Enormous investments have gone into CPAS worldwide. The estimated costs for each large hospital are about £33mln., yet the overall benefits and costs of hospital information systems have rarely been assessed 17 . “When systems are evaluated, about three quarters are considered to have failed, and there is no indication that they improve the productivity of health professionals 17 ”. There are also questions about what to invest and how financial return will be. There are claims that CPAS may reduce healthcare cost significantly, but this is still based on sensible assumptions, and only few studies report on actual savings in expenditure, which seem to be ever increasing 6,8,9 .
Greater use of IT is key to reforming the NHS UK. It is perhaps the world’s largest IT project, with proposed budget of £12 bln. till 2008, although some reports concluded that spending on technology had to double at once if the NHS was to reach its targets; the NHS spends less on IT per employee than any other industry sector 6,11,20 . But there is more worrying problem in large government IT projects tend to go wrong. They are often late, over budget, or both; sometimes even abandoned altogether (e.g. “Pathway” a benefit-payment card scheme involving the Post Office, Social Security Department and a computer-services firm, collapsed after 3 years, wasting £300 mln.; Child Support Agency’s system; etc.) 11 . The problem is that these projects are over-ambitious and government agencies tend to be useless at project-management, normally handing it over to the firm implementing the project without independent scrutiny. Such firms usually try “to reinvent the wheel”, rather than use cheaper, existing technology, which means that only the original supplier understands how the system works 6,8,11 . “Even when the potential savings are credible enough, decision makers often remain in the labyrinth of vendors’ claims and reality 2 ”. Even if the government learns the lessons from previous failures there are other troubles: NHS is not a single organization, but a loose confederation of thousands of GPs’ surgeries, pharmacies, hospitals and clinics – implementation at local level, despite central supervision, may be problematic 6,11 .
There are over 20 Patient Management System (PMS) suppliers in the UK , although only small fraction dominates the market 5 . Yet, their technology should work alongside health care policy makers and health care professionals in developing products that benefit doctors, patients and health care research. This also means cooperation with laboratories and pharmacies to guarantee that systems are well-matched, e.g. 89% of UK prescriptions are computer-generated but only 62% are endorsed by pharmacy computing system 5 . This is the project involving 270-odd health trusts, 18 000 sites, 28 000 hospital doctors, over 30 000 GPs, and 50 mln. potential patients. Every last detail (including patients’ access to their own records) should be in place by 2010. Contracts worth over £6 bln. have been placed already 18 . Yet support by the users is critical for the huge, even technically successful, project. So far only one in eight doctors said their consultation was adequate, and three-quarters said they had never been consulted at all 8,18,19 . But at least the heart of the scheme has doctors’ firm support: four-fifths of them told that providing national CPAS is really important 8,18 . British Medical Association says the procurement process was rather secretive, and many people in the NHS do not know the detail of what is happening, even though it will transform their working lives and have a huge impact on patient care 6,10 . With the introduction of new technologies into the health care sector, comes the need for training medical professionals in the use of it, both in order to eliminate errors and negative perceptions, “the machine is as good as the user 5 ” 8 . “Not ensuring users understood the reasons for implementation from the beginning and underestimating the complexity of healthcare tasks are the reasons for failure 20 ”.
Despite the fact many clinicians recognize the potentials of the CPR in improving the quality of care and reducing the cost, introduction has been slow. First of all, many of the benefits mentioned are potential and yet to be assimilated into the system. And secondly, lack of integration and flexibility in CPR use, which does not motivate healthcarers to change the working style 2,8 . Nevertheless, it is evident that clinicians play a crucial role in the quality, content and usability of the CPR 2 .
As it was mentioned, “the technology of CPAS is based on capability to both improve quality of care and control costs through better information flow management within the organization and introduce the mechanisms such as the timeless and spaceless organization of the work place, de-localisation, and automation of work processes” 11 . Generally this means reorganization in clinicians’ practicing habits as in the UK hospital setting doctors and nurses spend a quarter of their time on gathering and using information 9,10 . Administrative personnel may face extra burden of scanning documents or transcribing handwritten forms. Storage of paper records will gradually be replaced by electronic archiving systems. Computer-based repositories require decisions as to where data reside and who is responsible for their management. Such systems bring great changes to the daily activities of staff 2,9 . Other organizational changes may involve the scheduling of physicians’ time, billing system and service fees 6 .
The security and confidentiality of patient data are of paramount importance 8 . At a ward level this is managed by ensuring that all staff are trained in the security of data and understands the principles of the Data Protection Act before they are issued with a username and password, which is changed regularly for security reasons 3 . Also where the NHSnet has access to the Internet there are software security guards to ensure nobody can get access to the NHSnet from outside 3 . Computer viruses are the potential threats to the security as well. All medical records are registered with an appropriate data protection registrar and controlled by medical records department 3 . There are recommendations that at the local level, a senior clinician should be responsible for ensuring that patient information is held in accordance with national guidelines (so-called Cadicott Guardians) 3,8 .
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The implications of this change