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Chapter 7 Processes, Organizations, and Information Systems
Ca Se StUD y 7
Interorganizational IS – The National Programme for IT in the
NHS Experience

The National Health Service (NHS) is the United Kingdom’s The National Programme for IT
publically funded healthcare system which serves the healthcare
needs of its people, and proudly boasts its ‘cradle-to-grave’ and in the NHS
‘free-at-point-of-contact’ credentials when compared to some In 2002, the National Programme for IT in the NHS (NPfIT) was
other countries’ similarly funded systems. It was founded in launched to reform the way information was used in England
1948 and continues to evolve organizationally, clinically, and and transform services and the quality of patient care. This
in its development and use of information technologies, just like was to be realized by developing a number of national sys-
its publicly and privately funded counterparts in Europe, Africa, tems, including a broadband network and a system to share
Asia, the Middle East, Australia, and the U.S. Although overall X-rays. The central aim was to develop a fully integrated elec-
control lies with the Department of Health, the NHS is divided tronic patient records database that would encompass the entire
into a number of regional centers, including London, North, and patient records system. This was to be designed to reduce reli-
South, each of which has semi-autonomous control of health- ance on paper files and make accurate patient records available
care provision in an organizational structure, which includes continuously across the different parts of the NHS, and allow
Trusts, Community Health Services, and General Practices. the rapid transmission of information.
The National Programme for IT in the NHS (NPfIT) was The system was intended to be made up of two components
established to develop systems to electronically administer representing each NHS patient: the Detailed Care Record (DCR)
patient information throughout the regions and their organi- and the Summary Care Record (SCR). The DCR would contain
zations. This required the development of interorganizational complete details of the patient’s medical history and treatment that
information systems. These parallel developments over an would be accessible to a patient’s General Practitioner and local
extended period of time provide us with an opportunity to learn community, and hospital care settings, for example, in the event of
from the experience of similar projects that had very different the patient being referred for hospital treatment. The SCR would
outcomes. contain key medical information, such as allergies, made available
Consider, for example, the development of the shared across England to NHS staff involved in treating the patient.
X-rays system and the electronic patient records system. The Figure 7-23 shows some of the organizations involved in
shared X-rays system was delivered on time and on budget, and the NPfIT in the NHS. Clearly, an interorganizational informa-
because of its success, is used nationally throughout the differ- tion system was needed. As you know from this chapter, such
ent NHS regions of England and in the organizational units, projects are often difficult to develop and manage, and it is not
including Trusts and General Practices. By contrast, the elec- surprising that some providers failed to deliver the systems
tronic patient records system, which was being developed for needed, most notably the electronic patient records system.
each of the regions and organizational components of the NHS,
was cancelled after a long period of investment and beyond Electronic Sharing of X-rays System
what had originally been planned, and as such, is considered
a failure. The electronic patient record system was never put The electronic sharing of X-rays system was part of the Picture
into operation completely, despite having cost 6.40 billion GB Archive and Communications system (PAC). This was one of the
Pounds (NAO, 2011). Although the programme in its original national systems being developed for the NPfIT. From the outset, the
form was cancelled after the National Audit Office report of involvement of health professionals gave evidence of the organiza-
2011, it was estimated that the expected total expenditure tion and planning of this project. This meant that the requirements
would have been 11.40 billion GB Pounds by 2015–16, if it had for the system were clear and unambiguous, and thus grounded in
been implemented. clinical necessity versus political ambition. Importantly, an integral
The two projects started at about the same time, and part of the programme involved the specification and implementa-
although they were of different scales, they had proportionately tion of a high-speed computer network linking all parts of the NHS
the same scope, goals, funding (the electronic patient records organization, which enabled the relatively straightforward imple-
system eventually ended up overspending by several billions mentation of the X-rays sharing application.
of GB Pounds) and the same required date of completion. In As was noted by Campion-Awwad in 2014, “The computer
terms of the population sizes of Trust regions of England, the accessible X–ray system was delivered smoothly on budget and
two systems would have potentially served the same number of on time. The X-ray system was a rare product of consultation
patients. What then caused the outcomes to vary so much? with health professionals, and was also assisted by plans that