A pessimistic view of the chances of hitting targets for getting the Integrated Care Record Service (ICRS) up and running emerged with week from an audience poll at the Clinical Information Systems and Electronic Records conference in London.
Organisers conceded that the poll returns were a small sample of opinion, but the response was unequivocal: 92% believed targets would not be met. There was a degree of philosophical acceptance about the expected delays, however. One respondent said: “Targets are never reached on time.”
Others were more critical. Comments included:
"Implementing a ruthlessly standardised system is bound to run into serious opposition from doctors…”
"Too ambitious a plan, data quality in trusts isn’t good enough. We can’t match up patients between our pathology database and patient database – what happens when we send this information beyond boundaries?”
Asked what the main barriers were to achieving the targets, the audience raised a host of issues including:
"Security, confidentiality, cross boundary information flows, lack of financial resources for implementation, ownership of data…”
"Local culture, local ownership/commitment from the top team. Will it ever be a serious priority?
"Insufficient time for proper consultation, insufficient time to engage clinical users properly.”
Management of legacy systems, the need to redesign processes and the danger of a national solution being dismissed as “not invented here” were also cited.
Yet most respondents thought there was potential for ICRS to make a positive impact on patient care provided training, testing and service redesign was done properly.
An invitation to offer more general comments drew out further concerns about confidentiality and sharing information. “Please clarify and define pseudonomization and what it means on a national basis,” said one respondent.
Concerns about communication were also raised. “NPfIT (National Programme for IT in the NHS) communication is atrocious…” wrote one poll respondent while another commented, “We need more information on the ICRS and the national programme.”
In a expert panel discussion of the results, Chris Canning, associate medical director for clinical information at Southampton University Hospitals Trust said his thoughts were reflected in the poll responses and commented: “There’s a large selling job to be done.”
David Rosser, a doctor working in intensive care who is also lead for EPR at the University Hospitals, Birmingham, commented that the focus seemed to be on creating information at higher levels “rather than for those of us who are trying to get the job done.”
Richard Fitton, a Derbyshire GP who led a project on patient access to records for the Electronic Record Development and Implementation Programme (ERDIP) said bluntly: “There’s no way we are going to reach these targets.”
Dr Fitton argued that patients needed to view records in order to give informed consent for them to be used. This was a major issue which the country had not begun to address.