There has been no shortage of bad news from the UK regarding the status of the National Program for IT (NPfIT) and 'Connecting for Health'. Now the knife is coming down and cuts will be made to a project that was touted a number of years ago as the largest international IT project ever.
December 10, 2009: Last weekend it seemed as though the death knell might finally be sounding as Chancellor Alistair Darling popped up on The Andrew Marr Show to call for cuts to the project, declaring that it is not a front line priority at this time. Well, maybe not from the point of view of the Treasury which sees the NHS programme as a cost encumbrance that would be a politically useful item to cut back on. But the Department of Health clearly has other ideas. After all, this is its flagship IT project, the biggest civil IT project in etc etc etc. So it's going to take more than Alistair Darling pre-announcing cutbacks to put a stop to that. When Health Secretary Andy Durham made a statement to the House of Commons he made that perfectly clear when he ignored Darling's assertion that the Programme was not front line critical and proceeded to sing its praises while lightly scarping £600 million from the (current) budget over four years - Special Report: Andy Burnham's unhealthy diagnosis for NHS IT
So, what does this all mean for physician EMRs in the UK? It is likely going to significantly stimulate the growth of existing vendors in the EMR market as the 'top-down' large system EMR strategies are scaled back. Connecting for Health (CfH) has been focused on the development of large level EMR providers known as Local Service Providers - LSPs. These vendors had committed to develop and deploy MD office solutions, but have had very little success (some statistics indicate that fewer than 200 MDs were willing to try these EMR systems, the most well known being iSOFT's Lorenzo). They were unable to convince MDs to migrate from their existing solutions for a number of reasons, one of the most important being a lack of functionality in their products in comparison to existing products currently in use.
One of the outcomes of CfH being scaled back is the simplification of choice. For the primary care trusts, they now have fewer potential options and will likely be aggressively seeking to work with existing EMR vendors that have clients in the market.
There are advocates who believe that the answer lies in the patient driven personal health record (PHR). Perhaps this is true, although we still have a long way to go to develop workflow processes that integrate PHRs into the delivery of care.
Parts of the Connecting for Health program have been a great success including GP2GP transfer of patient records, however for the most part, the top-down approach has not worked (again!). There is a difficult and uncomfortable balance that must be reached between desire to be in control and the development of policies that stifle growth and innovation and are ultimately viewed as political interference. This should serve as a very prudent warning to Canada. The large majority of healthcare in this country is delivered locally. Solutions need to meet the needs of local providers, yet also support the union of all care providers across the continuum of care ecosystem. While the need for national infrastructure is important at the large system level, we should be investing a significantly greater proportion of scarce healthcare dollars where 80% of the care is provided.
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