Is the UK health service IT project just too ambitious? administration

摘要

Choose and Book is the E196 million showpiece of the UK National Health Service's (NHS's) programme for IT, allowing patientsto book an outpatient appointment at a hospital of their choice while sitting in the GP surgery or at home.Sally Hope, a GP in Oxford, is not the only one of her profession who is frustrated with technical problems in the system, which after months of fiddling is still "intermittent". But perhaps more importantly, she is not persuaded of the benefits to patients."We have 1000 patients over the age of 75 years. We have to give them a password and they don't make sense. They're often phoned late at night when they're asleep and they're slightly confused anyway and they're asked which hospital they want and it's unsettling. Then you don't know if they've booked it or not. The whole thing is such a waste of time", she says with a heavy sigh.The 10-year NHS programme for IT, which was launched in June, 2002, is the most ambitious, most complex, and largest non-military IT programme inthe world. The aim is to update the ageing and fragmented NHS IT systems, while linking 30000 general practitioners to nearly 300 hospitals. Connecting for Health, the government agency tasked with delivery, is confident it will bring enormous benefits to the NHS and says there has been clear progress in laying the foundations of the programme, which will include a centralised electronic patient record system, electronic prescribing, and facilities for archiving and viewing x-rays and othertest results.But Fairey, who in the 1980s was responsible for NHS information and planning systems, added they had ensured speed at the expense of clinician involvement. "You have to attempt some sort of engagement or it won't work. That is in my view the major barrier."Also, these are huge contracts so it doesn't surprise me that some of the contractors are finding it very difficult. There's no doubt that in order to secure business in the first instance they promised the earth. It is my worry that it will slow down because it was too ambitious and as it slows down you will get disillusionment", he says.Clinician engagement, or lack of it, has caused problems. Plans for the electronic patient record had to be scaled back after strong pressure from clinicians and patients. Choose and Book had much slower uptake than predicted. And at least 10 hospital trusts have decided to finance their own computer upgrades after losing faith in the centrally procured systems.