Senior NHS staff support IT modernization but say that continuing delays are putting patient safety at risk, according to a study published on bmj.com today.
The NHS information and technology programme is the largest civilian IT programme in the world with projected expenditure of over £12bn. The main features of the programme are a new networking service, called N3; electronic booking, called Choose and Book; electronic transfer of prescriptions; and a nationally accessible summary of patients' records, called "the spine."
Researchers interviewed 25 senior managers and clinicians responsible for implementing the programme in four NHS hospitals in England. Interviews were conducted in two stages, 18 months apart, to compare progress and perceived challenges over time.
Interviewees unreservedly supported the goals of the programme, but had several concerns.
In the first round of interviews, the main concerns were about financial deficits, delays in replacing patient administration systems, and poor communication between Connecting for Health (the agency responsible for delivering the programme) and local managers.
Eighteen months later, the issue of financial deficits was even more acute. There was also concern that managers could not focus on implementing the system because of competing financial priorities.
Continuing delays in replacing patient administration systems and poor communication were also still apparent in the second interviews. Respondents reported uncertainty about the timetable for delivery and felt disempowered and frustrated with the lack of consultation.
Furthermore, the delays were now seen as an unacceptable risk to patient safety. One respondent said: "Our path system is extremely out of date ... it's a huge risk to the trust that we're still carrying this path system." Another warned "there are a number of risks that are associated with our old system, some very serious risks."
Respondents also questioned whether NHS-wide connectivity would ever be achieved.
Finally, there was little support for Choose and Book and none of the interviewees was optimistic about the ability of Connecting for Health to deliver the systems. "The software is not fit for purpose. " said one director of information management and technology.
"The staff we interviewed were unreservedly in favor of IT modernization," say the authors "but this support will quickly diminish unless more progress is achieved."
They believe that Connecting for Health needs to address the uncertainty experienced by trusts and take responsibility for advising about interim decisions, while trust managers urgently need concrete information about implementation timetables, long term goals of the programme, and value for money. Trusts also need help in prioritizing IT modernization, they conclude.