Unpublished Concerns Regarding NPfIT

From Nhs It Info

This section of the dossier contains previously-unpublished expressions of concern that we have received from people who have extensive direct knowledge of NPfIT and the challenges of developing large IT systems. These expressions are made publicly available here with the explicit permission of their respective authors.

Other individuals who also feel that they can make informative and constructive contributions to this dossier are welcome to contact us by email. It is essential that any such contribution include clear identification of its author. On request, we will protect your identity and/or that of your organisation in the published contribution. It is essential, however, that we are able to verify that (i) you are who you say you are and (ii) that the contribution is from you.

Contents:

Contents

Comments on computerisation programme: the hidden international dimension (10 Aug 2005)

Text of a letter sent by James Wimberley to the NHS in August 2005 concerning the computerisation of medical records of Non-British Patients within the UK and of British patients abroad.

Three parables of IT and CRS (16 Oct 2006)

"Doctors and nurses can find it hard to make other people understand what they want and need from IT systems to help them in their work. This results in confusion, and delivery of unsuitable or unusable software. I believe this has happened with the National Programme for Information Technology (NPfIT) Clinical Records System (CRS) in the programme “Connecting for Health”. I think our basic needs are simple: who are our patients, where are our patients, what problems and diagnoses do they have, what are we treating them with, some space for free text, and an ability to print the information. Anything else is a major luxury once these requirements are met. I have written three stories as allegories or parables to help to shed some light on the problems. . ."

What CfH Could and Should Learn from Defence Procurement

Malcolm Mills

". . The magic bullet is the employment of high calibre and properly experienced people in pivotal posts in the programme management organisation. In the UK, US and Europe, much basic and operations research has been carried out in Defence, and many many volumes published, on the development and procurement of IT-based systems and services in the years since computers were first used towards the end of the 2nd WW. Some fortunate people (yours truly included) have been lucky to have been involved with these developments for some of this time. Unfortunately, many of the cognoscenti have not practiced outside of Defence and take their knowledge into retirement, and the grave. Little encouragement is given or interest shown for them to pass on to other communities the basics of what they have learned. A few fortunate ones do look over their shoulders from time to time and when they do, they see much in common. Why should this be? Well, although the health environment may (appear to) be different, much is similar. And of key significance, critical programme ‘building blocks’ are the same: ‘people are people’ (whether they wear a military uniform or a white coat) -they have the same two arms, two legs, one brain, can be trained, have the same basic cognitive, perceptive, neurological and social, behavioural characteristics etc etc. And the basics of ‘computers in defence’ are the same as the basics of ‘computers in health’. They are constructed with the same physics, same von Neumann architecture, same EM theory, logic, Shannon’s Laws, etc., etc. . ."

Submission to the PAC by Robin Guenier (3 Nov 2006)

"It is impossible to exaggerate the importance of the NHS National Programme for IT (NPfIT). It is my view, shared by others including many clinicians, that if the NHS is to be properly effective in the 21st Century its information systems must be transformed. So it was excellent news when the Government announced in early 2002 that it was to take the advice of the review it had asked Derek Wanless to undertake and had decided to invest a huge amount of time and effort in an ambitious programme of NHS IT reform. . . . Yet, after four years, it begins to look as if NPfIT may well be heading for failure. There are many signs of this – late deliveries, disappointed users, cost growth, loss of key suppliers, etc. The extraordinary thing is that this is happening largely because the Department of Health has chosen to disregard the clear lessons of earlier project failures and, in particular, the advice of Government and Parliamentary experts. . ."

A Consultant's Eye View (3 Nov 2006)

"I am a Consultant Physician with considerable expertise in clinical systems. I also am an experienced clinical user. I am writing to explain why I have been so disappointed and concerned after my training sessions on an NPFIT Clinical Records Software system (CRS) featuring a Patient Administration System (PAS) and Orders and Communications. My fear is that should we "go live" with this system, our hospital might close down within hours. . ."

Submission to the PAC by Larry Benjamin (6 Nov 2006)

"I am a consultant ophthalmic surgeon working at Stoke Mandeville Hospital, Aylesbury. I have a long-standing interest in IT and its use in Medicine and although a member of the Worshipful Company of Information Technologists, I am writing as an individual and a consultant in the NHS for the last 16 years. . . My worry regarding the implementation of NpfIT is that it has been introduced “backwards”. By this I mean that the national spine and its associated infra-structure has received much attention whilst very little effort has been put into useable local systems for day to day input of clinical data – the very life blood of any clinical system. . ."

Submission to the PAC by John Mason (7 Nov 2006)

"Information Technology in the NHS - What Next? This document is triggered by the Richard Bacon and John Pugh suggestions and is a comment on the present state of IMT in the NHS, with suggested ways forward."

Notes on a Speech by Richard Bacon, Royal Society of Medicine (28 Nov 2006)

(By Colin Tully)

Nine propositions about NPfIT that he believes to be true

(1) The scale of expenditure is so huge as to be incomprehensible and therefore to resist effective scrutiny.

(2) Local implementation costs are likely to be three-to-five times larger than procurement/development costs.

(3) Major problems have arisen from the speed at which central contracts were let.

(4) Patient administration systems are being put into hospitals before the hospitals are ready.

(5) Trust managers are being browbeaten.

(6) Deployment has not gone according to CfH's schedule.

(7) We should learn lessons from the fact that key players in the industry did not bid, and from the withdrawal of key contractors.

(8) We should ask why CSC have stayed in.

(9) We should question the assumption that the Care Records Service is of central importance. It won't be delivered by 2010. That means that providers will fall short of their revenue targets, and trusts will fall short of the services they've been promised.

Four propositions about NPfIT that he believes to be questionable

(1) Patient records need to be available anywhere in the country.

(2) Local trusts can't procure IT effectively.

(3) We need a single massive system.

(4) Having a national programme saves money.

Final remarks

(1) Bad projects cannot tolerate/withstand scrutiny and criticism. Good projects can and do.

(2) There was a very abbreviated reference to recent work by "Doctor Foster". It is possible that this related to the report entitled "Understanding the information needs of SHA and PCT boards", at http://www.drfoster.co.uk/library/localDocuments/IntellCommBoardJuly2006.pdf.

(3) There have been six Senior Responsible Officers [within DH? responsible for NPfIT?] in three years.

(4) The entire thrust of the NAO report was changed during the year when its content was being "negotiated" with CfH. NAO were "ground down".

Comments by Stephan Engberg on CfH's Security and Confidentiality FAQs (20 Dec 2006)

"This is what I call a Single Point of Trust Failure system, where you have massive concentration of risk and no inherent security except perimeter security. Since perimeter security must be considered void for anything but totally isolated systems, this is a ticking "trust bomb". . . In fact the purpose of this "security" system is more legitimisation and centralisation, with dis-empowerment as a (possibly intended) side effect, than security of patients, as that would involve active identity management and especially empowerment."

A Brief Note On The Apparent Divergences Between Europe's Data Protection Commissioners And The Government With Respect To The Electronic Patient Record (May 2007)

"The Working Party of European Data Protection Commissioners has published a document on the privacy of medical data within an Electronic Health Records (EHR) system. The document states that unless there is a substantial public interest to the contrary, the patients' wishes concerning the processing of their own medical data via an EHR system should prevail. . ." [By Dr C.N.M. Pounder, Editor of Data Protection & Privacy Practice - Late submission to the Select Committee on Health's Inquiry into the Electronic Patient Record]

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