Published: 17/03/2005, Volume II5, No. 5947 Page 16

Spending more than£6bn on the national programme for IT creates a massive business opportunity for hardware and software manufacturers and an enormous challenge for managers in the NHS.

It could also transform the delivery of healthcare in the UK.

A major component of this transformation will be greater transparency in the activities and outcomes of healthcare professionals.

It will be possible for clinical and non-clinical managers to discern in real time what services are being delivered to patients. It will also be possible to identify regular service users and review the appropriateness of their primary and secondary care treatments.

Perhaps the best clinical opportunity will be the possibility of innovation in the measurement and management of patient outcomes, as advocated in January's Atkinson report on government productivity.

In some private (eg BUPA) and public organisations there is now routine use of health-related quality of life measures that measure the physical, social and psychological functioning of patients before and after elective surgical and other procedures.

Analysis of such measures using safety-engineering techniques helps to identify clinical outliers and the implementation of remedial training and other interventions.

For some clinicians this may seem threatening, in particular as such information could be used in their appraisal. However the response of clinicians as a whole is likely to range from apathy to enthusiasm.

The national programme's challenge is how to enthuse and motivate the whole profession.

Without systematic support by clinicians the national programme may fail and there will be a vast waste of taxpayers' resources.

Isolated use of IT can be frustrating because of the integrated nature of modern medicine - for instance, diabetologists may adopt IT and go paperless, keeping all their own records and liaising with their GP colleagues electronically.

However if their consultant colleagues have not gone electronic, paper records remain essential. Thus a 75-year-old patient with diabetes may have both cardiological and renal problems. If renal medicine and cardiology are not electronic, the diabetologists will have to ensure that paper records are up to date so their colleagues have an accurate record of their interventions.

The professions have to be incentivised to adopt electronic methods systematically. The returns on this are likely to be substantial for hospitals and primary care trusts.

For instance, if a hospital was thoroughly electronic it would be able to dispense with the army of workers who move paper records around.

This may save£500,000 a year.

But how can consultants and GPs be persuaded to move swiftly and in an integrated manner to exploit this potential?

What are the potential roles of financial and non-financial incentives in 'steering' clinical behaviour? The government has recently announced new 'bribes' in primary care to get the GPs to implement the choice policy. Is there a role for similar phased inducements to push them along the route to the electronic revolution?

A policy of gentle persuasion is best, with generous investment publicity. Additional policies might include use of appraisal to cajole and induce IT change.

The supplying of information about individual activity and outcomes in electronic form and the use of policies requiring the abandonment of all paper records when presenting business cases or applying for bonuses might also accelerate change. No doubt NHS managers are using these and other inducements, as it is essential to persuade clinicians to wise up quickly to the programme's potential.

.Professor Alan Maynard is director of the health policy group at York University.