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Confusion about what information to include in electronic patient records as well as a lack of engagement with frontline NHS staff, particularly doctors, has been blamed for delays in creating the database promised by the government, which would be accessible throughout the health service.
A highly critical report from the cross party health committee says that MPs were dismayed at the lack of clarity about what medical details would be included in the two types of electronic records planned by the NHS IT programme—summary care record and detailed care record—and what they would be used for.
The confusion has led to delays of more than two years in developing and installing new IT systems in some cases. Many NHS staff have lost faith in the new system and are frustrated with having to rely on outdated software.
One example given in the report is iSoft's Lorenzo system for basic administration, which is to be installed in hospitals across the north and the Midlands, but will not be trialed until next year. Until it is in place the uploading of patients' medical records cannot begin.
The report calls for Connecting for Health, which took over responsibility for transforming information systems throughout the NHS from the Department of Health in 2005, to give local organisations and doctors a bigger role in implementing electronic record systems and deciding what systems they should adopt.
Kevin Barron, MP and chairman of the committee, said, “While 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.
“There is no doubt that the use of IT in the NHS has the potential to make positive improvements in patient care, especially for those suffering with chronic illnesses, but this will only happen if people in the health service, particularly doctors, play a positive role in its implementation.”
Doubts about the feasibility of implementing the government's plans for IT in the NHS and its ability to deliver clinical benefits have recently been expressed in reports by the National Audit Office in June (BMJ 2006;332:1467 doi: 10.1136/bmj.332.7556.1467) and the Public Accounts Committee in March (BMJ 2007;334:815 doi: 10.1136/bmj.39189.376979.DB). However, MPs said that they felt reassured that the plans could be implemented successfully provided certain changes were made quickly.
A highly centralised approach to the NHS IT programme has “stifled local activity” causing “frustration and resentment at trust level,” says the latest report.
Relaxing central control will make local trust and strategic health authorities feel more engaged in the project—something that has been missing from the project until now, say the MPs. It will also leave Connecting for Health free to focus on ensuring that contractors comply with the technical and clinical standards it sets down.
The report calls for a clear direction on what summary records should be like. Richard Taylor, MP and a member of the committee, said a demonstration at the department of health on what the summary record would look like got “more confused the longer it went on” and looked more like a detailed account of someone's medical history.
The report recommends summary records should be easy to use with a single standardised screen to display key health information that is vital for emergency care. Better communication with patients and doctors is also needed about how records are to be created, and the overall security of the system needs to be evaluated more rigorously, it says.
MPs also expressed dismay at the flexible approach to contracting taken by Connecting for Health. To date only one contractor involved in the programme, which the government has said will cost £7.5bn (€11bn; $15bn) over 10 years, has provided an estimate of when it will deliver commissioned systems. The telecommunications company BT has said that shared records will be available in the London area by 2010, but has been unable to say what level of sharing will be available.
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.”
She is especially concerned about the security and confidentiality of the summary records. “It is important that any problems are exposed through a rigorous independent review of the pilot programme before the SCR [summary care record] is launched across England and that the results of the review are made available to the public and healthcare professionals,” she said.
Joyce Robins, from the campaigning group Patient Concern, who gave oral evidence to the committee, said, “Patient confidence will only build up if things change radically from now on. So far the roll-out of the summary care record has been handled like a sales pitch, without the information we need to make choices. Plans for the more detailed records have been woolly and unconvincing.
“Most patients have no idea what it all means yet they are being shovelled into it willy nilly.”
Ms Robins welcomed that fact that the committee recommends following the French system, in which patients legally own their own records and clinicians can only access the record when the patient is present and agrees. “This is miles from what is being proposed at the moment,” she said.