The £6.2 billion National Programme for IT (NPfIT) has published a summary of its deployment plans for the first time, indicating what new IT systems are intended to be deployed to NHS organisations and by when, writes Jon Hoeksma. According to the plan, which is available here, deployment of hospital administration and clinical systems will begin at 54 NHS trusts by the end of March 2005. A further 311 trusts are set to receive systems by the end of 2005-6. The scale of the promised delivery, even in this initial phase, is certain to prove hugely challenging to meet. NPfIT’s ‘indicative deployment plan’ suggests that 32 English NHS trusts will begin deployment of a Patient Administration System (PAS) by the end of the health service’s 2004/2005 financial year, while another 22 will begin to deploy PAS with some elements of order communications – the ability to order diagnostic services such as blood tests and x-rays within a hospital. According to the plan trusts will start to deploy PAS, plus order communications and electronic prescribing beginning from 2005/2006. Although the document only provides broad indications of when the four local service providers (LSPs: Accenture, in the East and North East; CSC, in the North West; BT in London; and Fujitsu in the South) will start deploying core patient management and clinical functionality to hospitals, it outlines how progress and approach is already varying across England. No hospital systems are scheduled to be deployed in the South before the end of March this year. In London three NHS trusts are due to begin deploying basic PAS systems by April 2005. In addition, University College London Hospitals NHS Trust, which procured its system from IDX ahead of and outside the national programme, will get a version of PAS including basic order communications from NPfIT. In the North West and West Midlands cluster 11 trusts are scheduled to begin deployment of a basic PAS by the end of March 2005, with a further 19 to start work on deploying a version of PAS including some elements of order communications. One trust in the North West, Wirral Hospitals, is shown as taking PAS, plus order communications and prescribing from 2005/2006 even though the trust is currently procuring a fully fledged electronic patient record system outside the national programme that it plans to start deploying from May. A different ‘simple’ version of order communications, unique to the North East, is meanwhile due to begin to be deployed at three trusts in the North East and East Midlands cluster by the end of March 2005. Another 14 trusts are due to start work on the basic PAS system being provided by Accenture. Deployment seems set to take a little longer to begin in the second Accenture cluster in Eastern region. Here Accenture is due to begin deployment of 4 new PAS systems by year end. Some of the details remain extremely tentative. Sixty-five NHS trusts, mainly located in the North East Cluster, are shown as only having a planned ‘slot’ in the deployment schedule over the next three years, plans which are “not currently agreed with organisations". Significant systems and applications, including deployment plans for GP systems and Picture Archiving and Communication System (PACS) for digital diagnostic images are, however, not included in the deployment guidance. While the publication of the summary deployment plan, clearly badged as ‘indicative’ and ‘subject to change’, is a welcome development that casts some light on the national programme’s progress it poses almost as many questions as it answers. For instance, where are the big urban acute hospital trusts in the first wave? With a few notable exceptions the trusts in the initial wave of deployments are Primary Care Trusts (PCTs), mental health trusts or general hospital trusts. It seems surprising that implementing a new PAS system is such a high prioirity for so many PCTs. Second, what does deployment actually mean within the contractual terminology of the national programme? Does is mean beginning enterprise-wide implementations of basic PAS or order communications functionality from LSP data centres, or does it instead mean drawing up project initiation documents for installing a new system? EHI has sought clarification but the national programme had yet to clarify at the time of publication. A final question centres on whether the schedule can be delivered. The LSP approach is meant to be about deploying highly standardised solutions from industrial-strength data centres but this still depends on each NHS organisation being ready. Just as important will be the national infrastructure which local systems are meant to use to authenticate users, provide access to patient demographic data and handle all the messaging upon which the national programme is designed. Last week the National Audit Office attributed one of the causes of delay to the roll-out of Choose and Book as an “intermittent fault with authentication through the NHS Spine” that “prevented access to e-booking and other IT systems". It is not clear whether the NHS Spine in particular can yet fully provide the national authentication service and handle the volume of messaging that it is intended to carry.
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