A key report published one year on from the NHS IT strategy update ‘Building the Information Core’ warns that almost all NHS health communities have serious doubts whether they can meet the targets on delivering Electronic Patient Records (EPR) and says many other targets now seem ambitious.

In its first annual report on the service’s progress in implementing the modernisation agenda of the NHS Plan, the NHS Modernisation Agency identifies the continued lack of progress on IT as a serious barrier to modernisation efforts.

The otherwise upbeat report bluntly states, "There are concerns over the NHS’ ability to implement the modernisation programme on information and technology, upon which hinges a number of other reforms."

Crucially the report says, "Nearly all health economies are reporting doubts over whether they can meet the targets for electronic patient records." While few in health IT are likely to be surprised by such doubts, the report is the first high profile NHS report to acknowledge EPR targets are likely to be missed.

The report squarely identifies the main barriers as delays in promised funding, the current infrastructure, and problems recruiting IT staff and states additional IT investment will be required.

By this April 25% of acute trusts are meant to have level 3 EPRs in place with all meeting the target by 2005. To date only a handful of trusts have a functioning EPR.

Despite very heavy investment – some insiders place the figure at £50m — in the ERDIP programme (Electronic Records Development Project), the complex range of projects supposed to inform local EPR developments, publication of the key evaluation report has been pushed back from September 2001 to 2002.

Lack of progress on EPRs is also delaying other projects such as the development of telemedicine services, as is "the need for staff to wait to be given access to PCs".

One success story identified is NHSnet, with 95% of practices now connected and all GP practices on target to be computerised by March 2002. The report states, however, that "the targets in many other areas now appear ambitious".

Progress is also highlighted in a number of other areas including: NHS Direct – which took 5.7m calls last year, the introduction of electronic admissions booking systems, and development of electronic prescribing.

The report says that the target for booked admissions – that all bookings from GPs to outpatients or from outpatients to day case or inpatients should be made electronically by March 2005 – "should be achievable", with over 50 hospitals able to use electronic booking and an outline business case now completed.

Though progress on NHS connectivity, NHS Direct and booked admissions are all important steps in realising the goal of a networked NHS, it is EPR that remains at the heart of the NHS IT strategy and the NHS Plan’s core vision of delivering high quality, patient centred care.

And if the current programme for delivering EPRs is not delivering effective systems fast enough, what is the alternative? With the NHS now committed to bring in the private sector to run failing hospitals, will the same principle apply to IT projects that underpin the NHS modernisation agenda?