It's about people, not just technology

The problems at Nuffield and Newham trusts have highlighted the risk to patient safety that IT systems can pose, and have exposed the need for regulations

There are many reasons the National Programme for IT (NPfIT) in the NHS matters. One is that, at £12.4bn, it is costing about £2bn more than the total build cost for the Channel Tunnel. Another is that it could improve the treatment of patients.

If it works, the NPfIT will, for example, replace paper medical records that can only be in one place at a time, with an electronic file that can be accessed by hospital doctors across England. And an electronic medical record is less likely to go missing than a paper record.

But the national programme also matters because it has the potential to undermine patient care.

As revealed in a joint investigation last week by Computer Weekly and Channel 4 News, after Newham Primary Care Trust in East London and Nuffield Orthopaedic Centre at Oxford implemented a system from US supplier Cerner, some patients did not receive a timely appointment with a specialist because of IT-related problems.

An enhanced version of this same Cerner system is due to be implemented across England as part of the NPfIT.

John Bourn, head of the National Audit Office which investigated a report of a serious untoward incident after the go-live at Nuffield, said in a letter to MP Richard Bacon, "The [Cerner] system reported that it was printing letters inviting patients to clinics, and yet it soon became clear that far fewer people were turning up to clinics than expected as they had not received any notification to do so.

"Conversely, other patients were turning up for clinics that they were not recorded as having been invited to. The impact of this was inconvenience to patients, wasting of doctor and staff time and a need to reschedule appointments. The missed appointments then resulted in a backlog of outpatient appointments building up."

After a go-live at Newham hospital, details on patient appointments were lost - more than 110 of them for children. The problem was spotted in October 2004, but it was six months before health staff tried to contact parents of the children, and 30 were never tracked down.

The incidents at Newham and Nuffield were not specifically the fault of the supplier or the trust, but happened for a variety of reasons.

Even so, they highlight the potential for IT systems to damage the care of patients, a danger compounded by the absence of any statutory framework or even regulation to help ensure that the installations of new patient record systems in about 300 hospitals will not harm patients.

A paper on the safety of new IT systems was published by the British Computer Society at the Healthcare IT conference at Harrogate in March this year. Until now, the paper has not been publicised. It was entitled "Quality, Safety and Performance in Healthcare IT: is it time for regulation?" and was the work of Benedict Stanberry of Avienda, a healthcare IT consultancy.

Stanberry said that healthcare IT enjoys a "uniquely privileged position" when compared to drugs and medical devices such as x-ray equipment which have to go through formal checks to ensure they are safe. IT systems that are used pervasively in hospitals go through no statutory product licensing, manufacturing inspections or incident reporting.

If health IT systems fail they can affect the safety of patients. "Yet because there is a dearth of in-depth assessments of how well healthcare IT applications work in practice, there has been no consequent activity aimed at capturing, describing and then disseminating best practice - that is, how to implement and use healthcare IT applications safety, smoothly and responsibly," Stanberry said.

He added, "In fact we presently have a dangerous situation in which healthcare IT systems are being installed and implemented at breakneck speed."

Stanberry said the velocity of change meant that administrators, doctors, nurses and IT managers "have such different and conflicting views of the rightful role of IT in the care process that there is now a very real potential for anarchy".

Since Stanberry wrote the paper there have been some positive developments. Connecting for Health, which runs the NPfIT has, he said, been proactive in seeking to improve the safety of new systems.

Maureen Baker, special clinical adviser at the government's National Patient Safety Agency, said she and her team have been in partnership with Connecting for Health, which has "led to a proactive approach in developing safer IT products to support clinicians in delivering NHS care."

She added, "This partnership has achieved a great deal in a short time, with a great deal still to do."

But in the meantime there is no sign that the government will put in place a statutory framework to govern the safety of IT systems in the NHS.

Today, Stanberry rates the regulation of safety of IT systems at "C+ rather than B or A".

This is not a reassuring mark, given that new systems can harm patients - if only because their failure can cause a backlog of work which means that appointments and operations have to be cancelled.

Source material: Nuffield trust minutes, letter to MP Richard Bacon from John Bourn head of the National Audit Office, and final report into the serious untoward incident involving outpatient waiting time breaches in Newham - Newham Primary Care Trust

More information:

A case for treatment

Comment on this article: [email protected]


Read more on IT risk management