Chief information officers in the NHS have questioned key aspects of government plans to introduce electronic records for patients across England.
The concerns reflect a growing anxiety that the national IT programme, although strongly supported by NHS and IT professionals, is being rushed into service before technical, organisational and cultural problems have been resolved.
In 2000 the NHS Plan, introduced by Tony Blair, said the government promised "access to electronic personal medical records for patients by 2004". By then, it said "75% of hospitals and 50% of primary and community trusts will have implemented electronic patient systems".
Although the target is unlikely to be met, Whitehall officials want to introduce a national "data spine" by December 2004, which would contain a summary of patients' medical information. The idea is that a doctor anywhere in England could access their patients' records through the spine.
The spine is at the core of the Department of Health's Integrated Care Records Service, which includes electronic patient records. In internal documents seen by Computer Weekly, the DoH says it wants the spine to be delivered as part of ICRS phase one, which is due to be rolled out in some areas by December 2004. The DoH claims that this approach is supported by CIOs.
But nearly a dozen IT chiefs are, in fact, against plans for the spine to be delivered as part of phase one. They are all members of an ICRS sub-group who are among 28 CIOs appointed last year to help implement a £2.3bn programme. They have some influence over the national IT programme because, as IT chiefs of strategic health authorities, they help to control a budget of up to £200m.
Details of a paper agreed at a meeting on 18 March between Liz Watson, chairman of the IT CIOs' ICRS sub-group, and Duncan McNeil, head of the DoH's National Design Authority, have been leaked to Computer Weekly. "The CIOs' sub-group concurred that the national data spine was an important element of the ICRS programme but expressed a number of concerns about the potential inclusion of the national data spine as part of phase one deliverables by December 2004," it said.
Watson and other IT chiefs are anxious to stop information being fed into the spine by current NHS systems, many of which contain poor quality or unreliable data. She was given an assurance at the meeting that money would not be spent on enabling legacy systems to provide data to for the spine.
Although strongly supportive of the £2.3bn national IT programme, which includes ICRS, the IT chiefs described the timescale for the introduction of patient e-records as "aggressive".
They were also worried that there was no clear process to ensure "the collective views of chief information officers could be channelled into the strands of work related to ICRS".
But the DoH says it will not defer the implementation of the data spine. A spokesman said, "Delivery of the national data spine within phase one of the ICRS delivery is the most rational, rapid and best-practice approach."
Doctors may not accept £2.3bn IT plan
A former health minister and an NHS trust chief executive have expressed concern about whether doctors will buy into a £2.3bn national IT programme, which includes electronic patient records. The worries arose partly because the remit of the national IT programme office, run by Richard Granger, director general of NHSIT, will not include introducing the cultural, procedural and organisational changes needed for doctors to make widespread use of the new technology.