It is more than three years since ministers launched the national programme for IT in the NHS (NPfIT) with the publication of a strategy document "21st Century IT".
Computer Weekly warned at the time that it was an extraordinarily ambitious programme given that the Department of Health had failed to implement successfully much smaller, national technology-based schemes.
Now an authoritative paper, published by the British Medical Journal last week on the NPfIT, has raised some structural concerns about the project. Clearly its authors see their criticisms as useful advice: like everyone else they want the world's biggest civil IT programme to succeed.
One of their most important suggestions is that Connecting for Health, which runs the NPfIT, improves communication by listening as well as talking. "Improved communication could imply one-way traffic from NPfIT headquarters to trusts and this alone is unlikely to win co-operation. An improved sense of realism would be a start."
The paper, research for which involved detailed interviews with 23 people who are helping to implement the NPfIT in four trusts, comes at an important time.
Many trusts and GP practices are taking part in implementations of national systems and those running the scheme should be congratulated for helping to ensure that it is perceived by NHS boards of directors as an important initiative.
But it is far from certain that most GPs, doctors nurses and NHS staff will want to use systems that are imposed on them from central and regional organisations.
One trust chief executive told the paper's researchers, "There is a feeling of loss of autonomy and possibly lack or loss of functionalityÉ some of the systems we have got are pretty well customised and people get used to that level of customisation."
It is also worrying that the uncertainties everyone expected at the outset of the NPfIT still militate against support for the programme. "The lack of clarity from the NPfIT about future developments, with poor communication between NPfIT headquarters, the local service provider and trust managers, was reported to be a major concern in all four trusts," said the paper.
Ministers and Whitehall officials do not take kindly to criticism of the NPfIT. But if they denigrate this latest paper they could harm their credibility. With more than £6bn of taxpayers' money invested in the the national programme, Connecting for Health needs all the credibility it can muster.