Evidence submitted by Dr Jon Orrell (EPR
I would like to address the question:
Current progress on the development of the
NHS Care Records Service and the National Data Spine and why delivery
of the new systems is up to two years behind schedule.
The reason is that NPFIT was designed by international
"experts" with no knowledge of the complexities of medical
informatics in the NHS. They started from the top down, dismissing
existing systems as being legacy and intended to rip and replace
with new monopoly suppliers.
To the casual and uninformed IT management consultant
it seemed obvious that the big multinationals had the answers
and the little people doing the job on the ground were superfluous
and irrelevant. One would have imagined from the outside that
Hospital systems were the key and a national system would start
with a spine, then Hospitals, then primary care and GPs later.
In fact the truth is the reverse. The best integrated
electronics are already held in primary care by GPs. We have already
had the lifelong record, integrating summaries, medication, allergies,
letters and tests for over a decade. The sensible thing would
have been to build from the bottom up with this solid foundation
as the basis.
We tried the one size fits all approach in 2000
as part of an NHS pilot site. It failed twice and two years later
we adopted integration with existing systems. It worked. CfH have
exactly matched our timescales and conclusions. I warmly commend
the excellent pragmatic work of Gillian Braunold, who has determindly
bought the programme back from the brink of disaster (original
centralised plan) and come up with good work around solutions.
Keeping existing working GP systems being a brilliant example.
There are examples of success in action with
some ideas on consent. The key being to leave the GP as the custodian,
editor and monitor for the NHS patient record.
The key to success is to build on existing systems
by integration. This is quick and incredibly cheap compared with
the 12 billion rip and replace plan.
There are examples of success in action. http://www.e-health-insider.com/news/item.cfm?ID=2506
This Graphnet integration is the one we used
in our pilot, It was also used in Hampshire (see below). It costs
a fraction of the CfH rip off price and works in weeks.
<<Weymouth IT pilot site lessons for the NHS v2.rtf>>
Dr Jon Orrell GP
16 March 2007