Dr Nigel de Kare-Silver describes his experience of workshops to introduce the new system to users. "We were shown screens of a third rate computer program lifted from the existing system of US hospital administrators," while further meetings produced "lame presentations by various strategic health authority IT leaders."

He goes on to describe problems with the "choose and book" system, in which doctors will select from a list of local hospitals and book an appointment while the patient waits. This has a national implementation date of the end of December 2005.

"The application screens are slow, and the computers often fail to pick up the programs. There is no integration with existing clinical systems or with Microsoft Outlook," he writes.

But the "really frightening module" is the inability of the software to retain advice by either the consultant or the GP, or to integrate it with clinical results. "This is a major clinical governance issue, he adds.

While the ambition of the NHS agenda for IT change should be applauded, it is unfortunate that the contractors show no ability to deliver a system that is an advance on existing services, says the author. "It is frightening that the political drive to implement the system is failing to take account of professionals' anxieties."

Before allowing its delivery, clinicians from all backgrounds must demand a service that is rigorous in terms of clinical governance, friendly in its user interface, fast, and relevant to the needs of clinicians and patients, he concludes.

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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
5-May-2005