E-Health Insider cuts through the statistics to offer a snapshot of progress on ongoing efforts to digitise the NHS in England.

Whatever happened to the NHS Care Record Service?

2006 may well be seen as the year Connecting for Health (CfH) and its prime contractors failed to deliver on their promise of next generation integrated clinical record systems that would provide a rich, detailed local record and summary national record. During the course of the year not a single implementation of such a next generation system occurred, and it remains unclear when and whether such systems will now be delivered.

By the end of the year a board paper from Leeds, the largest trust in England, said there was no roadmap for the development of electronic records in its region.

The consequences of this fundamental failure have been huge, both on the NHS, CfH and its suppliers. In the absence of the next generation CRS systems CfH has only been able to offer existing systems. For the trusts that had little this has been a boon, but for those with more advanced IT, especially in the acute sector, the programme still offers them little. Unlike almost any other major IT project, CfH has largely focused on the laggards rather than those who were already well advanced and should have been its champions.

Throughout the year, the LSPs pushed permutations of existing systems to trusts which have shown little appetite for them. The ‘Plymouth solution’, billed by CfH as the solution to trusts’ needs, based on current iSoft products, was not enthusiastically embraced by trusts.

In the South it became increasingly clear that LSP, Fujitsu, needed to do considerable additional work on Cerner’s Millennium product before it was ready for wider deployment. As a result its ambitious roll-out programme has stalled.

Step forward the summary care record

Given the problems on local CRS the focus has moved, rather conveniently, to the summary care record which at times is now spoken of as ‘the record’ rather than as one component of it. Running two years late initial pilots are now due to begin in 2007, with Scotland’s Emergency Care Summary now spoken of as the model. Meanwhile a storm rages around whether patients should have to give explicit consent for their details to be uploaded to the new service, rather than the qualified implied consent favoured by the Department of Health.

The year existing solutions were rediscovered

In the absence of strategic next generation solutions, CfH and its prime contractors became increasingly desperate to deploy something, anything, which would be of use to NHS customers and enable them to get paid. Existing system suppliers – many of them recently told they had no future in the market – have been courted and in many cases provided solutions through LSPs.

As a result, almost all of the clinical systems provided to trusts – in community, mental health, child health and joint assessment, together with departmental systems for theatres, pharmacy A&E – have come from existing suppliers who were able to weather the early years of CfH. As we enter 2007 the trend towards existing suppliers looks set to accelerate both within and outside the NHS IT programme.

N3’s big roll-out (with a few small bumps)

The biggest pluses for the scheme have been on infrastructure with over 15,000 connections so far made and BT, the company responsible, saying they are on target to deliver all 18,000 connections by March 2007.

But as our sister title EHI Primary Care has revealed some GPs, particularly those in branch surgeries, report that N3 connections are too slow to access national applications and face hefty bills for upgrades. By the end of the year there were signs that a fairer deal may be on the way in 2007.

National spine services successes

Despite continuing delays to the spine summary record core services – including the patient demographics service, and user authentication and registration – are now in use on the spine, Hundreds of thousands of smart cards have now been issued to NHS staff, and a growing number of CfH-accredited systems now making use of these common spine services. The importance of a single mechanism to reliably identify patients cannot be understated.

Let’s get digital in radiology

Although some have questioned the value for money of the deals signed by CfH, and asked pointed questions about exactly where LSPs are adding value, the digitisation of medical imaging though the rapid deployment of picture archiving and communications systems,has been a genuine achievement that offers clinical and business benefits. By year end the programme was well past the half way mark with Fujitsu in the South still working towards 100% implementation by March 2007.

Slow but steady progress on Choose and Book

Having first been due to be implemented by the end of 2005, then the end of 2006 Choose and Book is now meant to be 90% in place by the end of March 2007. Despite generous incentive payments to GPs this target looks extremely unlikely to be met. As 2006 ended the system, which failed entirely last Christmas during an upgrade, was still being dogged by technical problems that routinely make it unavailable to some staff or too slow to use.

On the plus side implementations continue and improvements in the system are slowly occurring, the impression is that although it will take far longer than initially thought, electronic appointment booking will become the accepted route for referrals within the next few years.

Electronic Prescriptions Service

Like Choose and Book the Electronic Prescriptions Service is proving slower than originally intended: phase 1 has been widely deployed, but phase 2 appears to be running badly late. Again though it looks certain that although targets will be missed, there are healthy signs that EPS will eventually become the norm.

GP Systems of Choice, still waiting

The pledge to deliver on giving GPs a choice of systems has become like Father Christmas: comes round once a year and some people get very excitable, but few take it seriously. For 2007 it looks entirely possible that GP Systems of Choice will for the third year in a row be announced at March’s Healthcare Computing and then kicked into touch. The bottom line surely is that if CfH was ever serious about choice it would have happened by now.