London child health system led to vaccination problems

Problems with the introduction of a new child health information system, provided under NHS Connecting for Health to ten PCTs in North London and Essex, have created difficulties in identifying which infants and children are due for jabs, issuing vaccination calls and recording whether they have received them.

According to a report in the Observer the new child health software introduced in PCTs across North London since last April as part of the £6.2 billion NHS IT programme has left staff relying on manual records.

The paper reported that the new Child Health Interim Application (CHIA) software developed by BT is currently proving unable to ensure that all babies have had health checks, vaccinations, visits from health visitors and assessments for special needs. CHIA replaced the ageing Richs child health system from McKesson.

The report quoted documents leaked from the Health Protection Agency that state some parts of London still can’t send out appointments for immunisation or identify children who have not received their jabs.

Journalist, Michael Cross, is one of the parents affected. He told EHI: "Islington PCT seem to be doing their best, but I thought something was wrong when I received a scrappily formatted reminder for some jabs my daughter has already had. Better safe than sorry I suppose – though this won’t help public confidence in immunisation programmes."

EHI understands that the problems have resulted from an ‘interregnum’ between the ending of support for the McKesson Richs child health system last summer and the introduction of the new CHIA system, which was not fully operational until the autumn. This led to staff and the PCTs having to rely on manual systems and resulted in a backlog of data which must now be entered onto the new system.

NHS Connecting for Health, the DH agency responsible for modernising NHS IT, said that problems with vaccination calls instead resulted from “process failures” in the manual systems PCTs have had to introduce alongside the new software.

The agency denied that the problems are to do with the new computer system, and promised that problems would be resolved within weeks. The agency said: "In the next two months all children in the affected areas will be offered vaccinations at the right time".

The problems began in spring 2005 when ten primary care trusts across north London and Essex switched over to the interim software developed by BT, which replaced the existing McKesson Richs child health system.

CHIA was originally meant to be a strictly short-term stop-gap until child health functionality became available in BT’s integrated Care Records Service solution being developed by IDX. This was to have been available by June 2006 but with the NPfIT delivery schedule for London once again being renegotiated CHIA looks certain to be required for some time to come.

BT, which set up the system as part of its £996m contract to be the main contractor for NHS IT modernisation in London, denies any fault with its software. By the end of January BT had delivered the system to 10 PCTs, across 153 sites.

The company acknowledged that there had been some initial teething problems with the new CHIA but said these had been ironed out by last autumn. A further update to the CHIA software is due shortly.

An indication of these teething problems was provided by North East London Strategic Health Authority which in September 2005 reported: "This application has been deployed across all the Primary Care Trusts and a number of initial operational difficulties are being resolved.”

The SHA said of CHIA: "The front-line child-health teams have found it difficult to resource the increased workload of sustaining their operational activity, supporting the development and assurance of the new platform and managing the migration of records. Poor initial system performance and printing difficulties have exacerbated this challenge…"

In June 2005 Islington PCT’s Professional Executive Committee had reported early difficulties caused by the system, including “CHIA’s subsequent temporary shutdown and the temporary loss of an up to date database”.

NHS Connecting for Health denied any software problems, describing media as “inaccurate and scaremongering”, “children are not at risk because of new IT systems”.

The CfH statement said: “From the outset it was recognised that this system alone would not provide all the necessary reports about children’s immunisation status”. The system was therefore to be complemented by additional “manual” processes be to be developed by PCTs.

CfH suggested it was these manual PCT systems that may have caused problems. “It is possible that in some locations over the past 10 months the manual processes have not been correctly completed. And it could mean that some parents have not been correctly advised of their children’s immunisation needs. That is most regrettable however, it is not a fault of the computer system, it was a process error. The computer system is superior in many ways to what it has replaced.”

The agency added: “We are confident that the combination of the data available from GPs’ records and developments in the CHIA system will mean that in the next two months all children in the affected areas will be offered vaccinations at the right time. The new data will cover the whole period since the introduction of CHIA so that parents of children who may not have been correctly alerted will be advised of their child’s vaccination status."