The 10 projects at the heart of NHS IT

silicon.com reveals which are on time - and which are running late

silicon.com reveals which are on time - and which are running late

It's the world's largest health IT project, its projected cost has doubled in its lifetime to £12.7bn, and parts of it are running four years late: welcome to the National Programme for IT (NPfIT).

While the NHS's NPfIT has already outlasted several heads of IT, its chequered track record is not surprising given the ambitious scale of the project: replacing an ageing patchwork of 5,000 different computer systems with a nationwide infrastructure connecting more than 100,000 doctors, 380,000 nurses and 50,000 other health professionals.

Find out more about the 10 key NHS IT projects

♦&nbsp NHS Care Records Service

♦&nbsp Choose and Book

♦&nbsp The Electronic Prescription Service

♦&nbsp N3 national broadband network

♦&nbsp Picture Archiving and Communications System (Pacs)

♦&nbsp The Spine

♦&nbsp The Quality Management and Analysis System

♦&nbsp GP2GP record transfer

♦&nbsp NHSmail- a central email and directory service for the NHS

♦&nbsp Secondary Uses Service

The NPfIT faced considerable scrutiny since its inception. A National Audit Office report in May this year highlighted serious delays in introducing the electronic care records system at the heart of the scheme due to technical challenges, while suppliers Accenture and Fujitsu pulled out of delivering the system and one trust halted implementation of the care records service.

Meanwhile, technical issues in implementing the Cerner and Lorenzo patient administration systems (PAS), which will be the basis of the future rollout of the care records service, have resulted in only 130 PAS being deployed in 380 health trusts.

Richard Bacon, a member of the parliamentary spending watchdog the Public Accounts Committee, said of the project's missed deadlines and immature systems: "The programme is a reflection of the poor project management as a whole when it comes to government IT. A lot of public money has been squandered on the National Programme for IT."

The NHS IT body Connecting for Health (CfH) counters that the programme is more focused on making sure systems work properly rather than rushing them in to meet deadlines.

CfH says the programme is already starting to pay for itself, citing the £1.1bn savings expected by 2014 highlighted in the NAO report.

A spokesman for CfH said: "Collectively, the early adopter trusts, strategic health authorities, NHS CfH and CSC recognise the need to achieve the necessary quality criteria for go-live and view this as more important than a particular date."

Paul Cundy, former chairman of the British Medical Association's IT Committee, believes the project has overall been a mixed blessing for UK healthcare.

"It is a real mixed bag - those projects that worked very well have been clearly defined as delivering the best benefits to users, where the users have had input and where there has been political support for them.

"The ones where there is bad political interference, where there is no user input into design or are doing things that users do not want, those are the ones that predictably fail," Cundy told silicon.com. "The key is to ask people what they want."

silicon.com first put the core NHS IT projects under the microscope in early 2006.

Much has changed since then, however, and silicon.com has decided the time is ripe to revisit each of the major projects in the programme to get the latest on their highs and lows, and find out just how far away the NHS is from its interconnected dream.

Clink on the links below for more details of each of the main NHS IT projects - and their progress so far.

The projects:

  • NHS Care Records Service

  • Choose and Book

  • The Electronic Prescription Service

  • N3 national broadband network

  • Picture Archiving and Communications System (Pacs)

  • The Spine

  • The Quality Management and Analysis System

  • GP2GP record transfer

  • NHSmail- a central email and directory service for the NHS

  • Secondary Uses Service

    NHS Care Records Service

    The NHS Care Records Service (CRS) will provide doctors with instant electronic access to patients' medical records, cutting off the paper trail that sees medical professionals searching out documents stored where the patient was last treated.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    Each electronic medical record available on the system, known as a summary care record, will be formed from information held in a number of places, automatically brought together when needed. A summary of the record will be held on a national database called the Spine so that vital information - including the patient's name, address, date of birth, allergies and A&E visits - can always be accessed by medical personnel.

    In depth information - such as tests, X-rays, scans and other results - will be held locally.

    What progress so far?

    The deployment of the CRS is four years behind schedule and is not likely to be implemented across every NHS health trust in England and Wales until 2014 or 2015 according to a report by the National Audit Office.

    Progress has been hindered by technical problems and disagreements over how patients are asked for their consent for their medical records to be digitised.

    Five "early adopter" primary care trusts, Bradford and Airedale, Bolton, Bury, Dorset and South Birmingham, were chosen to create summary care records for patients and upload them to The Spine.

    Delays to the summary care records rollout have meant that only two of the five early adopter sites, Bolton and Bury, have uploaded their records to the Spine.

    Currently, patients in Bolton and Bury St Edmunds are able to view their own records using the NHS personalised site HealthSpace while patients in the other three early adopter trusts - Bradford and Airedale, Dorset and South Birmingham - will have access to their records over Healthspace once their care records have been uploaded.

    Meanwhile, the remaining 375 primary care, hospital and mental health trusts in England are rolling out patient administration systems (PAS).

    These PAS will initially handle more electronic admin records - containing details such as patients' names and addresses - and share them within parts of the local trust. A later date, the PAS will be upgraded to handle summary care records as well.

    Further problems in rolling out PAS means that six years into the National Programme for IT only 130 PAS have been deployed in 380 health trusts while delays to the deployment mean the majority of these systems are interim solutions, to be replaced by the Lorenzo software system at some point in the future.

    Trusts deploying a fully-fledged PAS have a choice of two systems, Cerner and Lorenzo. To date only 14 Cerner Millenium PAS software systems and just two Lorenzo system have been deployed.

    While Cerner release one users have the ability to connect to the Spine and upload summary care records, trusts using Lorenzo release one will need to upgrade their PAS system before enjoying the same functionality.

    Both Accenture and Fujitsu have pulled out of delivering the Care Records Service, leaving only BT and CSC left as the service suppliers.

    Some hospital trusts in the south are without any dates for when the PAS system will be implemented since Fujitsu's departure and Bath Royal United Hospital NHS Trust recently terminated its implementation of the Cerner system.

    Barts and the London NHS Trust reported that problems with the introduction of Cerner system had delayed the treatment of 11 cancer patients and The Royal Free Hampstead Hospital has had problems with data entry errors and other issues which contributed to a £7.2m deficit at the trust.

    These problems culiminated in the NHS London Primary Care Trust halting any futher deployments of the Cerner PAS while it resolves issues with trusts already using the system.

    Choose and Book

    The Electronic Booking Service - known as Choose and Book - allows GPs to make hospital appointments at a convenient time and place for patients.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    When patients need to be referred to a consultant, Choose and Book allows them to book the appointment on the spot with their GP. Alternatively, they can do it online or on the phone.

    The system aims to cut the lengthy delays, often lasting weeks, between visiting the GP and receiving an appointment from a hospital.

    Patients can choose to go to any hospital in the UK and the system is geared around allowing patients to choose their outpatient appointment according to their own priorities – whether that is the first available date, the hospital closest to their home, or fitting their appointment around their family or work commitments.

    CfH recently upgraded Choose and Book to streamline its interface and the way rejected bookings, work lists and reports are dealt with by the system. A second upgrade in mid-2009 will make it easier for users to search for services.

    Bookings can now also be made over the NHS personalised online health portal HealthSpace.

    The NHS is also combining its NHS Choices and NHS Direct websites under the www.nhs.uk address to provide a "front door" to all online health information services.

    What progress so far?

    The system has now been used to make 11.5 million appointments and is racking up 28,000 bookings a day but this is far below the original forecast of 39 million by January 2008.

    All NHS hospitals are now using Choose and Book and 93 per cent of GP practices use the service to refer their patients to hospital.

    Choose and Book is also being used for about 50 per cent of NHS referral activity from GP surgery to first outpatient appointment.

    Within the NHS however there is wide variation in utilisation rates between primary care trusts, ranging from over 90 per cent to below 20 per cent.

    The Electronic Prescription Service

    The Electronic Prescription Service (EPS) allows GPs to generate electronic prescriptions that will replace paper orders, improving accuracy and safety by ensuring prescription information need only be typed in once.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbspPicture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbspThe Quality Management and Analysis System

    ♦&nbspGP2GP record transfer

    ♦&nbspNHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    EPS will also be integrated with the NHS Care Records Service, recording what medicines have been prescribed and actually dispensed to patients.

    It is being rolled out in two releases: the first adds barcodes to paper prescriptions to speed up repeat prescriptions. The second release, meanwhile, will add electronic signatures to authorise electronic prescriptions.

    Patients with regular prescriptions are able to nominate a pharmacy to receive the prescription electronically and prepare the their medicine in advance.

    The project will involve "an enormous logistical challenge", the NHS said, because it involves upgrading prescribing and dispensing systems, as well as issuing smart cards to control staff access to the service.

    What progress so far?

    The service is widely available across the UK, used in 6,746 surgeries and 9,038 pharmacies.

    More than 111 million prescription messages have now been transmitted electronically and EPS is being used for more than 24 per cent of daily prescription messages.

    The first release is working well for pharmacies and is saving time in the processing of batches of repeat prescriptions.

    The second release is being tested before being deployed nationally to ensure it works well on local systems, with download times expected to vary depending on network speeds and other factors.

    N3 - The National Network

    N3 is the name for the National Network, a replacement for the old NHSnet network infrastructure and one of the largest VPNs in the world.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    The high-speed broadband network is vital to the delivery of new services such as the X-ray storage service Pacs (Picture Archiving and Communications System) and electronic prescriptions.

    Connections to the new N3 network started in April 2004 with the new network expected to save the NHS an estimated £900m over seven years, compared to its predecessor.

    What progress so far?

    By the end of April 2008, there were more than 32,000 connections to N3, including about 11,000 delivered through mainly to pharmacies.

    100 per cent of existing GP sites who require a connection have been linked up and about 1.2 million NHS employees now have access.

    One example of where the network is making a difference is a new lifeline for heart patients in Kent.

    The Kent and Medway Community of Interest Network (COIN) is a county-wide network which runs across N3 and it now enables faster diagnosis and treatment of heart patients by linking the county's hospitals and doctors, allowing medical notes and x-rays to be seen immediately.

    Prior to COIN, angiograms would have to be saved on CD and sent with the patient to a heart specialist in London.

    However, some GPs are complaining that the system is beginning to get bogged down by the volume of data being sent through it.

    Paul Cundy, former chairman of the British Medical Association's IT Committee, said: "N3 has been a victim of its own success and has worked well but because it worked so well there is more and more information going down it.

    "A patient said to me recently: 'This is dreadfully slow while waiting to access his diagnosis'. Connecting for Health needs to start thinking about upgrading capacity to reflect usage," he added.

    Picture Archiving and Communications System (Pacs)

    Pacs allows images such as X-rays and scans to be stored digitally, and all but removes traditional film from the process.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    As a result health professionals can access images on laptops or tablet PCs, speeding up the delivery of information - and cutting the costs associated with film processing and storage.

    Pacs is being delivered throughout England within five regions or "clusters", each working with a single local service provider (LSP).

    What progress so far?

    To date, more than 473 million images have been stored so far using Pacs supplied as part of NpfIT.

    Pacs has been fully deployed to all acute hospitals since December 2007 and the focus is now concentrated on image sharing between locations.

    A system to allow Pacs files between 20MB and 1GB to be transferred between locations will be in place by January next year while any smaller files can be transferred via the health service's email system, NHSmail.

    CfH is also working with security vendor McAfee and Pacs suppliers to enable encrypted CDs to be burned from the system.

    The Spine

    The Spine is part of the NHS Care Records Service and the central database where electronic patient records known as summary care records are stored.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    Only NHS staff, equipped with smart cards and pin numbers, will be able to access information on the Spine.

    A messaging system directs requests for patient details to the various parts of the Spine where the information is held, and retrieves the details.

    The Spine also supports Choose and Book and the Electronic Prescriptions Service.

    What progress so far?

    About 172,000 summary care records have now been uploaded to the Spine, less than 0.5 per cent of all UK medical records.

    Earlier this year CfH said it would halt the rollout of summary care records beyond five early adopter trusts until it considered concerns over the way trusts asked for people's permission before uploading their records electronically.

    In September this year, CfH changed the way patients could opt out of having their records uploaded to the summary care record system – so every patient now has to give permission before their records are viewed.

    There are more than 516,000 smart card holders who are registered and approved for access to the Spine. Access to the data is strictly controlled, based on a member of staff's role and need.

    QMAS

    The Quality Management and Analysis System, known as QMAS, is a national IT system which gives GP practices and primary care trusts feedback on the quality of care delivered to patients.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    The system shows how well each practice is doing, measured against national achievement targets and allows GP pay to be linked to performance, determining up to a third of their salary.

    What progress so far?

    QMAS started to be rolled out in 2004 and by mid-February 2005 QMAS software had been supplied to all of England's GP sites.

    GP2GP

    The GP2GP system allows patient records to be electronically transferred to a new practice when a patient moves doctor.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    Under the current system, many patient records are printed out and posted - and then retyped at the other end.

    Electronic transfers are intended to be more accurate and secure - and much faster than the current paper-based approach, which can take up to six weeks to complete.

    What progress so far?

    In November 2006 the first live transfer took place as part of a trial of the system. GP2GP has now been used for 327,482 medical record transfers and the rollout to GP surgeries is ahead of deadline with just under 60 per cent of the practices in England currently use the service.

    Some 4,969 GP practices have had upgrades to the new system and 4,262 of these are now actively operating GP2GP.

    Paul Cundy, former chairman of the British Medical Association's IT Committee described the system as "world beating tech" which works "very successfully", and takes a lot of the effort out of the previously complex and cumbersome process of transferring large files on patients.

    The system is so popular, demand is outstripping supply, Cundy said.

    NHSmail

    Formerly known as Contact, NHSmail is a secure national email and directory service, provided free to NHS staff and developed with Cable & Wireless.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    NHSmail provides a national directory of people in the NHS, including their name, email addresses, telephone numbers, name and address of their NHS organisation, and information about departments, job roles and specialities.

    Users have an email address that stays with them as they move around the NHS, and the service features calendars and folders that can be shared with other users, plus automatic encryption of emails.

    What progress so far?

    An average of 983,152 messages are sent and received across NHSmail daily.

    The number of registered users is increasing every week and there are now almost 400,000 registered users - when migration of staff to NHSmail is complete, that figure should rise to over one million users.

    All members of staff for NHS Connecting for Health, the department looking after health service IT, have already migrated to NHSmail.

    CfH has deferred migration of NHSmail to Microsoft Exchange 2007 from Mirapoint until January 2009 because it could not guarantee that the upgrade would meet the standard of the existing system.

    Secondary Uses Service

    The Secondary Uses Service (SUS) is a database of more than one billion confidential patient records used to improve NHS treatment and healthcare.

    Find out more about the 10 key NHS IT projects

    ♦&nbsp NHS Care Records Service

    ♦&nbsp Choose and Book

    ♦&nbsp The Electronic Prescription Service

    ♦&nbsp N3 national broadband network

    ♦&nbsp Picture Archiving and Communications System (Pacs)

    ♦&nbsp The Spine

    ♦&nbsp The Quality Management and Analysis System

    ♦&nbsp GP2GP record transfer

    ♦&nbsp NHSmail- a central email and directory service for the NHS

    ♦&nbsp Secondary Uses Service

    Records are held on nearly all patients in England who have stayed in hospital, visited outpatients or attended A&E.

    Data includes personal details such as date of birth, postcode and NHS number, together with coded medical information.

    As well as being analysed internally, encrypted data from the SUS is passed to the Dr Foseter Unit, an academic body which uses the data to analyse outcomes such as death rates in hospitals in order to improve NHS care.

    The unit's main funder is Dr Foster Intelligence – a joint venture between the NHS Information Centre for Health and Social Care and a private company, Dr Foster. The unit does not pass any identifiable information to Dr Foster Intelligence.

    What progress so far

    The Department of Health recently began consulting with the public on how it shares this data and the wider use of patient information in health research and managing and planning care.

    Questions have been raised by the Patient Information Advisory Group, a government advisory group, over whether the law supports the retention and processing of identifiable patient data to produce anonymous data extracts for analysis.

    The DoH has just created the National Information Governance Board whose remit will be to "ensure that patient data is stored and used securely" and that will oversee all issues relating to the handling of health service and social care information in England.

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