Can the new “electronic highway” for the NHS have a smooth launch?

The NHS in England is getting serious about information technology. It has to. Size, organisational complexity, and burgeoning knowledge are all driving in the same direction: a new “electronic highway” linking all parts of the NHS. The new system will provide “seamless care for patients through GPs, hospitals, and community health services.” That, at any rate, is the hope.

Typically for Britain, many innovations in NHS computing have been the brain children of talented enthusiasts. The GP, the registrar, or the manager who could see a better way of referring patients, retrieving their records, or juggling available bed space have all made their mark. But the day of the amateur geek, however inspired, is over.

Like other branches of government that spend taxpayers' money, the Department of Health likes to emphasise the measure of its task. Hence the talk of 300 million GP visits annually, five million hospital admissions, and so on. Richard Granger, joint director of the NHS National Programme for IT, has pointed out that by the time the new network is up and running, 850 000 staff will have access to it. Only the system operated by the United States's defence department can boast more users.

The present system has grown piecemeal, often to link buildings or departments in a single trust. The replacement programme was formally established in October 2002, but the awesome task of designing and installing the infrastructure takes time.

N3, the new network due to replace the existing NHSnet, will be national but will be run by five suppliers, each covering a different area and each able to compete on price. N3 will not just handle data, emails, and the like but will also act as the NHS telephone network and offer rapid transmission of x ray films and other images.

The engineers claim that it will mesh smoothly with systems already in place. If an old system is due for renewal or cannot be integrated, it will—after local consultation—be replaced.

Security is an issue with any computer system, and the national programme planners say that this was a priority requirement in all the contracts. “Access to the system and what users can see and update will be determined by the user's role,” a spokesman told the BMJ. “For example, a receptionist will not have access to clinical information.”

The programme is ambitious, but the implementation of computer systems in the UK public sector has a dismal record. Will this one be any different? The organisers claim to have learnt the lessons of past failure and say that they have “broken down the procurement and implementation into achievable bite size chunks.” By phasing the system in gently, the planners believe they can minimise disruption.

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Perhaps. But the recent resignation of Professor Peter Hutton, chairman of the project's National Clinical Advisory Board, is seen by some as a hint of troubles yet to come. The wording of Hutton's resignation statement was less than explicit, but it's generally assumed that what prompted his departure—after only six months—was some dissatisfaction with staff consultation over impending change. There was some surprise when, in March, ProfessorAidan Halligan became joint director general of the programme with responsibility for ensuring clinical involvement. It is possible he and Hutton do not agree over how best to proceed.

The success of innovative information technology depends on more than connecting the right wires. If the organisers of national programme don't already know that, they soon will.