Lessons from the NHS National Programme for IT

Abstract

The size of this commitment makes the NHS NationalProgramme for IT (NPfIT), delivered by the NHS Connecting forHealth (CfH) agency, of major international importance.NPfIT covers 330 acute hospitals and mental health trusts, andprimary and community care organisations across England (Scot-land, Wales and Northern Ireland have opted not to participate).At the core of the program is the “Spine”, a central link to a patientregister, electronic prescription service, messaging service, and asummary care record. A web-based booking system, Choose andBook, which allows patients to select or change appointmenttimes, is currently used for 12% of bookings. Radiology picturearchiving, electronic prescription transfer, email, and an NHS-widedirectory have been implemented, but electronic patient records, acommon user interface and secondary use of data are significantlydelayed.The NHS chose to procure systems centrally and implementthem locally. Procurements included NHS-wide systems (emailand Choose and Book), enterprise-wide agreements (eg, withMicrosoft), and five local service providers to implement theregional solutions. Local service providers are free to choose andchange subcontractors.Local systems must conform to national standards, as in Aus-tralia where all jurisdictions have agreed to use standards promul-gated by the National E-Health Transition Authority. Cleardifferences are our federal structure that allows each state its ownprocurement process, financial and regulatory framework, andcontrols, thus hindering the unified “big bang” approach possiblefor England.Once all costs of implementation and training are accounted for,the final budget for NPfIT could blow out to as much as £30billion.