Volume 3

The Electronic patient record : sixth report of session 2006-07 / House of Commons, Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
2007
Catalogue details

Licence: Open Government Licence

Credit: The Electronic patient record : sixth report of session 2006-07 / House of Commons, Health Committee. Source: Wellcome Collection.

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    is the frustration of relying on old-fashioned systems when they can see the possibility of new ones, but there is also the issue of actually running these legacy systems, the difficulty of getting parts and so on, and concerns that they might crash. Q384 Sandra Gidley: So that in effect makes it more unsafe than the paper-based system because they have reduced reliance on them. Is that what you are saying? Professor Fulop: Yes, and considering going off piste, as it were, and replacing the PAS system because they do not want to carry on waiting would obviously be a ridiculous and inefficient use of resources. Q385 Sandra Gidley: Because technology rapidly gets to its limits and it has needed replacing for some time and the longer we wait— Professor Fulop: Some of these systems are ten years old, say, and they are out of date. There was a classic example from our study where in one trust they had to get parts from eBay because it is such an old system you cannot get parts any more. Mr Shackman: Can I come in here because I agree absolutely with that? However, a great many trusts have perfectly good PAS systems. They may not be 100% up to date but they work perfectly well, and I think with them the frustration has been, stepping back a bit, that replacing their existing PAS with an NPfIT PAS of itself will not do a huge amount for them. It is replacing functionality with not dissimilar functionality. The disappointment and perhaps where patient safety comes in is with the delay in starting to implement the all-important clinical support systems that sit on top of the patient administration systems and you cannot think of a better example than a system that supports electronic prescribing. My understanding is that the vast majority of prescribing in the NHS is done by junior doctors in hospitals, who by and large are the least experienced people, so a system that will help them make that safer is really a big deal and people have known that this functionality is available. It has been available for some years. I did a very quick assessment of a pilot some four or five years back and the delay in getting the ground patient administration systems in, whether it be the Cerner system or the iSoft system, is delaying what is really important, getting the clinical support functionality in and, as I say (as a partial outsider now) and have said all along, that is what is really frustrating many people. Professor Fulop: \f | could add another example to the e-prescribing: e-test ordering and browsing, whereby tests are ordered electronically and can be viewed electronically. In one of the trusts we looked at they had implemented that prior to NPfIT and had this great system which the staff loved and, for example, it had reduced duplication of tests, it meant that patients and staff did not have to wait around for tests, it speeded everything up. When you see that possibility that is why others find it frustrating that they have not yet got access to that. Q386 Sandra Gidley: Patrick O’Connell, do you agree that patient safety has been compromised? Mr O’Connell: | am not sure I am qualified to talk about patient safety but I can speak about it from a delivery standpoint, so if you phrase the question from a delivery standpoint I will answer it. Q387 Sandra Gidley: I was asking you to comment on whether patients have been put at risk by the delays that your company have presided over. Mr O’Connell: That question presupposes that the systems in place today before I put a system in place— Q388 Sandra presupposes? Mr O’Connell: We are replacing what exists and from my standpoint I do not think I am qualified to comment on the safety of patients before or after NPfIT. Gidley: Sorry—that question Q389 Dr Taylor: I am delighted we have got you here, Mr Shackman, with a long memory because I was involved with the fitting and implementation of a PAS system exactly 15 years ago and we had ordercoms about 13 years ago. I fail to see where all the delays have come from. You have been very critical of Millennium Release 0. Is there any improvement with Millennium Release 0 on what was available ten or 15 years ago on PAS systems? Mr Shackman: | must tread carefully because I am not an expert on Millennium, but my understanding is that Cerner Millennium is a very well proven system. It is working in many places all over the world providing exactly the sort of support that we are looking for here. My understanding is, and I look to Patrick here who will correct me if I am wrong, that Release 0 of Millennium is basically pre- NPfIT software which has been implemented in the UK down in East London, and I am sorry but the name of the trust escapes me. Release 0, as I understand it, had not properly been anglicised. My understanding is that Release 1, which I understand from stuff in the press this week will be available early next year, will be the proper anglicised NPfIT version of it, so today’s problems, one would hope, will disappear, but I bow to Patrick who will know a lot more about it than myself. Q390 Dr Taylor: So does Release 0 do anything more than the original PAS systems that many hospitals have had for quite a long time? Mr Shackman: No, and alas it appears to do slightly less if we read the reports of those trusts that have implemented it. Q391 Dr Taylor: So Millennium Release | is now becoming available? Mr Shackman: | understand from the press that it will become available from next year. Q392 Dr Taylor: What are we getting in London from BT? Is that Millennium Release 0? Mr O’Connell: To begin with you are getting three RO releases, then R1, then R2, then R3.