Doctors call for input in massive health care IT project in U.K.

The national health service program is under fire for budget overruns and a lack of openness

The British Medical Association (BMA) today urgently called on the leaders of the U.K. National Health Service (NHS) IT project to reach out to doctors and other health workers, arguing that the current lack of engagement with the medical profession may doom the entire project to failure.

"Large-scale public IT projects do not have a good track record in the U.K., and so it is paramount that the NHS learns the lessons of history and engages with the frontline staff who will be using the new systems," said Dr. John Powell, chairman of the BMA's IT committee in a speech at the eHealth Conference in London. "So far, the level of engagement and consultation with the medical profession has been wholly inadequate."

As the massive effort to upgrade the IT infrastructure of the state-run health system moves on from the procurement stage to the implementation stage, the NHS National Programme for IT (NPFIT) has come under heavy criticism for budget overruns and for a lack of openness, including evaluation of its various IT projects.

Last month, the U.K. government's Department of Health announced that its 10-year estimate for the cost of the project had jumped from $11.4 billion to between $27 billion and $55 billion.

Yesterday, the new NHS e-mail system, called Connect, finally went live to the 95,000 existing users but began suffering outages and delays within the first few hours and into today. Cable & Wireless PLC was contracted to manage the NHS e-mail and directory system after the NPFIT canceled its original 2002 contract with Electronic Data Systems Corp. The terms of that cancellation have been kept confidential.

Along with new local IT infrastructures and a system for transmitting prescriptions electronically, the NPFIT includes plans for a database of electronic health records for 50 million patients in England that would be accessible by 30,000 doctors and would handle 5 billion transactions a year by 2008. Also in the IT plan is an e-booking program called Choose and Book, designed to allow patients to make hospital appointments online from a choice of locations.

According to Powell, the BMA has been very supportive of the national approach to the NHS IT project, attempting to reach out to the NPFIT. But those leading the project have been slow to realize the importance of working cooperatively with doctors and instead have taken a seemingly oppositional stance against the medical profession.

The NHS IT program "should support health care workers in delivering a better service to their patients. We hope that improvements to IT systems will reduce the administrative burden on doctors so they can spend more time treating patients. But this goal will only be realized if the [NPFIT] can provide systems that are at least as effective as those currently in use," Powell said. "Clinical staff must be consulted. There is no point investing billions of pounds in systems that do not have the confidence of users."

Officials at the NHS were not immediately available to comment.

When Powell took over as chairman of the BMA's IT committee in January, he said he immediately wrote to Richard Granger, director general of NHS IT, asking to develop a strong working relationship. However, despite repeated attempts, he has yet to receive a reply from Granger or his staff. "It has taken me awhile to be this publicly negative," Powell said.

The BMA is not alone in its frustration with the NPFIT leadership. One health care worker who is working to launch and run the Choose and Book system in a regional hospital alliance said the lack to coordination between those implementing the system and the clinicians is hampering the project's success.

"I've been in the front line of the e-booking system since we started the program in May, and though we have been trying to lobby from the middle for direction and a partnership at the top, it's not happening," said the administrator, who asked not to be named. "I've got a big scar on my forehead from banging my head on what seems to be a brick wall."

Professor Ricky Richardson, the clinical director of HealthSystems Consultants Ltd., which is working with the NPFIT, told attendees of the eHealth Conference that help would be on the way within the next month, though he did not provide any specifics. "Despite all of the uncertainty, I passionately believe in the NPFIT and that the program merits all of our support," Richardson said. "If just 60% of the NHS IT program works once it rolls out -- and I think it will much more successful than that -- it will be a template throughout the world."

Copyright © 2004 IDG Communications, Inc.

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