First Anniversary for National IT Programme

Birthday greetings to the NHS National IT Programme! It’s 12 months since a new centrally-driven plan for transforming the NHS through IT was announced at Healthcare Computing 2002.

So what illumination can we expect at this year’s event in Harrogate? Word is that it may well be a lot less than people had hoped.

The past year has seen a new strategy published, an extra £2.3 billion committed for the first three years of the programme, the new NHS IT Director General appointed, some furious activity behind the scenes as the details are worked out, and a great deal of dust and confusion across the NHS.

E-Health Insider understands that there will be no new significant announcements about precisely how the extra money will be spent – though infrastructure and picture archiving and storage systems (PACS) are likely to be early beneficiaries. Also expect an announcement on the award of the lucrative contract for the National IT Programme Project Office.

Most importantly delegates at Harrogate are likely to hear about the phasing of the Programme and some more details about Integrated Care Records Services (ICRS), and the concept of a ‘data spine’ – the first stage of the development of a shared electronic record.

While a draft specification for ICRS was published in July, this was a high level ‘vision’ document that lacked any specifics about what will be delivered, how it will be phased and what the technical architecture will be. A full ICRS specification is set to be published in April.

However, the initial ambitious scope of ICRS appears to have been seriously scaled back, for the time being, at least. Both the former health minister, Lord Hunt, and Department of Health director of information, analysis and research, Sir John Pattison, have sought to manage expectations about when a full ICRS will become available.

E-health Insider understands that phase one of ICRS will now focus on building an ‘information spine’. ICRS will initially only provide views of existing data on different systems, but lack the ability to write back to source systems. Particular emphasis will be placed on allowing hospital doctors to access patient information held on GP systems.

What is clear is that ICRS looks set to be pretty thin in the first years of the Programme, and thereafter either be incrementally developed or provide the golden thread to link together the much deeper community-wide clinical applications to be delivered by Local Service Providers.

Official documents indicate that by the end of phase one clinicians in all settings will have: email, the ability to browse information online and view basic clinical correspondence relating to their patients – such as demographics, limited clinical correspondence and laboratory and radiology results.

A community wide integrated patient index is also to be delivered in phase one. Patients meanwhile are to be offered a limited ‘Healthspace’ web-based electronic record for recording personal health-related information – an initiative currently being developed by NHS Direct.

Electronic referrals, requests for tests and community-wide order communications, together with electronic hospital discharge summaries and electronic transfer of prescriptions are not due to be included within ICRS until the end of 2006. And not until the end of 2008 will full community-wide electronic patient records with integrated care pathways be in place across the NHS.

With phase one of ICRS implementation set to run to 31 December 2004; phase two up to 31 December 2006; and later phases up to 2008, this suggests that clinicians and other NHS staff well may be seriously under-whelmed at what benefits ICRS actually delivers to them over the next few years.

The documentation seen by E-Health Insider stresses that the above functionality will provide the minimum baseline all health communities will be expected to reach, it is hoped that some health communities will actually achieve much more.

The director of one leading technology firm told E-Health Insider that while providing views of patient information will clearly deliver clinical benefits, clinicians may unfavourably contrast the limited early capabilities of ICRS with the far more advanced functionality of their existing local systems. He suggested that ICRS could initially be like having “read only email”.

The chief executive of one clinical application vendor commented: “The thinner ICRS is the less value there is for clinicians.” He added: “We have actually moved backward on the definition of what ICRS is over the past year.”

He also expressed concern that the relentless national focus on developing a robust new procurement approach is driving the shape of ICRS. “The definition of ICRS appears to be based on what is achievable rather than what is desirable or actually needed.”