How does joint procurement affect the design, customisation and usability of a hospital ePrescribing system?

What is it about?

In England, the former National Programme for Information Technology (NPfIT) was introduced with the aim of providing an Electronic Health Record (EHR) for every National Health Service (NHS) patient in the country. At the time, the NPfIT was the largest, public, health sector Health Information Technology (HIT) programme ever undertaken. Post-NPfIT, the UK government now wants the NHS to go paperless by 2018. However, some worry that the goal of going paperless is setting too difficult a task too soon. This qualitative study aims to explore how the joint procurement model that was in place during the NPfIT has affected the design, customisation and usability of electronic prescribing (ePrescribing) systems in use today. To explore the impact of the NPfIT procurement process, we studied two sites where an ePrescribing system had been jointly procured within one of the NPfIT’s geographical areas. We found that the procurement process, relationships with the system supplier and the strict contractual arrangements under the NPfIT had contributed to reported usability problems with the ePrescribing system and to difficulties with implementing and customising the ePrescribing system. The NPfIT arrangements had limited the sites’ ability to make changes to the ePrescribing system, and this impacted on the system’s usability and the users’ perception of its usability. This study illustrates how important the early stage of procurement is in the process of implementing an ePrescribing system. The joint procurement model, as used during the NPfIT, appeared to make setting up an ePrescribing system more difficult and less efficient in the two sites we studied.

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