For the latter part of the morning, our students from Walter Sisulu University in Mthatha, South Africa, are presenting some of their MSc Health Informatics work (www.chirad.org.uk/mthatha.htm); specifically a review/critique they undertook of the UK’s National Programme for IT (NPfIT). The session was introduced by Graham Wright, who explained the background to the development of the MSc course and some of the background to the development of NPfIT.

Prof. Jimmy Chandia started the series of presentations, setting the context of NPfIT and the work that the students had done on exploring the implementation of the project. In addition, the students had looked at lessons learned and mistakes, with a view to South Africa trying to avoid repeating them. Menti Masiza explained the background of the original strategy for NPfIT; the vision, she said, was to deliver a 21st century health service through efficient use of IT, to use modern IT to deliver the NHS Plan, to deliver services to the patient and to support staff through effective electronic communications and knowledge management. The original plan saw the appointment of Local Service Providers through national procurements. The approach was a top-down, government driven approach with a centralised plan and big bang type of strategy.

Tony Odama talked about the NPfIT infrastructure, starting by summarising the inherited levels of computerisation prior to NPfIT and how it differed between different parts of the health service; these, he described as technological islands. He explained the development of the NHS number, a 10-digit number to provide a unique patient identifier for the NHS, and described the N3 network and that it aimed to provide sufficient bandwidth for transmission of digital images from PACS systems.

Dr Pradhan explained the nature of the ICRS (Integrated Care Record Service) and cited Dr Ashwin Hurribunce’s view that ‘integration is not merging’. He covered some of the issues and problems of the multitude of paper records that exist for patients, and why benefits would accrue from the development of electronic patient records (including error reduction, speeding up clinical communications, and assisting in diagnosis and treatment). ICRS is seen as a cornerstone of NPfIT, aiming to provide an integrated clinical information system across the whole care continuum, through a ‘life-long health record service’ that can be shared between different clinicians in different care settings, organisations and tiers of care. Ntsiki Mashiya followed with further detail on the nature of the ICRS and the NCRS, including the Summary Care Record (SCR) and the Personal Demographic Service and its relation with the National Data Spine. The SCR is currently being piloted in parts of the UK, and there are provisions for patients to opt out of its use.

Dr Khatry-Chhetry talked about the Electronic Prescribing Service, introduced with a view to providing benefits to patients, as well as reduced administration and fraud. He notes that it is behind schedule, with greater useby GPs and in community settings, but less use in hospitals, and there remain concerns and issues around electronic signatures and patient privacy.

Nomawethu Mjekula talked about Choose and Book, the e-booking component of NPfIT. It was originally designed to promote the government’s ‘patient choice’ policy and to remove lengthy waits and improve services. Lulamile Klaas covered the six implementation phases.

Dr Yogi Parimalarani talked about the students’ views of the lessons learned from NPfIT. She noted the importance of strong political support by the Prime Minister and continuity of leadership, although there was a drive to fast-track and meet deadlines., and professional anxieties were often not taken seriously and the experience of expertise of health informatics professionals tended to be ignored. Benefits included cost savings in the procurement processes, but there were problems of local capacity development for the future. One of the major problems of NPfIT, she says, was communication, which was handled badly, with lack of transparency. There was also lack of early involvement of users and champions in managing change. Other problems included shortages of skilled IT staff and of trainers to train staff, as well as a mismatch between the training and implementation. Clinicians were not consulted and involved early in the whole project/process.

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