BCS calls for complete overhaul of NHS IT project

Tags: A BCS BCS Health CfH Choice Choose and Book Community Data emergency Government GP HIS Informatics Information Infrastructure Interoperability iS N3 NPfIT Quality Reform Savings Spine Standards Strategic UK Virtual

15 Dec 2006

A new report from the British Computer Society has called for a fundamental rethink of the NHS IT programme, including putting one hold current plans for a national system of summary records and for the scope of NHS Care Records Service to fundamentally re-defined.

Rather than attempt to build a monolithic national database of records the BCS report urges that that electronic Care Records it argues thatto resolve outstanding data and technical difficulties a distributed model based on existing systems is a better bet: "a virtual service offering views of the distributed records available for a patient would seem appropriate".

The report urges that the £12.4bn NHS national programme for IT be completely recast as a locally based programme, based on delivering specific niche clinical systems from a range of competing suppliers, supported by standards and core national infrastructure.

The strategic paper from the BCS says there is a pressing need to realign Connecting for Health (CfH) if it is to be an enabler of business and service transformation and be seen as useful by NHS staff.

The BCS believes that the failure to make these key connections with local clinical and business priorities is "a major reason why so many NHS staff view informatics, particularly, NHS CfH, as of little relevance".

The 20 page report by the BCS Health Informatics Forum Strategic Panel reviews the progress of the National Programme for Information Technology (NPfIT), which it describes as being ‘about half way through their planned lives’. Twenty recommendations are made starting with the need to "provide a business context for NPfIT owned at national and local level".

An evolutionary approach is called for, which focuses on local implementations at the trust and provider unit level and provides "speciality, service-specific and niche systems that will encourage clinical involvement and give quicker benefits". The new approach urged should build on what currently works "rather than focusing on relatively few monolithic systems".

On the summary Care Records Service the report urges policy makers to, "Put implementation of the Personal Spine Information System (PSIS) on hold. Instead it says they should consider following the route taken north of the border and "Consider developing the equivalent of the Scottish Emergency Care Summary". It says this could be achieved by providing views of records from GP systems.

One initial step urged by the BCS is to finally fully implement GP system of choice at the practice level and provide an accreditation process "for all new and existing systems, both against the chosen standards and functionality requirements".

In his foreword, Dr Glyn Hayes, chair of the BCS Health Informatics Forum, says: “Until very recently the sponsors of NHS CfH have seen information technology (IT) as a fix for the challenges faced by the NHS. This is a common mistake: IT enables change, is sometimes a catalyst for change, but it is not an end in itself. This misconception has been a prime cause of large-scale IT project failure since computers first became commonplace.

“The problem has been heightened by NPfIT’s top-down nature; the patchy reflection of NHS requirements in the procurements in 2002; and the subsequent changes in those requirements to meet the government’s NHS reform programme, We believe that this is one reason why so many NHS staff have yet to see NPfIT as a key enabler of business change and it has thus discouraged the local ownership of NPfIT implementations. “

Speaking to the Telegraph, Ian Herbert one of the report’s authors, said the BCS undertook the study to support CfH. “We did it initially because CfH was under very heavy attack, and we could see it being axed, and there may be things that need to be changed but we don’t want it to be axed.”

The report says that NPfIT is changing in the right direction and is delivering useful services, but questions whether the scheme is worth its £12.4m price tag. Criticism is pointed on the claims of savings made the CfH.

“The NPfIT has been successful in limiting payment for non-delivery, but having under spent because of not delivering is hardly a success and the central costs incurred by NHS CfH are such that, so far, the value for money from services deployed is poor,” it says.

Crucially the BCS paper says that the NPfIT may have inhibited the implementation of existing operational systems and that more may have been delivered without the programme.

“While the NPfIT has delivered a number of local operational systems including PACS, PAS, and some Community Health and departmental systems, it is possible that at least similar levels of delivery could have been achieved by the processes that were in place prior to the NPfIT. “

It adds that CfH has not planned ahead, and NPfIT implementations may not meet the new Department of Health initiatives.

“Arguably the major weakness of NHS CfH is that it currently lacks a business context: we have rapid policy implementation without the associated informatics planning. The output-based specification used in the NPfIT tendering process is not – and never was – a substitute for business requirements, and to make matters worse, these have changed greatly since it was produced.

“Without the relevant informatics in place, the planned reforms – Choice, Payment by Results, Practice-based Commissioning, independent sector providers and direct payments – will not succeed. There is therefore an urgent requirement to align NHS CFH implementation schedules with the timetable for NHS reform: the poor line-up between the 18 week wait target implementation and its IT support is a case in point.”

Overall, the report calls for health informatics to be radically improved with an infrastructure that helps to develop choice and contestability, engages patients carers and the public, puts in place principles for the treatment of chronic diseases, brings new technologies closer to patients and allows staff to cope with increasing demand.

Dr Hayes said: “The government has committed very significant resources for NHS informatics, but relatively little has yet been spent and less still is visible in front-line informatics. We wish to see this commitment play its proper and vital role in the new NHS. Starting from where the NHS and NHS CfH are now, our report is intended to start a constructive, urgent and open dialogue to support this goal.”

The 20 key recommendations made by the board are:

• Provide a business context for NPfIT owned at national and local level

• Focus on local implementations at trust and provider unit level

• Persuade local NHS management that informatics is an essential part of business solutions and service transformation.

• Adopt a patient-centered approach at the local health community level

• Have an evolutionary strategy, building on from current successes

• Greater emphasis on standards allowing interoperability

• Establish basic informatics elements standard across the UK enabling treatment of patients at any English hospital.

• Fully implement GP systems of choice at practice level

• Create an accreditation process for all new and existing systems

• Revisit and reallocate roles and responsibilities of the NHS at each level.

• Make CfH a partner with NHS management, users, informatics community, suppliers patients and carers based on trust and respect.

• Resolve issues surrounding sharing of electronic patient data.

• Use the Spine transaction and messaging services to share information

• Create a clear definition for the NHS Care Records Service

• Put implementation of the Personal Spine Information System (PSIS) on hold

• Consider deploying the Scottish Emergency Care Summary

• Collaboration from all clinical professions, NHS informaticians and managers to create guidance on good informatics practices.

• More appropriately skilled/qualified staff are likely to be needed

• Data quality is critical to reaping the benefits of the raised investment in IT.

• Continue with N3 broadband, transaction and messaging service, personal demographic service, spine directory services, electronic prescription service, choose and book and GP to GP electronic record transfer.

Readers Comments

Brilliant

15 Dec 06 15:58

Finally someone has said it all - including the courage to identify the disunity between the continuous revolution of health service reform and system (re-)specification.

>>“there may be things that need to be changed but we don’t want [NPfIT] to be axed.”<<

Agreed, but it is hard to see how many existing NPfIT structures can be gerrymandered to accomodate these changes. In particular I would welcome an explanation of where clusters and LSPs would fit in this new devolved vision.

Distributed Model

15 Dec 06 17:45

This was exactly what the NHSIA was working on and I had a working version demonstrated to me some 2 or 3 years ago. There is no need for a national database. A distributed model works - I've seen it!

IMPACT ON COSTS & TIMESCALES?

16 Dec 06 10:29

1. A reminder:- contracts to the value of £6.2 billion have been placed with private sector suppliers. If, as the BCS report implies, the deliverables from these contracts do not meet requirements then renogotiation of them will add to costs and timescales. 2. I read in a recent Sunday paper that the government could cancel the whole NPfIT for £ 1.5 billion. IMO that is the least worst option.

Statement of the Obvious(?)

sjmccreary@btinternet.com

16 Dec 06 21:50

The report's recommendations are difficult to argue with as they appear to be a statement of exactly what should be happening. As with so much good practice, eg healthy lifestyles, the key thing is not what's required but rather, how it can be achieved.

Cheerleaders for Betamax

18 Dec 06 12:23

Surely this report is of academic interest only? Can anyone seriously suggest that all of the current investment be abandoned at this late stage and when some benefits are beginning to be realised?

Elephant in the room

18 Dec 06 12:59

From your summary, the BCS does not give a clear steer on the Detailed Care Record, the lions share of what has mostly failed to be delivered to date.

In my view their evolutionary recommendation should include extinction of the LSP arrangements, and the hopeless idea that we can go straight to a standardised Care Record across great tracts of the country. That should be in a subsequent iteration if we could first prove we can migrate to Electronic Practice.

Cerner and Isoft can implement systems for individual hospitals. Interference and constrictions from CfH and LSPs are what has made deployment extremely difficult. Cut CfH, cut LSPs, and using standards and data models, go back to true local ownership, and Trust or Local Community level domains. The current arrangements will fail to achieve paperless practice in secondary care. and it would be better to acknowledge this, have whatever legal settlements, potentially including continued use of the Cerner/Isoft software, but start afresh.

To Betamax person

18 Dec 06 13:44

The BCS report does not suggest that everything should be abandoned, it is recommending a pragmatic movement forward from where we are now, in line with what the end-users need to help them do their job! Keeping to the analogy, with the VHS / Betamax videotape concepts - the market was itself able to make the providers listen by tuning their buying patterns to what at the time delivered for them ... a lesson perhaps??

pardon the pom poms

18 Dec 06 14:56

The VHS format's defeat of the Betamax format became a classic marketing case study, now identified with the verbal phrase "to Betamax", wherein a proprietary technology format is overwhelmed in the market by a format allowing multiple, competing, licensed manufacturers.

so which one is vhs and which one is Cf...oops betamax?