Two independent studies of the health service's IT-based modernisation plan suggest that some costly systems may go unused by many doctors and nurses - a risk little mentioned by officials when the programme was launched in 2002.
The documents lend support to the claims of critics over the past three years that Whitehall will find it difficult to gain support among local clinicians for systems that are supplied centrally and which require major changes in working practices.
The national programme for IT in the NHS (NPfIT), for which contracts worth £6.2bn have been awarded, was launched in spring 2002 before any parliamentary or public debate on how much it should cost, or what shape it should take.
The documents, published last week, show that although the aims of the NPfIT are strongly supported by NHS staff, there is concern about how well the programme is progressing.
A draft consultation paper issued by the British Computer Society's Health Informatics Forum listed many benefits of the NPfIT so far but said there were "still fundamental ignorances of what the new solutions are intended to address".
Clinicians see that informatics will improve healthcare. But the BCS paper said, "There are still concerns that a lack of engagement will lead to solutions without appropriate clinical focus and that are unwieldy in operation."
It added, "While the programme is going in the right direction, the first phase is only producing benefits for some of the sites involved, particularly those who had no previous patient administration system. Those who were well ahead and had high expectations of what the new strategy would bring them are, in the main, still disappointed."
The BCS paper also said there was a possibility of a £10bn medium-term funding gap that would need to be met locally.
The BCS emphasised that its paper was a draft consultation document, on which anyone is invited to comment, before the society's final position statement is prepared.
A separate "baseline study" on the NPfIT by market research company Mori, commissioned by Connecting for Health, also presented a mixed picture.
The NHS Confederation, which represents health service organisations, said it welcomed the report's generally positive findings. "Mori's research demonstrates that much more work must be done to fully engage clinicians in NPfIT and to convince frontline clinical staff that the main key benefit of the programme should be to improve patient care," it said.
A spokesman for Connecting for Health said of Mori's research, "The survey does show that we need to build our engagement and communications further with frontline staff, especially doctors and nurses."
Avoid focus on criticism, say health service officials
Connecting for Health, the government agency running the world's biggest civil IT programme, has asked Computer Weekly to avoid focusing on the critical content of an independent report into aspects of the scheme.
The document is a draft consultation paper of the British Computer Society's Health Informatics Forum. The paper lists the benefits of the programme and also contains damning criticism.
A spokesman for Connecting for Health said, "I would hope that in your reporting of the BCS paper that in the interests of fairness and balance you will not be focusing on the critical content of it."
The agency said it could not comment on a paper which has not been shown to Connecting for Health yet. "To ask us to comment on a paper which has been leaked to the media and which we have not yet had sight of is most unfair; we could not possibly give a reasoned response."
ComputerWeekly editor Hooman Bassirian said, "It is incredible that an organisation with such an important remit as Connecting for Health wants to avoid balanced and fair reporting of this draft consultation paper
"It is imperative that Connecting for Health listens to, and takes account of the informed and helpful views of its end-user community. The success of the IT modernisation of the NHS depends on the objective and unfettered debate of all the key issues - positive and critical."