http://bmj.com/cgi/content/full/324/7342/870/b

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BMJ 2002;324:870 ( 13 April )
 

News roundup

NHS misses target for introducing electronic records

Katherine Burke London

The NHS has completely missed last month’s target to introduce electronic patient records across a third of acute hospitals—much as the medical profession had predicted. Department of Health officials admitted this month that only 3% of acute hospitals had introduced level 3 electronic patient records by 31 March, compared with the target of 35% set in its 1998 information technology (IT) strategy, Information for Health.

No results have been released for the other seven targets for March set in the 1998 strategy, suggesting that they are also showing disappointing progress.

A level 3 electronic patient record for a single episode of care would cover four areas: prescribing details, tests and procedures ordered, test results, and the "integrated care pathway"—to project manage the patient’s care. A department spokeswoman admitted that there have been "problems implementing electronic records" but claimed that the targets are part of a long term strategy to implement electronic records across the NHS by 2005. "The targets have always been about setting a direction of travel, raising the priority of key areas or applications for IT and measuring progress [locally]," she said.

The department implied that the NHS plan, national health reforms, and the growth of clinical networks had affected progress on electronic patient records, but that moves will gather speed.

Doctors with an interest in informatics have long been expecting the strategy to unravel, after politicians reworked the original document, drafted by Frank Burns, chief executive of the Wirral Hospital NHS Trust.

Dr Paul Cundy, chairman of the information management and technology subcommittee of the BMA’s general practitioner committee, claimed that the NHS’s IT strategy was doomed because of the government’s failure to ringfence money properly, its misguided decision to build expensive bespoke systems rather than adapting off-the-shelf software, and confusion over accountability.

"GPs have always been more computerised than secondary care. The fact that we can’t exchange results is a continuing source of frustration for us," said Dr Cundy. "They’ve spent millions of pounds on new systems, which—by the time they are delivered—are obsolete and don’t work."

Another GP with informatics expertise, Dr Grant Kelly, who chairs the BMA’s overall committee on IT, believes that the targets were always overambitious and politically motivated. He claimed that the government has failed to put its money where its mouth is and is focusing on elaborate IT systems that will sound good on paper rather than deliver practical, useful solutions at a fraction of the price.

Instead of investing in a centralised appointment booking system, Dr Kelly thinks the NHS should adopt a standard way for computers to exchange information so that GPs can refer patients electronically for hospital appointments.

Under such a system a GP would fill in an electronic form that would be sent to hospital departments in a secure format and the booking would be made automatically. This would save on administrative staff time and waiting times.

Dr Kelly has also written to health minister Lord Hunt to press for the Read code system of clinical terms to be improved. "It doesn’t matter what information you exchange if no one’s going to trust it," said Dr Kelly. He claimed that the department’s response had been encouraging.

The 1998 Information for Health strategy laid out the following eight targets to be achieved by April 2002:

· 35% of all acute hospitals to have implemented a level 3 electronic patient record system

· 25% of health authorities to have made substantial progress towards integrated primary care and community electronic patient records

· All parts of England to use NHSnet for appointment booking, referrals, discharge, and radiology and laboratory requests and results

· Community prescribing with electronic links to GPs and the Prescription Pricing Authority

· Telemedicine and telecare options to be considered routinely in all health improvement programmes

· A national electronic library for health, accessible through intranets in all NHS organisations

· Information strategies to underpin completed national service frameworks

· Initial electronic heath records running at demonstrator sites.
 
 

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