The National Health Service’s drive to digitalise its processes and information management – the Connecting for Health (CfH) scheme – is one of the most high-profile and expensive IT overhauls the UK has ever seen.

One of the cornerstones of the programme has been to transform the NHS from a paper-intensive organisation to a quicker, more efficient one, whilst improving patient care in the process. Many patients’ experience of the NHS is a frustrating one: waiting weeks for a letter to arrange a hospital appointment, only to find it is at an inconvenient time, leading to more rounds of letters and more delay.

In 2003, the NHS signed a contract with services company Atos Origin and software provider Cerner to revamp this system by allowing patients to book appointments online.

What was initially envisaged as simply an electronic booking system has developed into the ‘Choose and Book’ application as choice became a political priority for the government. Patients are now be able to pick a time and one of several locations convenient for them, removing the stress of having to wait for their appointment letter to be delivered.

In 2003, outsourcing providers, management consultants, NHS clinicians and experts in technology delivery were brought together in a “multidisciplinary” team to develop a solution, says Clare Mitchell, the group programme director for Choose and Book. In July 2004, an idea initially proposed by the NHS’s Modernisation Agency back in 1998 was brought to fruition in a programme called ‘Thirteen Ways to Book’ – from the Internet to call centres.

“We had a proof of solution,” says Mitchell. “This was completely different from a proof of concept; it wasn’t merely a paper exercise. It meant suppliers going to a test centre in Hatfield, setting the scene of a Monday morning in a GP clinic, proving that their technology worked, that users liked it and that it would integrate with other services.” Mitchell describes such a thorough test as “a big ask for suppliers. It was seen as too much pre-award of contract.” But despite some grumbles, her team got what they wanted.

Progress, however, became stilted. In late 2004 and on into 2005, Mitchell’s team had to work to persuade doctors that the system was able to keep doctor and patient information secure. “We hadn’t seen it coming,” she admits. “We’d done the penetration tests and we knew it was safe.” Choose and Book’s importance also tended to be played down within CfH, taking a back seat behind more high-profile priorities like cutting Accident and Emergency waiting times.

However in the last 18 months, investment has been pumped into the programme – advancing it so far that Mitchell openly wonders if it has been “on the bleeding edge rather than the leading edge!” GPs have been registered and provided with smartcards, NHS staff have been trained how to log on and authenticate themselves. The result is that in 2005 over 90% of Primary Care Trusts put orders in for the application.

Choose and Book is now being used in 4,500 GP practices nationwide and has been used in 51% of the total of around 10,000. Despite roll out taking longer than was initially anticipated, Mitchell enthuses: “There’s been lots of usability and lots of positives. There have been fewer ‘Do not attends’ [patients missing their appointments] and patients are no longer booking into GPs just to enquire when and where their appointment is.”

Over 290,000 appointments have been made using Choose and Book to date, and the current daily level is 4,000. But in spite of these gains, the system has come in for some harsh criticism for alleged cost overruns, delays and “lost” patients – of which Mitchell is painfully aware.  “There’s still a perception, from the national press at least, that it is not adding value,” says Mitchell. “However we know there are fewer letters going back and forth, and the GP feedback has been very good.”

Further reading

Log-on lifesaver - Two-factor authentication at Addenbrooke's hospital, April 2006

The Insider - Blame game for NHS, April 2006

Man and machine - designing usable applications, January 2006

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