User Surveys and Consultations
From Nhs It Info
Health policy debate (Feb 2004)
Britsh Medical Association
http://www.bma.org.uk/ap.nsf/Content/media13feb
"The biggest nightmare of the National Programme for IT (NpifT) is that significant numbers of clinical staff just refuse to change…So winning doctors' hearts, as well as minds, is crucial. Hence the top-level interest in the results of 1000 doctors' opinions published this week. It was carried out electronically by Medix, a respected sampler of medical opinion. The good news is that three-quarters of doctors…say the IT programme is an important NHS priority. The bad news was a raspberry for the project with the highest political profile, e-booking. That scored bottom on the question "is the focus on the right projects? Another worry is that doctors still believe they are not being told enough about the whole scheme."
EMIS users urged to protest about systems choice (2 Sep 2004)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=849
"The head of the EMIS National User Group (NUG) has written to all EMIS users calling on them to lobby their MPs, local Primary Care Trusts or Local Medical Committees to express their concerns about National Programme for IT (NPfIT) strategy on choice of GP systems. . . "The LSPs don't appear to be paying the slightest bit of attention to the GP contract commitment to choice [paragraph 4.34]," Dr Mary Hawking, EMIS NUG committee member told E-Health Insider."
Medix UK plc survey (Q558) of doctors' views about the National Programme for IT - NPfIT (Oct 2004)
Medix
"As a practicing clinician, I am concerned that this IT programme has all the hallmarks of previous governmental IT failures, for example failure to consult with end-users about how it will integrate with their daily work and make their work easier. If it is perceived as management or government driven additional tasks (which it is currently, by the few who have heard of it), then it will fail. Dr James Woolley, Psychiatrist, London."
A Baseline Study on the National Programme for IT (Jul 2005)
MORI for NHS Connecting for Health
http://www.connectingforhealth.nhs.uk/delivery/serviceimplementation/engagement/morifull.pdf
"Overall, the findings are positive, showing that staff are supportive of what the programme is trying to achieve and consider it an important priority for the NHS. However, they also indicate that some staff groups, especially front-line staff, are not yet fully engaged in rolling out the programme. . . Managers are most favourable towards the programme as it currently stands and Doctors are most critical of the programme."
QinetiQ survey reflects health professionals concerns about NHS IT security (19 Jul 2005)
Qinetiq
"As the National Health Service's (NHS) national programme for IT (NPfIT) is rolled out, a QinetiQ sponsored survey about NHS requirements reveals that 71% of healthcare professionals place IT security at the top of a list of current issues likely to remain a concern over the next three to five years. These are the headline results from QinetiQ's health sector survey reported today in Health Director magazine. The concerns about IT security are set against the background of implementation of the NPfIT scheduled between 2004 and 2010 and wide-spread criticism of patient confidentiality, cost and impossible deadlines. The NHS Care Records element - intended to hold electronic patients records securely on line and make them easily accessible to healthcare professionals and patients, and the Choose and Book element, an electronic hospital appointments booking systems for GPs and patients, are two areas under fire. Both are scheduled to be implemented in 2005."
Doctors "demoralised" by £6.2bn NHS IT scheme (5 Aug 2005)
Silicon.com
http://management.silicon.com/government/0,39024677,39151068,00.htm
"Frontline health service staff are "heavily demoralised" over the lack of information and communication around the £6.2bn NHS IT modernisation programme. Researchers at the London School of Hygiene and Tropical Medicine (LSHTM) claim the situation is so serious that the whole Connecting for Health programme (formerly known as the National Programme for IT) is at risk because it is falling behind schedule in key areas. The research team looked at four hospital trusts in England and, in the first part of what will be an ongoing study, talked to 23 managers and doctors involved in the implementation of the new NHS IT systems. Although the new IT systems are centrally funded under the Connecting for Health programme, the research found NHS managers are still concerned about where the money will come from for staff training and to accommodate changes in the way the NHS will have to work once the new system is up and running. Doctors are also concerned that previously scheduled upgrades to creaking radiology or pathology systems have been put on hold while funds are diverted to installing the new patient record system in every NHS trust. LSHTM health policy researcher Dr Naomi Fulop warned there is a risk of current systems failing before the new one is ready."
Challenges to implementing the national programme for information technology (NPfIT): a qualitative study (6 Aug 2005)
BMJ Information in Practice
http://bmj.bmjjournals.com/cgi/content/abstract/331/7512/331
"Results: The trusts varied in their circumstances, which may affect their ability to implement the NPfIT. The process of implementation has been suboptimal, leading to reports of low morale by the NHS staff responsible for implementation. The overall timetable is unrealistic, and trusts are uncertain about their implementation schedules. Short term benefits alone are unlikely to persuade NHS staff to adopt the national programme enthusiastically, and some may experience a loss of electronic functionality in the short term. Conclusions: The sociocultural challenges to implementing the NPfIT are as daunting as the technical and logistical ones. Senior NHS staff feel these have been neglected. We recommend that national programme managers prioritise strategies to improve communication with, and to gain the cooperation of, front line staff."
Knowledge of the Choose and Book Programme Amongst GPs in England (Sep 2005)
D.n for the National Audit Office
http://www.nao.org.uk/publications/gp_survey_2005.pdf
"An overwhelming majority of respondents felt that the consultation on implementation of Choose and Book was inadequate – 93% of respondents felt this."
BMA response to 'Clinical development of the NHS care records service' (5 Oct 2005)
BMA
http://www.bma.org.uk/ap.nsf/Content/ncrsresponse
"Whilst the BMA supports the sharing of information to improve patient care, we are disappointed that the architecture of a system, which will have huge implications to the delivery of healthcare, was commissioned and built prior to stakeholder consultation."
Medix UK plc survey (Q850) of doctors' views about the National Programme for IT - NPfIT (Jan 2006)
Medix
http://www.medix.to/reports/Q850.pdf
". . . many doctors believe that NPfIT could provide valuable benefits to clinical care in the NHS. However, they also confirm Medix's finding a year ago that doctors are increasingly critical of its costs and of the way it is being implemented. For example, whereas three years ago 47% of doctors thought NPfIT a good use of NHS resources and 27% thought not, today 17% say it is and 57% disagree. And, when asked to rate progress so far, only 1% considers it good or excellent. One aspect of earlier survey findings is unchanged however: most doctors have little information about NPfIT and continue to say that there has been inadequate consultation with them about it."
GPs dissatisfied with IT system (30 May 2006)
BBC News
http://news.bbc.co.uk/1/hi/health/5028762.stm
"Doctors have called for a review into the £6.2bn NHS computer project, according to a survey by BBC News. The IT upgrade aims to link up 30,000 GPs to nearly 300 hospitals in a radical overhaul of the NHS IT network. Half of the GPs said the "choose and book" online booking system was poor or fairly poor. The poll was completed by 447 hospital doctors and 340 GPs. . . Four out of five GPs had access to the computer system, but half said they rarely or never use it. Only about one in five said it was good or fairly good. The overwhelming majority - 85% - say there should be an independent review of the entire scheme by technical experts to check its basic viability."
Speech by Mr James Johnson, BMA Chairman at the Annual Representative Meeting 2006 (26 Jun 2006)
BMA
https://www.bma.org/ap.nsf/Content/ARM2006JJohnson
"I hear concerns from NHS managers, civil servants and politicians too. You tell me that the breakneck pace and the incoherent planning behind systems reform are seriously destabilising the NHS. The message I am getting from the medical profession is that the NHS is in danger and that doctors have been marginalized. The message I pick up from every meeting I attend, every bit of research that crosses my desk, every seminar is the same. Everyone is telling Government – you must get the professions on board; you must involve clinical staff; you can’t make this work without doctors. Connecting for Health is the obvious example. Last year at the ARM, I criticised the failure to engage with clinicians. There are some very good doctors involved with the project now, but overall I would have to say that another year has been wasted because doctors are still not at the heart of determining how the systems should work."
CfH still sidelining doctors, BMA chair claims (27 Jun 2006)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=1967
"The chairman of the British Medical Association has told his members that “another year has been wasted” in efforts to implement the National Programme for IT. In his keynote address to the BMA’s annual representative meeting (ARM) Mr James Johnson claimed that doctors were being marginalised in all aspects of system reform and that Connecting for Health was the obvious example of that."
Mixed feelings on NPfIT in primary care, poll shows (21 Jul 2006)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=2018
"Only one in four GPs feel favourably about the National Programme for IT although the overwhelming majority rate NPfIT as an important priority, according to Connecting for Health’s latest poll of opinion among doctors, nurses, NHS managers and IM&T staff. GPs felt substantially less favourable than hospital doctors, with 25% of GPs liking what they had seen so far compared with 46% of hospital doctors. MORI, which conducted the telephone survey of 1197 NHS staff between January and February this year, believe Choose and Book may be to blame for the lack of enthusiasm from GPs."
CfH “to learn” from nurse disquiet over IT programme (22 Aug 2006)
Computer Weekly
“Connecting for Health, the organisation in charge of the NHS’s £12.4bn National Programme for IT, has pledged to learn from a survey that showed nurses losing faith in IT developments. The Royal College of Nursing’s survey of nearly 4,500 nurses found that only four out of 10 believed current IT developments were a good use of NHS money – fewer than the 43% who disagreed. The level of dissatisfaction was nearly four times higher than the 2004 figure of 11%. Nurses also echoed concerns raised by doctors that they had not been sufficiently consulted over IT plans.”
Nurses and NHS IT developments: Results of an online survey by Nursix.com on behalf of the Royal College of Nursing (22 Aug 2006)
Royal College of Nursing
http://www.e-health-insider.com/tc_domainsBin/Document_Library0282/nursix-rcn-survey-2006.pdf
“This survey was commissioned by the Royal College of Nursing to investigate the views of UK nurses about NHS IT developments. 4,451 nurses responded. The objectives were (a) to investigate nurses’ views about NHS IT developments, especially the proposed integrated electronic patient record system, known in England (and in this report) as the Care Records Service or CRS, and (b) to consider how those views had changed over the past two and a half years. . . although many nurses are enthusiastic about CRS, that enthusiasm has declined over the past two and a half years. Further they continue to know little about it – inadequate consultation having barely improved over the years. . . there has been a sharp reduction in those believing that spending several billion pounds on IT is a good use of NHS resources: two and a half years ago, 67% said “yes” and 11% “no” whereas today the figures are 40% and 43% respectively . . . If current NHS IT developments are to succeed and to realise the hopes many have of them, a fresh approach by the Department of Health seems essential: if understanding of the benefits of these changes amongst individual front-line nurses were to be massively increased by rigorous, interactive, detailed and widespread personal communication, their support and enthusiasm for changes is likely to strengthen. That should vastly improve the chances of a successful outcome.
NHS staff in London lack confidence in the new IT system (10 Nov 2006)
Amicus web-site
http://www.amicustheunion.org/Default.aspx?page=4981
"According to an independent survey commissioned by Amicus union , NHS staff in London lack confidence in the implementation of the NHS' controversial new IT system to link GP surgeries to hospitals. Only nine per cent of respondents believed that their views had been taken into account and only eight per cent believed the new system will represent value for money. Eighteen per cent disagreed with the statement 'the new IT system will help them do their jobs better' and 49 per cent did not know. The respondents were asked a number of questions on their attitudes towards the implementation and eventual outcome of the IT new system. A surprising number of respondents were unable to answer many of the questions, choosing the "don't know" option. 42% of the respondents did not know whether the new IT system for transferring patients records between GP surgeries and hospitals would be quicker and more efficient. 48% did not know whether the new IT system would decrease bureaucracy. The survey was conducted to gauge the level of consultation over the introduction of new IT systems in the NHS. NHS Connecting for Health is delivering the National Programme for IT to bring modern computer systems into the NHS aimed at improving patient care and services. The NHS over the next ten years intends to connect over 30,000 GPs in England to almost 300 hospitals and give patients access to their personal health and care information. BT, is responsible for deploying NPfIT (National Programme for IT) software in London. Whilst the union acknowledges the importance of the new IT system for improving patient care, the lack of staff involvement is symptomatic of the NHS' and its providers failure to listen to its staff who are responsible for delivering patient care. Amicus is calling on the NHS and its providers to give end users a greater say and more information on the delivery of the new IT system. Whilst the NHS has undoubtedly got better, morale amongst health service employees is at rock bottom, made worse by a series of rapidly introduced changes without the involvement of staff. . ."
Medix UK plc survey (Q1066) of doctors’ views about the National Programme for IT (NPfIT) – 21 Nov 2006)
Medix
http://ixdata.com/reports/106620061121.pdf
"Most doctors recognise the benefits of NPfIT. For example the majority, 58% of GPs and 69% of non-GPs (mainly hospital doctors), believes it will improve clinical care in the longer term. And most of the main NPfIT services are supported by respondents: for example 64% regard the Care Records Service as important with 51% of GPs and 65% of non-GPs agreeing it will help clinicians make better decisions. However, overall support for NPfIT continues to fall: nearly four years ago, 67% of GPs said that it was an important priority for the NHS – now 35% do so. For non-GPs, the equivalent figures are 80% and 51%. And, although 25% of GPs and 41% of non-GPs are still enthusiastic about the project, that is down from 56% and 75% nearly three years ago. Further, most doctors, 76% of GPs and 61% of non-GPs, do not consider NPfIT a good use of NHS resources. Only 1% of doctors rate its progress so far as good or excellent. . ."
Survey reveals doctors' pessimism about NPfIT (19 Feb 2007)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=2491
"A survey of over 3000 doctors has revealed that the overwhelming majority are not optimistic that the National Programme for IT (NPfIT) will change the NHS - but only a small minority thought it should be abandoned at this stage. Only 9% of doctors expressed optimism about the programme's potential to change the service and a resounding 91% disagreed with them. The survey, commissioned by The Times, and carried out by doctors.net, also revealed that 76% thought NPfIT had been a "frustrating project". . . Overall, responses to the five survey questions relating to NPfIT, showed that the 3,092 NHS doctors surveyed were not convinced of the programme's merits but did not believe it should be abandoned or receive any additional funding. Respondents to the survey came from NHS doctors of all grades working in both general practice and hospital medicine. The results come after the chairman of the British Medical Association council, James Johnson revealed that a BMA survey had found that systems like Choose and Book are overwhelmingly unpopular with both GPs and hospital consultants. . ."
PCTs struggle to support patients exercising choice (15 Mar 2007)
Health Service Journal
http://www.hsj.co.uk/healthservicejournal/pages/N1/p13/070315
"Most primary care trusts are struggling to support patients who need help choosing a hospital, a survey by the King's Fund has found. . . GPs' hostility was compounded by the enduring problems with IT and with delays experienced by PCTs in getting leaflets and other information to disseminate. In many areas PCTs had focused on IT problems rather than equity. One PCT said: 'The focus to date has been on rolling out booking (to DoH targets that we consistently fail to hit because of technical problems with the hospital software). We have therefore focused very little energy on choice.'"
Majority of GPs blame NPfIT for worsening morale (19 Apr 2007)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=2624
"Almost three out of four GPs blame the National Programme for IT for worsening their morale in the last year, according to a survey of almost 500 family doctors. The poll of 477 GPs conducted by Medix and Doctor magazine found that more than half of GPs said their morale had worsened in the past year with most blaming workload (76%), followed by NPfIT (74%) and central targets (67%). The survey follows on from a poll conducted by Medix and co-sponsored by EHI Primary Care in November last year which found that only 35% of GPs rated NPfIT as an important priority for the NHS compared to 67% four years ago. The Medix/Doctor survey which also questioned almost 1000 doctors in secondary care found that GPs are the group of the clinicians who feel the most badly affected by NPfIT. A total of 36% of GPs said NPfIT had worsened their morale with a further 38% blaming it for “significantly worsening “ morale compared to figures of 31% (worsened) and 26% (significantly worsened) for the entire survey group of 1437 doctors. One GP commented: “Patient Choice and "Choose and Book" have had a major negative impact. They have led to a two-tier system.” Another said: “The massive waste of resources to achieve almost no potential benefit in Choose and Book is breathtaking.”"
50% of GPs won't upload records without explicit consent (19 Apr 2007)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=2623
"One in two GPs have signalled their intention not to upload patients’ clinical details to the NHS Care Records Service (NCRS) without explicit patient consent, in direct opposition to Department of Health (DH) policy. The position being adopted by doctors in primary care, is revealed in a survey of 1026 doctors’ views about the National Programme for IT (NPfIT) carried out this month and commissioned by EHI Primary Care. The survey is the latest of seven polls on the subject conducted by the healthcare online research organisation Medix and also found doctors are increasingly critical of the cost of NPfIT and how it is being implemented. The extent of doctors concerns about confidentiality are highlighted by the survey results with 51% of GPs, and 47% of non-GPs, saying they will not or are unlikely to upload a patient’s clinical details to the NCRS without specific consent, just months ahead of DH plans to begin uploading patients’ details as part of a pilot for the Summary Care Record. Almost four out of five GPs (79%) also think the NCRS will lessen patient record confidentiality. . . Overall support for NPfIT appears to be continuing to fall with only 35% of GPs now rating it an important priority for the NHS compared to 67% four years ago. In the longer term just under one in five GPs (19%) believe NPfIT is likely to lead to a significant improvement in patient care with 39% expecting a slight improvement and 21% believing it will make no difference. . . On a slightly more positive note the survey shows support for Choose and Book is growing, up from 17% at the beginning of this year to 26% today. Four out of five GPs now have experience of Choose and Book and about half of those now say they use it for more than 40% of referrals. However, of those using it regularly, more than 90% say that it increases the time in dealing with a referral and more than 70% think it either make no difference to or is detrimental to patient outcomes. . ."
Two-thirds of GPs against sharing their medical records (24 Apr 2007)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=2635
"A survey of GPs by Pulse magazine has found that only a third plan to advise patients to allow their details to be shared using the NHS Summary Care Record. The survey revealed that GPs are also cautious about sharing their own records with just a third saying they will allow full sharing, while four in ten say they will opt out completely and allow none of their details to be shared. Some 66% of the GPs who responded said they won't allow their own records to be shared. Pulse reported that despite a concerted Government PR and marketing campaign to sell the merits of the NHS IT programme in general and Summary Care Record in particular, some 80% of the GPs who responded still believe that shared electronic care records threatened patient confidentiality. The survey results also indicated that the majority of GPs who responded – some 67% - oppose the implied consent 'opt out' model, which currently forms the basis for the roll-out of SCR under NPfIT. The GP magazine also reported that in an interview Lord Warner, the minister formerly responsible for the NHS IT programme, had warned that GPs had become over-protective of their existing record systems. "GPs too often moved themselves from a position where they had been the leaders on IT in the NHS and were turning themselves into Luddites." In an earlier April poll of almost 500 GPs by Doctor magazine almost three in four blame the National Programme for IT for worsening their morale in the last year."
Researchers warn NPfIT delays risking patient safety (17 May 2007)
e-Health Insider
http://www.e-health-insider.com/news/item.cfm?ID=2695
"Lack of effective communication and delivery delays are leaving trusts disenfranchised and weakening local commitment to rolling out the National Programme for IT creating risks to patient safety, leading academics have warned. Competing priorities, lack of financial resources and repeated delays in the delivery of new systems are all said to be hindering efforts by senior NHS trust managers interviewed to sell the programme locally. The study, published in the BMJ, warns of the risk to patients’ safety if Connecting for Health, the agency responsible for the NHS IT programme, continues to leave trusts in the dark. It says trusts are attempting to mitigate clinical risks by opting for interim systems, but warns that interim systems outside of the programme will be inefficient when the new national programme systems are eventually introduced. The researchers say: “The lack of integration offered by interim applications has left senior trust staff questioning whether NHS-wide connectivity will ever be achieved and why trusts have had to wait several years for the new systems.” The findings come from a quantitative study of progress on the NPfIT programme in acute trusts. The research was carried out by researchers from Imperial College, King’s College, the London School of Hygiene and Tropical Medicine and Bristol University, found that senior NHS managers interviewed supported the goals of the programme, but had several concerns. The 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. . . In a response the paper, CfH said patient safety was not an issue: “It is untrue to suggest patient safety is being compromised. NHS CfH is giving full priority to trusts with the oldest existing systems. In the past twelve months alone, we have installed 162 systems in the hospital sector including 15 hospital patient administration systems and 62 Picture Archiving Communications Systems, which capture and store images electronically. “Progress introducing systems in acute hospitals, like the four in this study, has been slower than expected and some of this has been dependent on legacy IT suppliers and ensuring trusts are fully prepared for the new systems. We and the local service providers work alongside trusts to fully support existing systems ahead of installation of national programme systems.” The CfH statement added that the paper identified challenges which they take seriously and work hard to address. . ."
A fifth of patients reject e-records (8 Jun 2007)
Healthcare Republic
http://healthcarerepublic.com/news/GP/662815/fifth-patients-reject-e-records/
"A two-man practice in rural Dumfries and Galloway has dealt a serious blow to NHS Scotland's consent-seeking process for the electronic patient record. NHS Scotland mailed households explaining its emergency care summary (ECS) and telling patients how to opt out of having their data available for download outside their GP practice. As a result, 646 patients out of a population of five million (0.01 per cent) have refused consent for data extraction. But when Wigtown GPs Dr Gordon Baird and Dr Mary Donnelly sent a personal letter to their 1,710 patients explaining the data extraction process and asking the same question, 326 - 19 per cent - withheld consent. The Wigtown refusal rate is more than 1,500 times higher than in the whole of Scotland. . . In August 2006, households in Scotland were sent an eight-page booklet on the ECS and told to let their GP surgery know if they did not want data uploaded. . . Joint GP clinical lead in England for Connecting for Health Dr Gillian Braunold said she understood the leaflet was sent as 'junk mail'. GPC chairman Dr Hamish Meldrum said: 'In England we are still in discussions but the intimation is that patients will be given the chance to review what they want to be uploaded.' He said public confidence in Scotland might have been dented by problems with the Medical Training Application Service."
MPs call for pharmacists to have access to CRS 3 Jul 2007)
e-Health Insider Primary Care
http://www.ehiprimarycare.com/news/item.cfm?ID=2836
"Pharmacists in primary and secondary care must be given read-write access to the NHS Care Records Service (NCRS), according to a report from MPs. The All-Party Pharmacy Group’s (APPG) report on the Future of Pharmacy argues that pharmacy needs access to the NCRS to realise its potential as a health service provider and criticises Connecting for Health (CfH) over lack of consultation with pharmacists. The report states: “We do not believe that CfH has engaged adequately with the profession or its representative bodies and we are concerned that pharmacy is not being regarded by CfH as an essential participant in the NHS’s IT connectivity programme.” . . . Dr Howard Stoate MP, chairman of the APPG and a former GP, said almost all those who gave evidence to the APPG were in favour of pharmacy access to the NCRS. He told EHI Primary Care: “It’s absolutely essential – GPs and pharmacists can’t share care of patients if neither knows what the other has done.” The report says the British Medical Association told the APPG inquiry that it questioned how much of the record pharmacists should be able to access and had concerns about pharmacy’s ability to protect patient confidentiality, particularly within a commercial environment. The MPs says they were unconvinced by those concerns. . . The APPG report claims that consultation and engagement with pharmacists by CfH has been disappointing and focused largely on the Electronic Prescription Service (EPS) while largely ignoring wider connectivity issues and the Care Record. The report adds: “We were surprised and concerned to hear that stakeholders not involved in the consultation process included multiple pharmacy chains, independent local pharmacies, local pharmaceutical committees and pharmacy system suppliers.” The report claims progress on EPS has been “slow and erratic” and says CfH’s original target that EPS would be fully operational by the end of 2007 is unlikely to be met. . ."
Nurses raise doubts over NPfIT (26 Jul 2007)
BCS
http://www.bcs.org/server.php?show=conWebDoc.13306
"Nearly a third of nurses believe the security of the NHS National Programme for IT (NPfIT) will not be an improvement over that of current paper-based records, according to a new survey. The poll, conducted by the Royal College of Nursing (RCN), also found that while two-thirds of nurses welcome the idea of electronic patient records, just half believe the initiative will boost patient safety. In addition, two-thirds of respondents said they had still not been consulted about the new system and the data that it will hold. 'The health service has a challenging time ahead if it wants nurses to be ready for the new software, which will have a positive impact on professional practice and the contact nurses have with patients,' commented RCN general secretary Dr Peter Carter. Earlier this week, the NHS began the national rollout of the GP2GP software application, which allows electronic patient records to be transferred between GPs."
'Widespread concerns' about NPfIT penalties (1 Aug 2007)
e-Health Insider
http://www.e-health-insider.com/news/'widespread_concerns'_about_npfit_penalties
"In a new survey NHS foundation trusts have reported 'widespread concerns' about the limited functionality of key systems from the NHS National Programme for IT. Some foundation trusts (FTs) that have sought to delay taking systems until problems are fixed say they have been told to expect fines running into many millions of pounds. The FTs report that in many cases the nationally purchased software is incomplete or less capable than their current systems. NHS Connecting for Health the agency running the £12bn NHS IT programme, and which drew up the contracts, including penalties termed 'non-deployment charges', confirmed to E-Health Insider that a number of trust chief executives had recently written expressing their concerns at the potential fines. The DH agency said no fines have yet been levied. Carried out by the Foundation Trust Network, part of the NHS Confederation, the survey examined foundation trusts’ experiences of the National Programme for IT (NPfIT) and found “widespread concerns about the functionality of NPfIT systems as a whole”. E-Health Insider has obtained a copy of the confidential June survey, which includes responses from 48 of the 54 FTs, representing the cream of the health service. One acute FT reported being told that its local health community would have to pay a £20m fine if it decided not to take the early software offered for NHS Care Record System (CRS). Another reported facing a potential fine of £11m if it delayed installing software. While national systems including e-booking and digital x-ray communication and storage are widely used, the report says ‘most’ FTs have opted out of certain parts of the national NHS IT system including the crucial CRS software required to develop electronic patient records. Where some FTs have sought to opt out of using systems that only partly met their needs or were less capable than existing systems, they have been told they risk incurring penalty payments. FTs reported being told they face penalty payments to Connecting for Health (CfH) and its prime contractors if they refuse to install software they don't judge to be fit for purpose. The 'non-deployment charges' form part of the local service provider (LSP) contracts for the NHS IT programme to which the Department of Health committed all English NHS trusts in 2001. The biggest concerns about the software on offer centre on problems with the CRS, mental health systems and maternity, but also extend to picture archiving and communications systems (PACS) – often cited as the great successes of the programme. The survey results make damning reading, detailing FTs’ concerns about the limitations of key systems being provided by the NPfIT programme. “Almost every respondent had concerns about the functionality of some part of the system and most had opted out of certain parts of the NPfIT system,” says the survey report. NPfIT systems identified as particularly problematic include patient administration systems (PAS), mental health and maternity. The greatest cause of concern was the CRS based on Cerner’s Millennium and iSoft’s Lorenzo software delivered by LSPs. . . Despite the extent of the problems cited, FTs report that when they have sought to delay implementations until systems meet their needs or opt-out of taking NPfIT systems entirely they have been told they face fines running into millions or even tens of millions of pounds. . ."
Nurses unsure whether NHS can deliver an electronic patient record (1 Aug 2007)
British Journal of Healthcare Computing & Information Management
http://www.bjhcim.co.uk/news/2007/n708006.htm
"Over half of nurses do not believe or do not know whether the NHS can deliver an electronic patient record in the foreseeable future, according to a new survey by the Royal College of Nursing (RCN). The RCN survey of 2,600 nurses found two-thirds of nurses (66%) welcome the introduction of an electronic patient record, although there continues to be a high degree of uncertainty about the impact the record will have on patient care, safety and confidentiality. Only half the nurses surveyed believe electronic records will improve patient safety, while 30% feel the security of the system will not be any better than the paper records currently used in healthcare. The survey also found that almost two-thirds of nursing staff had not received any IT training within the last six months and nearly half (45%) have to share a computer at work with more than five people. Worryingly, 16% of nurses say they are forced to share a computer with more than 20 people. The 2007 survey, the fourth year running the RCN has polled nurses on IT, shows two thirds of nurses have not been consulted about the introduction of the new record or the information that will be entered on it. This figure is unchanged from a similar survey carried out in 2004, which found 63% had not been involved in the new system's design or development. . ."
Hospitals abusing Choose and Book to bend rules (21 Jun 07)
Pulse
http://www.pulsetoday.co.uk/story.asp?storycode=4113156
"PCTs and hospital trusts are manipulating Choose and Book to manage referrals and hit waiting list targets, a Pulse survey has found. One in five GPs is being forced by trusts to make all referrals through Choose and Book, and 61% believe it is being used by PCTs as a referral management system. More than half of respondents say they are unable to refer to a named consultant through Choose and Book, and 45% say they are being blocked from referring to a hospital at risk of missing its 13-week waiting time target. More than two-thirds say they do not feel Choose and Book has been a useful addition to GPs' referral resources. The poll of 398 GPs, carried out on behalf of Pulse by doctors' mobile communications firm Pearl Medical, paints a detailed picture of the problems GPs attempting to use Choose and Book are facing, and follows fierce criticism of the system at last week's LMCs conference. The Pulse Common Sense on IT Campaign is calling for Choose and Book to be scrapped in its current form along with closer controls on patient records. . ."
Patients nervous over care records (5 Sep 2007)
Pulse
http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4114350&c=2
"Far more patients want to opt out of the Summary Care Record than Connecting for Health has claimed, a new Pulse survey suggests. The poll of 2,600 patients found most were broadly supportive of care records in principle f but as many as a quarter wanted to opt out of the scheme. The research, carried out for Pulse by online market research company Opinion Health, found more than half of patients had concerns over confidentiality, and three-quarters wanted to be asked to give their explicit consent to take part. The survey gives one of the first indications that unease over the project exists in patients as well as doctors, and raises questions over Connecting for Health's implied consent strategy. . . The survey also shows widespread lack of patient knowledge over Connecting for Health's plans, with more than half of patients having no idea that plans for Summary Care Records existed."
Trailblazing GPs want Care Record scrapped (22 Oct 2007)
Pulse
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4115393&c=2
"Two-thirds of GPs in the first area to adopt the Government's controversial Summary Care Record want to scrap the project, Pulse has learnt. Plans to roll out the scheme in Bolton, Lancashire, are already three months behind schedule. But now an LMC survey shows most of the town's GPs are opposed to forging ahead with uploading patients' details and sharing them with local hospitals. The LMC said GP opposition remained despite months of Connecting for Health road shows and events aimed at winning them over. Ninety-eight of the town's 169 GPs responded to the survey. Just 20 respondents were in favour of forging ahead with the Care Record while 67 were against. So far, 8 practices in the town have uploaded their patient details but the Summary Care Record has yet to be deployed in unscheduled care. Dr Chris Woods, a member of Bolton LMC, said: 'It's a statistically useful survey and it seems to point to the fact that the majority of doctors don't want it.' Dr Bernard Newgrosh, a GP at Great Lever health centre in the town, said he was 'totally against' the project.. Some 166 of his patients have already opted out of having a Summary Care Record - even though his practice is not taking part. 'A girl came to see me practically on the first day of this thing and asked if her termination of pregnancy was in her record. She said she was 'dead meat' if details of the termination got out.' Bolton PCT admitted the project had caused 'a degree of controversy' among GPs. Dr Gillian Braunold, clinical director for the summary care record and a GP in Kilburn, north London, claimed a 'critical mass' of GPs were already on board with 34 of the town's 57 practices signed up. 'I met 40 of them on Wednesday who were very happy,' she said. The PCT had hoped to start using the records for unsched-uled care in July and in the out-of-hours service by late September but the project has been delayed. Chris Russ, assistant director of IM&T at Bolton PCT, blamed the slow progress on key staff being away over the summer holidays but insisted: 'The PCT now plans to introduce access to the out of hours service shortly, which will be followed by the walk-in centre and A&E at the Royal Bolton Hospital..'"
Doctors' support for NHS IT programme plummets (19 Nov 2007)
Computer Weekly
"Doctors' support for the NHS National Programme for IT (NPfIT) has declined sharply in the past three years, the latest survey from medical research company Medix has revealed. The survey of 1,000 NHS doctors, sponsored by Computer Weekly, raises questions about the project's success and adds weight to calls for a published independent review of the £12.4bn scheme. It found that 23% of GPs and 35% of other doctors supported the aims of the NPfIT, compared with 56% and 75% in 2004. Seventy six per cent said it was important to have an independent review of the NPfIT. The falling support from doctors is a worry, said professor of software engineering Martyn Thomas, a spokesman for 23 academics campaigning for a review of the NPfIT. "This is not good news for the project because without this support it cannot possibly succeed. It is serious and depressing that support is falling as the project progresses. You would expect this to rise as the project goes forward," he said. The Medix report said, "Five years after it began, doctors still support the principles of the project, but most are critical of its costs and believe it is being poorly implemented." The survey found that less than 50% of doctors believe the NPfIT is an important NHS priority, compared with 80% in February 2003. Comments from those surveyed suggest that management mistakes and spiralling costs have led to disenchantment among doctors. "Computerisation of the NHS is inevitable, and if it works well I am in favour of it. But many good ideas have floundered on computerisation, and huge sums have been wasted by government on some projects," said one doctor. Angela Eagle, exchequer secretary to the Treasury, told parliament last month that the NPfIT was a success. "Without the programme, the NHS could no longer function, and it is already providing essential services and significant benefits to tens of thousands of clinicians and millions of patients. It is therefore a success story that ought to be acknowledged," she said. A spokesman for NHS Connecting for Health, which runs the NPfIT, said it consults with a wide range of clinicians in the development of systems and in their use. "In the light of wider experience and evidence, the results of the Medix survey do not appear to reflect the general picture on the ground or chime with other recent comprehensive surveys," he said.
Family doctors to shun national database of patients' records (20 Nov 2007)
The Guardian
http://www.guardian.co.uk/society/2007/nov/20/nhs.health
"Nearly two-thirds of family doctors are poised to boycott the government's scheme to put the medical records of 50 million NHS patients on a national electronic database, a Guardian poll reveals today. With suspicion rife across the profession that sensitive personal data could be stolen by hackers and blackmailers, the poll found 59% of GPs in England are unwilling to upload any record without the patient's specific consent. Three-quarters of family doctors said medical records would become less secure when they are put on a database that will eventually be used by NHS and social services staff throughout England. Half thought the records would be vulnerable to hackers and unauthorised access by officials outside the NHS. A quarter feared bribery or blackmail of people with access to the records and 21% suspected that social services staff would not adhere to the confidentiality rules. The poll of more than 1,000 doctors was conducted by Medix, a healthcare online research organisation previously used by the Department of Health to test medical opinion. It found GPs are increasingly concerned about the department's plan to automatically upload the records of everyone who does not register an objection. . . The summary care record is part of a £12.4bn programme to modernise the NHS's IT systems. The poll found 70% of GPs and hospital doctors do not think the programme is a good use of NHS resources and only 1% rate its progress as good or excellent. Three-quarters said they wanted an independent review before further sums were committed. . ."
Four out of five doctors believe patient database will be at risk (31 Dec 2007)
The Times
http://www.timesonline.co.uk/tol/life_and_style/health/article3111428.ece
"Only a fifth of doctors believe that a national electronic system for storing patients' records will be secure, a poll for The Times has shown. More than three quarters are either "not confident" that data will be safe or "very worried" that data will leak once the £20 billion National Programme for IT (NPfIT) is running. Asked how well they thought that local NHS organisations would be able to maintain the privacy of data, only 4 per cent said very well. The majority, 57 per cent, said quite or very poorly. The poll was carried out online over Christmas. In general, the GPs, who have the greater experience of IT systems, are more sceptical than the consultants. Asked the question "Do the benefits of electronic patient records outweigh the risks?" a narrow majority of all doctors polled said no. Among GPs, the gap was much wider, with almost two thirds doubting that the benefits would outweigh the risks. . . When it was announced, little effort was made to consult the medical profession or the public. The Government is now paying the price, with scepticism in the profession and evidence that some patients will fight to keep their medical records off the system. Admissions by the Government that data on millions of families had been lost by Revenue & Customs, and that nine NHS trusts had lost patient data, have sharpened the security. The poll, carried out for The Times by Doctors.net.uk, shows that while doctors see virtues in centralised electronic records they are also well aware of the risks. More than two thirds (70 per cent) agree that such records will improve patient care. Consultants are more strongly in favour than GPs, with 78 per cent agreeing or strongly agreeing that care will be improved, against 53 per cent of GPs. . ."
Doctors have no confidence in NHS database, says BMA News poll (1 Feb 2008)
BMA
http://www.bma.org.uk/pressrel.nsf/wlu/SGOY-7BELTV?OpenDocument&vw=wfmms
"Nine out of ten doctors have no confidence in the government's ability to safeguard patient data online, a poll conducted by BMA News has revealed. More than 90 per cent of respondents (93 per cent) to the survey said they were not confident patient data on the proposed NHS centralised database would be secure. A series of recent high-profile data losses, such as the HM Revenue and Customs computer discs containing the details of 25 million child benefit claimants and security breaches during last year's online training recruitment fiasco for junior doctors, have left doctors sceptical about safety. Nine out of ten of the 219 doctors who responded to the Doctors Decide poll said they did not feel they were in a position to assure patients that their data would be safe. More than eight out of ten (81 per cent) said they would not want their surgery data stored on the national NHS 'spine'. Wiltshire trainee cardiologist Dr Sally Simmons was one of those caught up in the medical training application service security breaches last year. Her personal details became publicly available and could potentially have been used by identity thieves. She said: 'I have received no apology from the Department of Health despite writing to the former health secretary [Patricia Hewitt]. I was also affected by the loss of the two child benefit CDs with my bank details on them. Not surprisingly, I have no faith in any form of IT security that this government proposes.' However, Berkshire GP and consultant in family planning Dr Meg Thomas said: 'This will help with continuity of care and communication between primary and secondary care 'There may be a risk but paper records are also going astray. We need to join the 21st century and quick.'"
Connecting for Health faces criticism over national IT programme (3 May 2008)
Computer Weekly
"Connecting for Health, which runs much of the NHS's £12.4bn National Programme for IT (NPfIT), is expected to come under strong criticism in a report commissioned by the government into the progress of online health records. The study by researchers at University College, London, is also expected to highlight criticisms of the government by executives at Connecting for Health. Connecting for Health (CfH) pushed primary care trusts to implement the summary care record, despite the immaturity of the technical solutions, the report is expected to reveal. The study analyses the first go-lives of the national summary care record system, a key part of the NPfIT was designed to give 50 million people in England an online summary health record including allergies and medications. Staff implementing the project said they had been asked to meet unrealistic deadlines. Local NHS project leaders struggled to reconcile political timescales with making the technology work properly. And although some GPs embraced the scheme others believed they had been coerced into it. One primary care trust informant described the command and control structure at CfH as bullying while other staff told researchers they were highly stressed, working far beyond their contracted hours. The report, scheduled for release on Tuesday, is expected to show the lengths to which health officials were prepared to go to convey the right message to the public on the summary care record programme. . ."
Political pressure on NHS trusts to use immature database (3 May 2008)
Computer Weekly
"The first NHS trusts to upload medical details to a national database as part of the £12.4bn National Programme for IT (NPfIT) were pressured for political reasons to push ahead quickly despite the immaturity of the technology, an independent report is set to reveal. A year-long study of the summary care record early adopter programme - a key part of the NPfIT - will show how politics and large, complex IT projects can be a toxic mix. The study is expected to find that most users in the first trusts to go live with the system were broadly enthusiastic about giving doctors online access to medical records in an emergency and out of hours. But the researchers at University College London found that the summary care record remains an immature technology which staff describe as clunky, which interfaces poorly with other systems, and which many staff have given up using until it works better. UCL's report is also likely to reveal that IT executives in early adopters were pressured to implement the system to redress what had been described as a worrying lack of progress on the NPfIT. . . The report evaluated live trials of the summary care record at trusts in Bolton, Bury, South Birmingham and Dorset. The system will take extracts of local medical records held by GPs. Any medication or allergy information will be uploaded onto a national database, called the "spine", which is run by BT. The UCL research is expected to report resentment among participating primary care trusts that Connecting for Health pushed forward on a tightly managed, largely non-negotiable timetable for implementing the summary care record despite the immaturity of technical solutions. There was further resentment from GP practices pushed excessively by primary care trusts in turn. The report also found that the public doubted whether the summary care record system was worth the money being spent on it."
Survey slams NHS computerised booking system (5 Aug 2008)
IT Pro
http://www.itpro.co.uk/605163/updated-survey-slams-nhs-computerised-booking-system
"The new NHS computerised booking system is failing to deliver sufficient choice to patients, according to research carried out by University College London. UCL surveyed 104 patients referred to Hillingdon Hospital who had used the Choose and Book system. Cerner, in partnership with Atos Origin, developed and implemented Choose and Book as part of the National Programme for IT (NPfIT), the tech upgrade run by NHS Connecting for Health. The Choose and Book system seeks to provide patients with choices regarding the time, date and place of their first outpatient appointment via a computerised booking system. The survey found that 66 per cent of respondents said that they were not given a choice of date for their outpatient appointment. A further 66 per cent of patients said that they were not given a choice of appointment time and 86 per cent said that they had been given a choice of fewer than four hospitals. Meanwhile, 32 per cent reported not being given any choice of hospital at all. The study also revealed that 63 per cent of patients had not been aware before their GP appointment that they were entitled to choose which hospital they were referred to. Those who had booked through their GP surgeries appeared to experience less choice than those who had booked online. Patients who had used online booking did report some technical difficulties. Patients using the old booking system found that they were not given the same level of choice of hospital as those who did use Choose and Book. However, Choose and Book patients did not report being offered a choice of time and date any more frequently than those who had used the old system. Shockingly, the survey found that only one patient reported that they had been offered a choice of four hospitals, appointment date and time, which is the desired level of choice that Choose and Book was designed to offer everyone. . ."
Public Service Review: Health Issue 16 (12 Aug 2008)
PSCA International
http://www.publicservice.co.uk/feature_story.asp?id=10105&topic=Health%20and%20social%20care
Professor Naomi Fulop, Director of NIHR King's Patient Safety and Service Quality Research Centre, evaluates concerns over the National Programme for IT:
". . . Continuing impact of financial deficits. . . Managers distracted from implementing the programme by other priorities. . . Poor communication between Connecting for Health and local managers. . . Continuing delay in replacing patient administration systems (PAS). . . Growing risk to patient safety associated with delays. . . Loss of integration of components of the programme. . . An important lesson from our study is the difficulty in achieving an appropriate balance of responsibility between government and local healthcare systems. Devolving control of IT to local managers results in a lack of standards, and disparate functionality. However, with central control the sheer size of the task makes communication and realistic goal-setting difficult. A third strategy is now in place, setting central standards but with local implementation. The role of Connecting for Health is shifting from implementation towards providing a national infrastructure and standards-setting body. Implementation will be devolved more locally. Even with these changes, the issues raised in our study still need to be addressed. Connecting for Health still needs to involve local end-users in discussions about the form, the national infrastructure and national standards; these should not be imposed. Further, devolving responsibility for implementation locally raises questions about the degree of local customisation permitted. We found that local customisation is an important factor in successful adoption. However, too much customisation might weaken national standards and the ability to pass data between providers. Finally, a national infrastructure needs to help trusts to prioritise IT modernisation against competing financial pressures, for example, by its inclusion in performance management frameworks. New plans need to be communicated throughout the NHS with clear timetables to end the uncertainty. A recent Audit Commission study (May 2008) reported that the National Programme is running four years late and that a single NHS electronic patient records system will not be in place anywhere until 2014, increasing concerns that delays in replacing old systems may compromise patient safety."
Half of GPs will refuse to take part in Summary Care Record rollout (17 Nov 2008)
Pulse
http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4121179&c=2
"The national rollout of the Summary Care Record faces foundering on a wall of opposition from GPs after it emerged that half are refusing to take part. A Pulse survey of 314 GPs showed a slight thawing in the profession's attitude to the plans, with 56% now supportive and one in three saying Connecting for Health's switch to a 'consent to view' model had helped win them round. Yet 49% said they still had no intention of taking part in the programme when a rollout beyond six early adopter PCTs begins next April, and 51% said they would not share their own records. One in five said they planned a blanket opt-out and would automatically remove all their patients from the scheme - a claim which drew an exasperated response from Connecting for Health. A spokesperson said: 'It is the patient's choice if they would prefer to opt out of having a Summary Care Record created.' Dr Catti Moss, a GP in Guilsborough in Northamptonshire, said she planned to opt out all her patients' records because she considered 'a major data leak almost certain'. 'The whole idea of having a unified record system for the whole NHS is potentially disastrous,' she said. 'It would have been faster, safer and more reliable to have simply concentrated on developing systems for existing systems to communicate safely and securely.' Dr George Paige, a GP in Coventry, added: 'The changes to consent are a move in the right direction but unenforcable with any corrupt user of the spine. 'I do not believe with the hundreds of thousands of people working for the NHS that none is corrupt or unbribeable.' A Connecting for Health spokesperson remained tight-lipped on how plans for a wider rollout were progressing, but said: 'There are no plans to incentivise rollout.' GPs also expressed fears over widening access to the Summary Care Record, with four in five opposing access to records for pharmacists - a proposal the Department of Health is considering."
Readers back reformed NPfIT (5 Oct 2009)
http://www.ehiprimarycare.com/news/5264/readers_back_reformed_npfit
e-Health Insider Primary Care
The National Programme should not be scrapped although it should be reformed, a major survey by E-Health Insider and Doctors.net.uk has concluded. The poll on the future of electronic health records in England was run last month in response to the publication of the Independent Review of Health and Social Care IT and the Conservative Party's response. Although the Conservatives did not call for the programme to be scrapped, they called for much of its central architecture to be "dismantled" and for its multi-billion pound local service provider contracts to be renegotiated in favour of more local control over IT decision making. Respondents to the survey, which has been released today to coincide with the start of the Conservative Party conference in Manchester, broadly backed this approach. EHI readers, in particular, backed interoperability rather than centrally purchased systems as the way forward. Jon Hoeksma, editor of E-Health Insider, said: "The support given to the national programme was surprising, but it probably reflects a growing recognition that the NHS needs to get good IT systems in place. Doctors, NHS IT professionals and suppliers all want a national programme. Just not the one that they have got." Doctors were keener than IT managers and suppliers for the national programme to be scrapped. Indeed, more than half (54%) of the GPs who took part through Doctors.net.uk agreed that the programme should be ended, in comparison with 43% of consultants and just 25% of junior doctors. Just 22% of EHI readers working in the NHS and 28% of suppliers felt the programme should be ended. But an overwhelming majority - in excess of 80% in all groups - wanted it reformed. In line with this, two thirds (66%) of EHI readers felt that centrally purchased, common systems were not the best way to develop detailed electronic patient records; and 86% felt a wider range of interoperable systems using standards to share data would be. Doctors were less clear on this point. But then, doctors had different views from other groups on why progress on implementing IT in the NHS has been so slow. EHI readers were much more likely than Doctors.net.uk readers to blame "centralised policies" (with 24% and 16% picking this as the biggest obstacle) but fewer blamed "political interference" (13% and 25%). Doctors were more likely to blame lack of consultation with clinicians in designing systems (46% and 29%). Asked about the importance of the different things that the national programme is trying to do, there were some clear differences of opinion. There was overwhelming support among all groups for detailed care records and Summary Care Records except among GPs (only 9% of whom rated SCRs as "very important"), but much less for Choose and Book, particularly among GPs (only 3% of whom rated it "very important"). Asked about the Clinical 5 for hospital systems, there was strong support for a patient administration system and order communications. But EHI readers were much keener on e-prescribing than Doctors.net.uk readers (with 12% and 5% picking this as "most critical to clinical care"). Doctors were more anxious to see discharge letters with clinical coding in place (27% to 8%). "The survey shows that reforming the programme may not be as straightforward as some of its opponents suggest," Hoeksma added. "The principles of Dr Glyn Hayes' independent review are well supported, but a further round of highly-politicised change is not."
NPfIT study urges 'middle-out' approach (3 Sep 2010)
eHealth-Insider
http://www.e-health-insider.com/news/6211/npfit_study_urges_'middle-out'_approach
The largest study of the national roll-out of the NHS Care Records Service to date has concluded that its top down, standardised approach has led to much slower progress than originally envisaged. The study, led by Professor Aziz Sheik from the University of Edinburgh, says the original approach of the National Programme for IT in the NHS has had to evolve to "admit more variation and greater local choice." It says that further implementation will be a "long, complex and iterative process requiring flexibility and local adaptability, both with respect to the system and the implementation strategy." It adds that whilst there is no clear evidence that a "middle out approach" will achieve the programme's goals, experience suggests that neither a purely top-down nor a purely bottom-up approach is likely to do so. The study, which is published in today's British Medical Journal, was conducted by researchers from four British universities. It looked at the experiences of five 'first-wave' implementation sites for NPfIT electronic health record systems. These comprised one Cerner Millennium site, one RiO site and three Lorenzo sites, although some took only element of a system or only took it for a specific department. The researchers examined documents and undertook observerations and interviews to determine the impact of the systems, and found "considerable delays and frustrations." Despite this, they say that "support for electronic health records remains strong, including from NHS clinicians." However, they also note that clinical enthusiasm tends to be generated by benefits in their immediate area of work "not necessarily to the benefits that would come from geographically widespread sharing of patient data." The study finds that the central contracts negotiated by the national programme in 2002 have led to a number of adverse consequences. "These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities." After reviewing alternative approaches from Europe, North America, Australia and elsewhere, it concludes that a "middle-out" approach should be tried, which "combines government direction with increased local autonomy and for restricting detailed electronic health record sharing to local health communities." The study makes four specific, policy related recommendations. These start with a need for fundamental questions to be asked and answered about what the country needs and what the country wants to pay for. It also identifies a need for the Department of Health to provide clear information on the future of NPfIT and provide consistency in its leadership. In addition, its says that trusts should be allowed to "communicate changing local and national NHS priorities directly to those working with them" and that linking contract payments to more "thoughtfully agreed outcomes" could potentially control costs and benefit both NHS trusts local service providers. The researchers are now undertaking a longer term, multi-site case study evaluating data collection that is due to end in 2011.
