Published: 15/01/2004, Volume II4, No. 5888 Page 3 4

A new system will allow patients to book their appointment or admission in advance. Jane Dudman follows the service from pilot to take-off

The national e-booking service is a prime example of the complexity involved in modernising the NHS.Work has been underway for many years to change and automate the way bookings are made - in itself no easy task. But it has now become part of the wider agenda to give patients a choice of where to get treatment, which will mean major change in the way the health service operates.

The national booking programme aims to let patients choose and pre-book the date of their appointment or admission - to outpatients as well as for elective treatment in hospital.

Targets were set for the programme in the NHS plan, which says that by 31 March next year, two-thirds of all outpatient appointments and inpatient elective admissions should be pre-booked. By 31 December 2005, there should be 100 per cent electronic booking.

The components that will make this possible are the electronic booking service, a computer application that makes bookable services available through a single interface, and the booking management services network, which will provide a single point of contact to make and change bookings.

All this adds up to a challenging task for SchlumbergerSema, the supplier appointed in October 2003 to implement the new national electronic bookings service, and Cerner, the firm developing the e-booking software itself.

Because of the terms of the five-year,£64m contract to design, develop and manage the new service, neither firm feels able to comment on their proposals or their schedule. But the first phase - due to be available by summer 2004 - will provide GPs with online access to hospital and consultant resources, so they can offer patients a choice of available consultants and hospitals for their subsequent treatment.

E-booking pilot schemes have been running since 1998 (see box below).Many of these are based on software from Revive, now a subsidiary of the iSoft group, which provides e-booking systems to 47 trusts.

Revive's e-booking software sits on servers at hospitals and interfaces directly with their patient administration systems. GPs access the software through a web browser over NHSnet. A more complex version will be necessary in the national service, if it is to offer GPs a range of hospitals, dates and times.

'We have established a migration policy for our clients so they will be able to move to the national service as and when it is available to them, ' says Revive managing director Michael Brett.

'The major issue is that it has taken us five or six years to get to this position.You do not go home on a Friday night with no e-booking and turn up on the following Monday with 100 per cent e-booking - the roll-out will take time. Given that the SchlumbergerSema and Cerner product is not installed anywhere yet, I think they face significant challenges. Our clients are certainly keen to see what will happen.'

The major technical issues are getting the new e-booking software rolled out and integrating the new system with the national data spine and local service provider services, which is supposed to be done by June 2004.Messaging formats also have to be agreed and implemented, and interfaces between GPs' systems and hospitals' PAS systems have to be put in place.

Cerner's UK marketing director Dr Phil Collins acknowledged in a recent article in the computing press that EBS has received a mixed reaction from clinicians.

'They rightly recognise that EBS is only a part of the solution and in itself will not fix the deep-seated problems of capacity, or of waiting times, ' he wrote.

'But it is, nevertheless, a part of the overall IT programme essential to underpin a modernised NHS... The service will give patients and the public a better feeling of service.'

The timetable for EBS is tight. The implementation strategy was due to go out to health communities in December and the national programme for IT is working to identify early adopters.

'At present, strategic health authorities are planning for the introduction of e-booking, ' says a national programme spokesperson. 'This will be followed by a phased roll-out, extending throughout 2005. The first e-bookings using the new software will go live in early adopters in summer 2004.'

Hugh Rogers, consultant urologist at West Middlesex University Hospital trust and clinical lead for the national booking programme, believes the move towards the new system will not be too painful.

'It was the experience with Revive that led us to build the specifications the way we did, ' he points out. The new system will not be drastically different. The Schlumberger system will do everything the Revive software did, and more.'

Liz Barfield, e-booking liaison manager at Royal Bournemouth and Christchurch Hospitals trust, which is running an e-booking system using Revive software, supports the new national e-booking service but feels the details of the new service are not yet clear.

'We know where we will end up, but how we will get from what we have here to the national service is not clear, ' she says. 'Because of the way processes work in hospitals, whether we have e-booking or not, certain processes have to be understood in order to put the technology on top so things run smoothly.'

The booking process is complex. In Ms Barfield's trust, there are 27 surgeries handling 400 bookings and referrals a month. This means that however the move towards the national e-booking service is handled, it cannot simply be a question of switching from one system to the next. 'The big-bang approach is not possible, ' she says. 'We will have to run two services in parallel, at least for a time.'

E-booking: a potted history

The move towards e-booking began in 1998, with 24 twoyear pilots launched as part of the national booked admissions programme.These pilots concentrated on introducing more streamlined booking procedures within certain specialties, such as day surgery.

The programme was initially part of the National Patient Access Team, but moved to the NHS Modernisation Agency when it formed in April 2001. It is now part of the agency's service improvement programme.

As part of this wider implementation, an electronic booking programme was established in April 2002, and is being delivered jointly by the national programme for NHS IT and the Modernisation Agency's national booking team.

The second wave of the programme, from 1999-2001, involved a further 60 pilot sites.Wave three, 2000-02, involved 197 sites. In October 2001, wave four rolled the programme out to 122 health communities, and by the end of January 2002, all acute hospitals in England were involved.

The target is to have 100 per cent prebooked admissions by the end of 2005, giving all patients a choice of a convenient time within a guaranteed maximum waiting time.

In autumn 2003, the government signed a contract with SchlumbergerSema to provide a national electronic booking service for the NHS in England.This will connect more than 30,000 GPs in England with about 270 acute hospitals and community or mental health hospitals.