Frank Burns on the health informatics review

Notwithstanding the publication of the Health Informatics Review, I am none the wiser about whether the national IT programme is still expected to deliver clinical information systems to service providers or whether the encouragement to pursue interim solutions is the beginning of the end.

My confusion might simply arise from my failure to grasp the subtleties of the "biggest IT project in the world" adapting to inevitable changes. On the other hand, it could signal that with the loss of another local service provider, the Department of Health is hoping the programme will die of natural causes (terminal exhaustion) and in the meantime a policy of "mess and muddle" is the best that can be offered.

More worryingly, having read the review, I'm still not convinced the authors fully appreciate that the goal of improving the flow of timely, reliable information for decision making, service development and individual patient choice is fundamentally dependent on the universal availability of functionally rich clinical management systems.

The case of an elderly relative of mine best illustrates the reason for my obsession with real clinical IT (as distinct from what I discern as the current policy priorities of the DH). Mary is 86 years old and had a major surgical procedure six years ago. The problem was diagnosed at the local district general and the surgery was carried out at the tertiary hospital. It was successful but unavoidably left Mary with lymphodaema. This predisposes her to suffer from frequent attacks of cellulitis which require antibiotics.

Unfortunately, she is prone to having adverse reactions to particular antibiotics. The problem first surfaced at the time of the surgery and various cocktails were tried before one was found that she could tolerate. Since surgery, Mary has reacted badly to a variety of antibiotics when being treated for bouts of cellulitis. The most reliable (only?) record of all her problems with particular antibiotics available to the out-of-hours GPs is the one kept by her daughter. If Mary didn't live with her daughter it is certain she would at some point have been prescribed medications that made her more ill than she was to start with (or, more likely, much worse).

The most frustrating thing about the review is the fact that 10 years after the publication of Information for Health (yes, I did write it and, no, it wasn't a complete success), the stakeholder engagement process has come up with exactly the same analysis of what the service requires by way of health informatics. Surely an inevitable outcome - the NHS hasn't been complaining about the goals of the national programme but about the process to achieve these goals and the snail's pace progress in delivery.

Despite this, I detect absolutely no sense of urgency in the review. The nearest it comes to a sense of urgency is the statement that "local informatics plans should identify the roadmap that achieves these 'clinical 5' as soon as possible". Well, it hasn't been possible over the last 10 years and the requirement for local funding presages the same fate for this initiative as befell Information for Health, so we may be in for another 10-year wait.

This is surprising given the assertion of the NHS chief executive in his speech to the World Health Congress earlier this year that investment in IT systems has and will save many lives.

Anyway, I've told Mary that the DH has appointed a brand-new chief information officer.

Naturally, she's thrilled.