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Extensive work was carried out during the 1990s to pilot electronic patient records through the health infomatics system (HIS) programme. This contributed to the publication, in 1998, of the Department's information for health strategy. Following publication, the Department piloted electronic records at 16 sites across the country under the electronic records demonstrator and implementation programme. Each project had its own focus, for example record sharing and confidentiality, and joint working between health and social care.
A series of outputs, evaluations and guidance reports from these projects, supplemented by lessons learned from projects in other countries, including the European Commission's advanced informatics in medicine programme, contributed to the specification of the NHS Care Records Service. A key purpose of the national programme for information technology (NPfIT) was to enable the benefit from the projects to be shared across the whole country.
During the early stages of the NPfIT procurement process, an electronic patient record pilot study with IBM at Warwick investigated primary care trust-level information gathering and reporting. Also during the procurement phase, detailed technical design studies were carried out and each supplier had to complete a series of proof of solution tests to ensure that they understood the national health service's requirements.
Further trialling of NPfIT systems is always undertaken at user sites and in user-based environments to pilot usability before rollout. Systems are only made available locally after successfully passing through extensive national testing phases. For example, both the quality management and analysis system for general practice, and the system to support payment by results, operated in shadow form for a number of months before going live.
All this activity is in line with the recommendations of the 'Successful IT: Modernising Government in Action', to demonstrate that products work before they are deployed, and to avoid big bang implementations.