the expected destination, or both.

Data already in the system was inaccurate and some doctors found the technology was not always simple to use, or did what they expected. Most worryingly, nobody seems clear on what has caused the chaos.

Since August things have got a little better. The 18-week backlog has come down from 26,640 to about 22,000. Some of the 22,000 on the list comprise duplicate records, but at least 14,000 are thought to represent actual patients.

The trust's board hopes things will be back to normal by December. But the trust has been hoping since April 2008 that a return to normality was around the corner.

It is difficult not to feel sympathy for Barts' IT specialists, doctors and administrative staff. The decision to go live was taken at a higher level, amid a ministerial imperative for the NHS to show that the NPfIT was delivering.

London officials wanted to show that the capital could deliver. But they may have fallen victim to the "irrational exuberance" which afflicts large IT projects.

Today the political pressure for the NHS to install the Cerner Millennium Care Records Service throughout London is as strong as ever. Ministers and officials hope that a succession of successful launches will throw a warm light over the NPfIT.

The Care Records Service programme is running four to five years behind schedule, according to the Public Accounts Committee.

Ministers want to catch up. So officials in London have announced plans to resume a roll out of the Cerner system. They say that the lessons from Barts and other sites have been learnt.

But going live elsewhere before anything has been published on what exactly has caused the problems at Barts may be a further demonstration of unwarranted optimism.

Ross Anderson, professor in security engineering at the University of Cambridge, said, "Hospital managers have good reason to ask why they are ordered to put in systems that are not fit for purpose and are then punished for not meeting targets when there has been a balls-up."

Politics has plunged some hospitals, particularly Barts, into administrative and operational turmoil in the name of the NPfIT. It will be a pity for patients if politics continues to dictate the roll out of the programme.

Next roll out

The next hospital due to go live with the Cerner Care Records Service is Kingston Hospital NHS Trust.

Another London hospital, the Royal Free at Hampstead, which went live with LC1, a Spine-compliant version of the Cerner Care Records Service, is struggling to keep track of patient appointments - and it launched the system as long ago as June 2008.

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