Troubled child health system to be replaced

NHS Connecting for Health (CfH) looks set to replace an interim child health information system deployed in London last year and has already halted plans to extend it to include a community module.

It has also emerged in a leaked letter, seen by E-Health Insider Primary Care, that a review of the problematic system has revealed “significant concerns” about the quality and completeness of historical data fed into the system and the effect this has had on past reporting.

The Child Health Interim Application (CHIA) used by ten London primary care trusts (PCTs) has been the focus of much concern over delays in delivery of the system and problems with data migration which meant PCTs have had to revert to paper processes leading to disruption of the child health immunisation programme.

A spokesperson for CfH confirmed to EHI Primary Care that the community module would not be deployed and an “option appraisal” on which system would be used for both child health and community would be completed by the end of September.

The statement from CfH says: “A decision has been made to concentrate efforts and resources on ensuring the safe and robust delivery of the child health component at the current time and to undertake an option appraisal of alternatives to CHIA for the 10 PCTs who currently use this interim product.”

EHI Primary Care understands that RiO, the community system already installed in two London PCTs, is likely to be adopted as the local service provider solution for all PCTs in the capital.

Last month the Health Protection Agency (HPA) strongly criticised CHIA after data from two PCTs using the system showed a drop in immunisation rates of between 7% and 10% for the five-in-one vaccine by between 10% and 19% for MMR. The HPA report found that thousands of children were missing from its Cover of Vaccination Evaluated Rapidly (COVER) programme but concluded it was not possible to say whether the data meant children were unvaccinated or not. However it said that the fall in coverage put individual children at risk and represented “a potential major public health threat.”

The child health system is used to collate data on immunisations and to issue reminders and recalls. GP practices hold immunisation records as do families through the ‘Red Book’ system.

CfH has consistently rejected claims that the problems have put child health at risk but a report to the June meeting of the North East London Strategic Health Authority by David Welbourn, chief information officer, makes it clear that this is not universally accepted.

In his report to the board Welbourn says that some of the functionality to support the effective working of the child-health teams in the affected PCTs, seven in north east London and three in north central London, is still outstanding, with delivery planned for August 2006.

He adds that the problems have meant that PCTs have reverted to manual processes which he says are “clearly less efficient and have higher risk of error.”

Welbourn’s report adds: “There are differing views about the level of clinical risk arising from this unfortunate position, even amongst the experts, although some of the more mobile and disadvantaged families are likely to have missed elements of the immunisation and vaccination schedule.”

The report says PCTs will be conducting a “look-back” audit once the August software delivery has been implemented, to ensure that any missed jabs are identified and appropriate action taken.”

EHI Primary Care understands that part of the drop in immunisation coverage shown since the introduction of CHIA may relate to problems with historical data.

A letter sent by Welbourn to PCTs in May, and seen by EHI Primary Care, states that some of the PCTs using CHIA had cleared their backlog of immunisation data and would be able to produce reports for the COVER programme.

However the letter adds: “The recent work has revealed significant concerns about the integrity of the historical reports because of variable data quality and completeness and it is likely that the 2005/6 report will show a step change from previous years so there will be a challenging task to gain confidence.”

A statement issued to EHI Primary Care by CfH says: “It is possible that the data rates may show a variance from previous years’ returns, however, we need to be clear that the data rate is not necessarily the same as the actual immunisation rate. An urgent piece of exploratory work is currently being undertaken in conjunction with the PCTs, which will enable validation of this data.”

Welbourn’s letter says that the problems with CHIA led the team from CfH, the NHS and LSP Capital Care Alliance to conclude that it would no longer be appropriate to deploy CHIA’s community module.

The letter adds: “We recognise that those PCTs who had used the community modules in RICHs will continue to be disadvantaged by this decision and we will conduct an urgent option appraisal of how we can best meet that need.”

In his report to NE London SHA Welbourn concludes: “There is considerable learning to be drawn from the child-health programme, not least because it is the first system to be deployed as a common system across multiple organisations. Two key aspects of data migration were underestimated – the impact of differences in clinical practice between the PCTs, and the impact of a highly mobile population leaving episodes of care record in different locations.”

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