Electronic patient record systems are vital to the future of healthcare in England, but there remain big questions and concerns over how and when they will be delivered by the NHS National Programme for IT. 

This is the central conclusion of a detailed report on electronic patient records systems published today by the Commons Health Select Committee. It states that the delivery of the NHS Care Records Service (NCRS) has "been hampered by unclear communications and a worrying lack of progress on implementing local systems". 

While work has begun on the first trials of the summary care record component of NCRS the report states that this is of secondary importance to the delivery of the local detailed EPR systems – the so-called Detailed Care Record (DCR) of NCRS – delivery of which has barely begun.

The Committee recommends that the Government ensures that regional Local Service Providers publish clear plans and a timetable for the completion of Detailed Care Record systems and sets a final deadline for the successful completion of the Lorenzo system.

The report also calls for more involvement by local NHS organisations and clinical groups in the implementation of DCR systems – due to be supplied by iSoft and Cerner – and more choice for users about what systems they will receive. The Patient Administration System (PAS) replacement strategy being pursued in England by NPfIT is contrasted with other approaches to EPR development underway internationally. 

The Chairman of the Health Committee, Kevin Barron MP, said: "Whilst the Government is getting the framework in place they still have some way to go before patients and the profession can see tangible benefits of the new system."

The report spells out the huge potential benefits to patients of EPRs, which are being created under NCRS, but says that delivery of the project remains uncertain with elements delayed by up to two years. 

While there have been successes such as PACS and the N3 network the report says that NPfIT’s overall progress in other areas "has been disappointing". In particular it says CfH has largely failed to deliver on its core objective of clinically rich shared local DCR systems. 

"It is on NPfIT’s success in delivering DCR systems that the programme’s ultimate effectiveness should be judged," says the report. 

The Committee calls for a more localised approach by NHS Connecting for Health, the DH agency responsible for NPfIT, to speed up implementation of the programme.

In particular the Committee singles out delays in the delivery of local Detailed Care Records – the rich local clinical component of NCRS – as a concern. The Committee describes such systems as the ‘holy grail’ for the EPR programme, but according to the report it is "not clear when they will become widely available".

The Committee also says it is concerned that iSoft’s Lorenzo system, due to provide the detailed EPR across the North and the Midlands, will not be trialled until at least 2008, leaving organisations relying on ‘increasingly outdated systems’ to support patient care. Such delays, it says, "have caused clinicians and managers to lose confidence in the programme". 

It says that as a result of this and other delays "it is not clear when joined-up DCR systems will become widely available". 

The report also says the Committee was unable to get clarity on what the systems finally delivered will do, "we found it difficult to ascertain either the level of information sharing that will be possible when DCR systems are delivered, or how sophisticated local IT applications will be". 

It observes that while NPfIT’s original 2003 specification documents established a clear vision for local electronic records systems "Four years later, however, the descriptions of the scope and capability of planned DCR systems offered by officials and suppliers were vague and inconsistent". Some witnesses, it says, indicated the original vision "had been abandoned". 

"We recommend that Connecting for Health publish clear, updated plans for the DCR, indicating whether and how the project has changed since 2003. We also recommend that timetables for completing DCR systems are published by all suppliers." 

Echoing previous NAO and PAC recommendations on NPfIT today’s report also identifies lack of local ownership as a problem that must be addressed as a priority. The NPfIT Local Ownership Programme is a first step "but does not go far enough".

It concludes: "An important cause of delays to DCR systems has been the lack of local involvement in delivering the project. Hospitals have often been left out of negotiations between Connecting for Health and its suppliers, and found themselves, as one witness put it, at "the bottom of the food chain"." 

The report’s recommendations include giving local organisations responsibility for negotiating with suppliers and for contract management, "and offering users a choice of systems wherever possible". The GP Systems of Choice (GPSoC) model is recommended as a template for the wider programme. 

The report also makes clear that it believes root and branch reform of CfH is needed if NPfIT in general, and DCR systems in particular, are to be successfully delivered. "We recommend that Connecting for Health switch as soon as possible to focus on setting and ensuring compliance with technical and clinical standards, rather than presiding over local implementation." 

Elsewhere the report states CfH’s centralised approach "will increasingly need to be modified, particularly if the DCR programme is succeed".

Commenting on the report for the BMA, Dr Vivienne Nathanson, the BMA’s Head of Science and Ethics said: “Public and professional confidence in the National Programme for IT is low and its credibility is at stake. Many doctors feel that they are seeing few returns for the investment in IT at a time when financial cuts are being made across the NHS." 

Dr Nathanson also backed calls for better clinician engagement and local ownership: "We support the committee’s recommendation of increasing local ownership of systems. The BMA has also recommended that local organisations should be offered a choice of systems. Implementation lessons must be shared nationally so that mistakes are not repeated."

Liberal Democrat Health Spokesperson, Sandra Gidley MP, added: “This ambitious project has suffered from a lack of consistent direction." She added: "Many of these problems could have been avoided by better communication with staff at a much earlier stage in the process."


The Electronic Patient Record (PDF)