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Errors with third-party NHS IT system led to “significant” patient risk

More than 20,000 records were left “out-of-date” while a second issue led to patients potentially given the wrong medication

Clinician's computer meltdown

Glitches with an IT system used across the NHS posed a "significant" clinical risk to patients, with thousands of health records left out-of-date.

The NHS discovered two errors this summer with TPP's SystmOne platform, used by more than 2,600 GP practices in England, including one failure that may have led to patients being given the wrong treatment or medication.

According to publicly-available board papers published on the NHS Digital website, seen by Health Service Journal (HSJ) and since seen by IT Pro, an error discovered on 14 August meant prescriptions cancelled using SystmOne were not cancelled on other systems. This includes SPINE, a platform predominantly by social care organisations and pharmacies.

A separate glitch, discovered just three days later, meant updates to patient records on TPP's platform were not carried over to their summary care record, an electronic patient record for patients in England held centrally by the NHS and accessed by clinicians.

"The clinical impact has been assessed as major due to the potential for the incorrect or inappropriate medication being provided to patients," the papers said of the first failure.

"The business impact is that practices are required to carry out clinical tasks from TPP in order to cancel the prescriptions. Practices may also have to contact pharmacies if the cancellation has been unsuccessful. Clinicians may also need to carry out a consultation with the affected patients."

Of the second error, the papers added the clinical risk was "significant" because incomplete or out-of-date patient information may have led a clinician to provide "inappropriate care".

The papers were being used to brief an NHS Digital board meeting on Wednesday. According to the briefing, both errors persisted for at least four weeks and were present in the system as of 12 September, the papers added. Its persistence "significantly" breached the four-hour service level agreement (SLA).

An NHS Digital spokesperson said the organisation would not be commenting on the failures, but confirmed it was aware of the issues and has been working with TPP towards resolving them. The spokesperson did not confirm whether the issues had been resolved.

These failures are the second and third major glitches with TPP's SystmOne platform that have come to light in the last few months, after ministers revealed in July that a separate IT failure led up to 150,000 patients' data being shared against their will.

Prior to the rollout of a new national data sharing opt-out tool, which has been launched in beta, an issue with the previous system handled by TPP led to a vast number of data-sharing objections not being submitted to NHS Digital's central service.

The coding error meant 150,000 preferences set between March 2015 and June 2018 in GP practices running SystmOne software were not sent to NHS Digital.

NHS Digital's CEO Sarah Wilkinson told the board on Wednesday she was "very disappointed" as this was likely to damage public trust in how data-sharing opt-outs are handled in future. She reassured attendees the new system is not reliant on third-party providers such as TPP used by GPs, and will instead rely on an in-house platform.

The first glitch concerning repeat prescriptions not showing as cancelled, highlighted by the paper, raises concerns in light of plans announced this week to introduce a new digital system to administer free prescriptions to patients.

A new system to verify patient identity in real-time, and automate certain functions, is being developed in an effort to clamp down on prescription fraud in England, which the government says is worth 256.1 million per year.

But the move was criticised by health experts who are concerned that various IT failures, exemplified by the one detected in August, may inadvertently lead to patients being charged for medication that they are entitled to for free.

"What if the computer says no?" said the chair of the board for the Royal Pharmaceutical Society in England Sandra Gidley, speaking with BBC Breakfast.

"This is a real dilemma. Because sometimes somebody has free prescriptions legitimately - they've got a medical exemption - they're something like a diabetic, they might forget to renew it, computer says no, you're not going to deny a diabetic their insulin, for example.

"This is potentially fraught with problems and we can't get the NHS systems talking to each other at the moment, so how the secretary of state thinks he's going to manage it for the Department for Work and Pensions (DWP) and other agencies when they can't even get Universal Credit (UC) right is slightly mystifying."

IT Pro approached TPP for comment but the company did not respond at the time of writing. A spokesperson told HSJ both errors have been fixed, and that the firm was working with GP practices to ensure any incorrect prescriptions or records were corrected.

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