For a GP practice, changing or retaining your clinical computer system is a decision that you are not going to take lightly. All systems and suppliers have their strengths and weaknesses. It is very important that you have the system that best suits your practice needs. PCTs operate in different environments and have different reasons for preferring a different system. Do not forget that you have the right to retain your current system, irrespective of the advice from your PCT. If the time comes to consider changing your system here are some questions to consider.
Problems may include software deficiencies: the system does not do something you really want it to do. You may be unhappy with the support services. You may be concerned with the suppliers plans for new developments or the scope for future upgrades. Are the problems critical and do they outweigh the advantages of the system and the difficulties of a change?
What do the other systems offer that your current system does not?
The principles of caveat emptor apply. Enthusiasts for a system, whether they are salespeople, PCT staff or current users may wax lyrical about the advantages of their particular system. It is up to you to assess their claims. Be very clear about what is available now. New software that is not quite ready for delivery often turns up late (sadly just about all of the NPfIT is an example of that) and its quality is unknown until it is used in the real world. Be very clear about the implications of the new functionality. For example, shared patient records sound very good in principal but there is clear evidence of the damage to patient records that sharing can cause (‘Facilitator Showcase: An Insight into TPP Community Templates - The Rotherham Experience’; PRIMIS+ Conference, October 2007) and a lot of work still needs to be done to ensure that all the issues about patient consent to shared records are dealt with. Sealed envelopes to protect very sensitive data are still in the development stage and many problems about their implementation still need to be sorted out (‘Sealed Envelopes Briefing Paper’; CfH, September 2006).
If you are considering a change we recommend you visit at least one practice that has been using the system for some time and make sure that it is an independent practice that will give you a fair assessment, warts and all. Don’t forget to ask about support standards and the contract they have. Ask particularly about whether the practice is free to change systems again in the future and what level of control they have over access to the patient records by people outside the practice.
The GPSoC PCT-Practice Agreement includes a statement about who controls access to the patients' electronic medical records. Although this appears unclear when read, the GPC has taken legal advice and is satisfied that the Agreement will not change the GP's role. In the terms of the Data Protection Act, it is the practice who remain the Data Controller, defined by the Act as “… a person who (either alone or jointly or in common with other persons) determines the purposes for which and the manner in which any personal data are, or are to be, processed”. This is essential to remain within the General Medical Council’s advice on confidentiality ‘Confidentiality: Protecting and Providing Information’. Check that your new system will help you meet the standards expected by the GMC and your patients.
Record sharing means that other health professionals outside the practice can have access to the patients’ medical records and their records become part of your General Practice record. This has several implications:
All suppliers publish development plans. You can find their NPfIT ‘road map’ on the GPSoC website. Visit Supplier Roadmaps. All the roadmaps lead to the same specification by the end of 2008.
Enthusiasts for change tend to minimise the effects on the practice of a change of system. Many practices who have changed have found the experience more difficult. Although Read code conversion may be fairly accurate, current computer systems use very different patient record structures. This is why it has taken so long for GP2GP transfer of electronic records to come about. By the end of 2007 only two suppliers will have achieved CfH accreditation for record transfer between suppliers. The costs of re-training in both time and fees should not be underestimated and many practices have found that it takes between 12 and 18 months to get back to the level of productivity that they achieved before the change of system. The EMIS National User Group has estimated that the cost to the practice of migration to a new system may be up to £18,000. Download the report here
There have been reports of PCTs who suggest that they cannot afford a new server for a practice struggling with an old machine and push the practice to a centrally hosted system where there is no need to replace the server. All the practice data is stored on a distant data centre run by the PCT, system supplier or a third party. One PCT has offered all practices that move to their preferred supplier new desktop PCs to replace machines that are 1-2 years old. PCTs received a sum of money from CfH in July 2007 which is roughly equivalent to £9,000 per practice. It was intended to help with the upgrade of practice ‘IT infrastructure’ to a level that allowed all practices to use NPfIT services such as GP2GP and the Electronic Prescribing Service. PCTs should have the money to replace out-of-date local servers, desktop PCs and printers for all their practices. Visit the GPSoC website: ‘Funding for Upgrades to GP IT Infrastructure’.
If you change system, you may be offered a system under a GPSoC contract with your PCT (the PCT-Practice Agreement) or under a contract between your LSP and the NHS. GPSoC contracts have been negotiated between CfH and GPs and agreed by the Joint GP IT Committee of the BMA, RCGP and National User Groups. The documents are all in the public domain. You can download the approved PCT-Practice Agreement and the latest plans for implementing GPSoC from the News section of the GPSoC website. There is more about the GPSoC contracts here. They protect practices' rights to retain or choose to change systems and establish that the practice controls access to their patients’ GP records. LSP contracts are not in the public domain and have not been endorsed by an independent GP body.
If you change system you will need two sorts of training: 1) on how the system works 2) how to make the best use of it for patient care and practice business. The former should be provided by the supplier and/or the PCT. The second is not so easy. PCT information facilitators or data quality staff may help. Check out if there are helpful local and national user groups for the new system. Remember that all training requires protected time and usually work through cascade principles that require a lot of in house training.
The quality and efficiency of support services are very important. Check whether you are expected to route support requests directly to the supplier or to a PCT help desk or both, what agreement is in place for service levels and what the reputation of the support services is like.