The 10 projects at the heart of NHS IT

NHS Care Records Service

The NHS Care Records Service (CRS) will provide doctors with instant electronic access to patients' medical records, cutting off the paper trail that sees medical professionals searching out documents stored where the patient was last treated.

Find out more about the 10 key NHS IT projects

♦  NHS Care Records Service

♦  Choose and Book

♦  The Electronic Prescription Service

♦  N3 national broadband network

♦  Picture Archiving and Communications System (Pacs)

♦  The Spine

♦  The Quality Management and Analysis System

♦  GP2GP record transfer

♦  NHSmail- a central email and directory service for the NHS

♦  Secondary Uses Service

Each electronic medical record available on the system, known as a summary care record, will be formed from information held in a number of places, automatically brought together when needed. A summary of the record will be held on a national database called the Spine so that vital information - including the patient's name, address, date of birth, allergies and A&E visits - can always be accessed by medical personnel.

In depth information - such as tests, X-rays, scans and other results - will be held locally.

What progress so far?

The deployment of the CRS is four years behind schedule and is not likely to be implemented across every NHS health trust in England and Wales until 2014 or 2015 according to a report by the National Audit Office.

Progress has been hindered by technical problems and disagreements over how patients are asked for their consent for their medical records to be digitised.

Five "early adopter" primary care trusts, Bradford and Airedale, Bolton, Bury, Dorset and South Birmingham, were chosen to create summary care records for patients and upload them to The Spine.

Delays to the summary care records rollout have meant that only two of the five early adopter sites, Bolton and Bury, have uploaded their records to the Spine.

Currently, patients in Bolton and Bury St Edmunds are able to view their own records using the NHS personalised site HealthSpace while patients in the other three early adopter trusts - Bradford and Airedale, Dorset and South Birmingham - will have access to their records over Healthspace once their care records have been uploaded.

Meanwhile, the remaining 375 primary care, hospital and mental health trusts in England are rolling out patient administration systems (PAS).

These PAS will initially handle more electronic admin records - containing details such as patients' names and addresses - and share them within parts of the local trust. A later date, the PAS will be upgraded to handle summary care records as well.

Further problems in rolling out PAS means that six years into the National Programme for IT only 130 PAS have been deployed in 380 health trusts while delays to the deployment mean the majority of these systems are interim solutions, to be replaced by the Lorenzo software system at some point in the future.

Trusts deploying a fully-fledged PAS have a choice of two systems, Cerner and Lorenzo. To date only 14 Cerner Millenium PAS software systems and just two Lorenzo system have been deployed.

While Cerner release one users have the ability to connect to the Spine and upload summary care records, trusts using Lorenzo release one will need to upgrade their PAS system before enjoying the same functionality.

Both Accenture and Fujitsu have pulled out of delivering the Care Records Service, leaving only BT and CSC left as the service suppliers.

Some hospital trusts in the south are without any dates for when the PAS system will be implemented since Fujitsu's departure and Bath Royal United Hospital NHS Trust recently terminated its implementation of the Cerner system.

Barts and the London NHS Trust reported that problems with the introduction of Cerner system had delayed the treatment of 11 cancer patients and The Royal Free Hampstead Hospital has had problems with data entry errors and other issues which contributed to a £7.2m deficit at the trust.

These problems culiminated in the NHS London Primary Care Trust halting any futher deployments of the Cerner PAS while it resolves issues with trusts already using the system.