Over 1,000 new NHS IT systems deployed

Connecting for Health (CfH), the Department of Health’s IT agency, has said that just over 1,000 system deployments had been made in the NHS in England by the beginning of August.

The headline figure appears, however, to be bolstered by the application of a very broad definition of deployment — including web-based applications and taking over the hosting of some existing systems.

There is no doubt that new systems are being deployed, but it is difficult to discern the true number from figures that include system updates, maintenance, line of product upgrades and bolt-ons to enable systems to connect with the spine or Choose and Book.

"A deployment is classed as a system implementation, upgrade or maintenance release," a CfH spokesperson told E-Health Insider. It also includes existing alternative GP systems and instances of the web-based referrer from Choose and Book in its figures. These account for almost three-quarters of the headline figure.

The CfH spokesperson confirmed to E-Health Insider that each upgrade of a particular system "such as a couple of maintenance upgrades" would each be counted as a separate deployment.

The figures also differentiate between ‘deployments’ and ‘active locations’. CfH says: "An active location is any location where there has been a deployment. An active location may have had a number of deployments."

CfH say an ‘active site’ could be any one of a single GP, GP practice, PCT or other NHS site where there has been a technical deployment.

Confusion is created, however, when the number of deployments of a system is less than the number of active locations stated. In London, for instance, three picture archiving and communication systems (PACS) deployments are listed, but only one active location. This suggests that a system does not actually have to be used to count as being deployed.

Among the genuine success stories, of which there are a growing number, are implementations of clinical systems, including: child health; single assessment process (SAP); the online clinical knowledge tool, Map of Medicine; the first few PACS sites; some community patient administration systems (PAS), a lot of Choose and Book systems together with a small number of departmental systems such as theatres, pathology and A&E.

A striking feature of these new systems is just how much divergence there is between the five geographical clusters. This is driven by a combination of differing local requirements and the fact local service providers (LSPs) only get paid when they deliver. In the absence of the LSPs’ core clinical solutions the pressure has been on to deliver something, anything.

In the Eastern cluster, for instance, eight child health, three community and 10 SAP systems have been deployed but no PACS. The North West is the only cluster deploying community PAS systems, 13 to date. Similarly the East and North east are the only clusters to have deployed radiology systems, one each. While trailing the other four clusters overall, the South is leading on PACS deployment with two sites: West Dorset and Salisbury.

Almost half of the headline number of deployments is accounted for by installations of the web based referrer –- the ‘naked’ online Choose and Book system. Some 495 deployments of this web application are recorded.

Another factor that increases the number of stated deployments is the inclusion of ‘alternative GP solutions’, even though in the North east and Eastern clusters they are acknowledged to be existing systems that LSPs have taken over responsibility for hosting.

Taken together, the alternative GP systems and web-based referrer account for almost three-quarters of the 1,040 deployments in CfH’s figures.

Even allowing for a degree of over-egging the figures they still appear to show a massive jump in new systems being delivered by the four LSPs -– CSC, Accenture, Fujitsu and BT –- responsible for delivering new clinical IT systems across England. By the beginning of June just 291 systems had been deployed. Two months later the figure given by CfH has shot up to 1,040.

The leap in deployments is particularly remarkable given that on 5 August CfH told E-Health Insider that a total of 147 systems were deployed in July. The agency told EHI in June that 291 systems had been deployed by the beginning of 9 June.

Assuming the accuracy of these previous updates the latest figures imply that 602 systems were deployed in the three week period between 9 and 30 June.

An even higher figure of 20,151 deployments to date is quoted by CfH. This includes 10,311 connections to the New National Network (N3); and making the Quality Monitoring and Analysis System (QMAS) available to 8,800 GP practices.

What still appears to be largely missing is evidence of the rich integrated care records systems to be delivered by the LSPs. These were intended to be first delivered as replacement PAS systems to acute hospitals and then through a series of subsequent releases as increasingly rich integrated electronic patient record systems.

But the once frenzied focus on what P1R1, P1R2, P2R1 and other releases were due to have delivered by now seems to have faded. Aside from some replacement PAS systems, and upgrades required for Choose and Book there appears to be very little obvious progress towards integrated electronic patient records as yet.

Nine PAS system deployments are listed in the Eastern cluster – the same figure as at the beginning of June. One is claimed for the North east, while 13 community PAS deployments, including orders and results, are listed for the North West and West Midlands. No PAS deployments have occurred in London or the South as part of NPfIT.

According to iSOFT the PAS deployments it has provided are installations or upgrades of of its Patient Manager system.  An iSOFT spokesperson told EHI that Patient Manager and Clinical Manager systems, which are based on earlier iSOFT systems, will play a vital role within Loranzo.  "Patient Manager and Clinical Manager are Lorenzo’s building blocks," said the spokesperson. 

CfH declined to name any of the NHS trusts that have received PAS deployments. "It is not our policy to name sites without their permission, as NHS organisations need time to focus on the implementation and bedding in of new systems," said a CfH spokeswoman. "This information will be forthcoming if NHS organisations confirm they are happy for us to make this information available."

Total deployment figures by cluster

Figures accurate as at 5 August 2005

Eastern cluster

London Cluster

North East cluster

North West Cluster

Southern Cluster