In an effort to learn from the mistakes of the past, Digital Health Age takes a look at why earlier attempts to make the NHS digital failed
The National Programme for IT (NPfIT) in the NHS was implemented in 2002 to make the NHS more technologically advanced, but after 10 years and almost £10bn the project was scrapped and labelled as the biggest IT failure ever seen, according to The Guardian.
Is there anything we can learn from the first digital health experience?
Confidentiality is key
The NPfIT was pushed through by the Labour government and according to a 2007 House of Commons report, The Electronic Patient Record, there was a lack of clarity about how patient data would be kept secure.
When the scheme began the secretary of state had powers to collect and regulate the use of personal health data. However, The National Programme for IT in the NHS; Case History by Oliver Campion, Alexander Hayton, Leila Smith and Mark Vuaran from the University of Cambridge, highlights that the government left the details about data security unclear.
The Department of Health (DH) issued a White Paper in 2002, Delivering 21st Century IT Support for the NHS: National Strategic Programme, which outlined that the “plans for the longer-term approach [to the issue of patient confidentiality] are currently being drawn up” however, they were not in place before the data was collected.
This lack of clarity surrounding the use of patient data was resurrected in 2007. At this point electronic patient records (EPR) were established, yet The Electronic Patient Record report showed there to be, “a lack of transparency and clarity in communicating the type of information contained in the aggregated records and there was also little clarity about the main purpose of sharing their information.”
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According to The National Programme for IT in the NHS; Case History, the government failed to have clear conversations with healthcare professionals before NPfIT implementation to find out what they needed from a digital NHS.
The case history also reported that members of the government and technology companies made the decision about how the NHS should work, not the end user and subsequently the system had “unprecedented scale and boundless complexity” that made it difficult for healthcare professionals to use.
In a bid to mend bridges with healthcare professionals, the chief executive of the NHS in 2007, David Nicholson, announced the creation of the NHS Local Ownership Programme. He admitted: “It’s clear that up to now people locally, NHS staff, boards of NHS organisations, have not felt as fully involved as they ought to have done.”
The new local approach meant local Primary Care Trusts, strategic health authorities and hospitals would take over the local delivery and implementation of systems, while the commercial strategy and contracts would remain the responsibility of Connecting for Health.
However, shifting the responsibility of implementation onto local Primary Care Trusts did little to fix the complicated technology and, “Fueled concerns that the NHS Local Ownership Programme was less about local control and more about Connecting for Health distancing themselves from accountability for the programme,” according to The National Programme for IT in the NHS; Case History.
Interoperability is important
EPRs were an important part of the NPfIT designed to make patient data accessible to healthcare professionals across a variety of locations, not only local surgeries.
However, when the government split NHS England into five regional clusters in 2003, it decided to give four different technology companies the contracts to these clusters.
In addition, three important data transferring elements of the NPfIT were sold as separate contracts, creating a situation were eight elements of the digital healthcare system were being provided by five companies over four different software systems.
This made data transfer difficult according to an article published in the British Medical Journal in 2006, Keeping the NHS electronic spine on track.
According to the article: “Data transfer was difficult because methods of information input differ between organisations and clinical care settings, and the individual fields needed to be matched to the available fields on the new system.”
More haste, less speed applies to healthcare
When dealing with technology it is well-known that developments move forward at a startling pace but rushing to complete a project can often cause bigger problems down the line.
The National Programme for IT in the NHS; Case History reported: “The Prime Minister pushed hard for a severely curtailed implementation timetable for NPfIT in order to have something tangible to show voters by the next general election, due in 2005.”
Rushing the NPfIT to produce tangible results created an unrealistic timetable for the project and less time for consulting with healthcare professionals, according to Anthony Nowlan, a health informatics expert and executive director of the NHS Information Authority.
In evidence provided to the House of Commons, Public Accounts Committee (PAC), Nowlan, observed that, “the haste to procure was overriding due diligence over the healthcare value and achievability of what was being done” and “efforts to communicate with health professionals and bring them more into the leadership of the programme were effectively obstructed”.
As a result, systems, which clinicians had had no say in and subsequently malfunctioned, were implemented to set deadlines. When these malfunctions became widely known, trusts were expected to transfer from the original systems to interim ones.
However, the PAC found the department’s decision to fund new patient administration systems rather than upgrading the Trusts’ current systems was flawed and failed to find solutions that were fit for purpose.
In 2006, the National Patient Safety Authority received reports on behalf of 79 doctors and administration staff at Milton Keynes hospital that the software was not fit for purpose and posed potential risks to patients as systems froze and files were lost.