Developing a common infrastructure to support collaboration
The service was centralized around its ‘Data Spine,’ which integrated patient registers, electronic prescription services, summary care records and a patient-facing portal for communicating with health professionals and updating medical details called Health Space. The spine was also expected to support radiology picture archiving, electronic prescription transfer and NHS email.
As a result of NPFIT, the National Health Service (NHS) expected to deliver better, safer and more efficient care by improving clinical decision making, reducing medication errors, speeding up the consultation process and reducing test duplication. By providing patients with easy access to both their personal health records and their medical professionals, the system also aimed to increase patient satisfaction.
However, the implementation of summary care records and Health Space was significantly delayed and eventually scaled back in mid-2011. Many issues, including insufficient clinical engagement, gaps in stakeholder expectations, and problems with technology, held the program back. “Doing things electronically takes time initially and adopting technology is hard,” noted Simon Eccles, Medical Director at NPFIT. “Things will go wrong so the technology has to be flexible.”
The NPFIT experience provides a number of key lessons to those starting out on an eHealth initiative. For one, its implementation required collaboration between many different sectors: political, clinical, academic, technical, commercial and personal. Differences in values, norms, priorities and methodology for each of these stakeholders were among the most challenging aspects of implementing NPFIT.
It is also important to create a favorable environment before purchasing IT systems and services. The UK system, for example, procured large commercial contracts from IT companies, before creating important structures in information governance, clinical coding and standards and information system architecture. Respondents to our survey also argued that the strategy for national electronic health records should not be left to the IT departments, since this scale of transformation requires fundamental changes to protocols, ways of working and organizational cultures that go far beyond systems implementation.