US conference gets a reality check on NPfIT

Former National Programme for IT industry liaison manager, Phil Sissons, delivered a transatlantic reality check this week, exposing some of the warts in the £6.2 billion programme to an American audience, US correspondent Neil Versel reports from the 22nd annual Towards an Electronic Patient Record (TEPR) conference in Baltimore.

In a keynote address this week, Sissons, now an ICT consultant said that there was a lot of truth in the negative reports about Connecting for Health (CfH), the agency running the National Programme for IT (NPfIT), despite the frequent denials by NHS officials.

A prime example of CfH failure, according to Sissons, is Choose and Book. “Of the 80,000 appointments that have been made, I can count probably about six that have actually been made using the system. The rest are been made by phone. And yet, Choose and Book is seen as a major step forward,” he said.

Similarly, the data Spine that is to make patient records portable throughout England, has 80,000 people registered to use it, but neither hospital nor surgical information systems feed information to it yet. “It’s an empty bucket,” Sissons said. “So it’s really working very well,” he added, tongue firmly implanted in cheek.

“Why has it been so hard and not as much fun as everybody thought?” Sissons wondered.

“The national programme is part of an IT procurement process—a couple of important words. It is not necessarily intended to improve patient care, but was there to procure IT. There’s a subtle difference,” Sissons said. Vendors made do with restrictive contracts and not much direction from the people who sign the cheques.

From a hospital perspective, Sissons says there is resentment about the top-down nature of the IT programme. “There’s no ownership of this system because it is being imposed,” he says. Meanwhile, deployment has been slow.

Two years into the 10-year programme, the NHS has not spent its CfH funds as quickly as planned, causing some officials to tout early cost savings. “We haven’t spent that two years’ allocation, therefore it’s a success,” Sissons observed, wryly.

“Hospitals are actually becoming renegade and are procuring their own systems because they can’t wait for the delivery of the national programme,” according to Sissons.

And many of those stand-alone systems might have to be scrapped because the NHS is insisting on “ruthless standardisation,” Sissons said. He is optimistic, however, that CfH officials eventually will embrace the idea of interfacing individual hospital systems with the national network. “What I can see in terms of trends and directions is actually a move away from the standardisation to look at ways of bringing together systems that are already doing what they need to do in a controlled environment.”

Sissons did allow that the 10-year programme is heading in the right direction, with the goal of improving patient choice and clinical quality. “It’s just not travelling the right road to achieve that.” Poor planning and lack of communication to healthcare providers are culprits, he said.

GP systems have not worked out to date because GPs are independent contractors to the NHS, Sissons argued. “This is one thing that the big LSPs don’t understand. The NHS is a loose confederation of organisations. It’s not like a Ford Motor Co. It’s not like a Shell Oil Co. It’s lots and lots of different organisations that can do what they like,” he said.

“They need to be cajoled down a particular route,” Sissons said. “They do not respond to: ‘Thou shalt do it that way.’”

Another problem, according to Sissons, is that CfH is not funding process change that consultants on both sides of the Atlantic say is a prerequisite for any clinical information system.

“Any change management, any local project management, implementation management—all of those things that actually bring improvements to the NHS—have to be funded locally. Local organisations didn’t have that money,” Sissons said. Savings from the technology are not likely to show up until the systems actually are in place, so the essential step might get skipped completely.

There is a saying in the US healthcare community that IT without workflow improvement is akin to automating chaos. That, Sissons said, is what Connecting for Health is doing—and doing it quite slowly.