Evaluation of IT modernisation in the NHS - NETSCC

Report to SDO for NCRS ProjectIntroductionBy the spring of 2002, just 3% of trusts were set to meet this target of achievingsome EPR functionality. 3 The Treasury’s Wanless report in 2002 suggested twomain reasons for this: budgets for information technology (IT), allocated locally,were being used to relieve financial pressures elsewhere, and the process ofsetting of central IT standards was inadequate. 4 The report recommended ringfencing and doubling the IT budget. The government responded with £2.3bn for anew National Programme for Information Technology (NPfIT) in the NHS inEngland. 5 In November 2003, there were still considerable uncertainties aboutthe NPfIT.The first progress report for this project covered the period from October 2003 toJune 2004. It was extended to cover nine months with the intention that the researchteam should propose changes to the study protocol in light of (a) the government’semerging new IT strategy and (b) discussions with participating Trusts about how thenew strategy would impact on their local plans for implementation of EPRs.Originally, the government drew a clear distinction between EPRs and electronichealth records (EHRs). The former were intended to cover the management anddocumentation of single health care episodes, whereas the latter were intended to besummary longitudinal records (“cradle to grave”) of key health information forindividuals. In the NPfIT, this distinction was dropped, with aspects of electronicmanagement and documentation of care integrated and referred to as the NHS CareRecord Service (NCRS).A more fundamental change was the switch from a policy of delegating responsibilityfor implementing IT modernisation to local NHS organisations, to a policy ofcentralised specification and procurement. 5 Key features of the NPfIT were stringentnational data and IT standards, procured and paid for nationally. Implementation inacute trusts was through one of five geographic partnerships with industry, called“clusters”, with IT applications being provided by a local service provider (LSP) foreach geographic area contract by the NPfIT through a process of nationalcompetitive tendering. The main national features were a new national networkingservice providing broadband, called “N3”; electronic booking, called “choose andbook”; electronic transfer of prescriptions; and a nationally accessible, “cradle tograve” summary patient record called “the spine”(Figure 1). The provision of4