• Governance
• Evaluation Methodology
• Healthcare Quality Improvement

England's National Programme for Information Technology (NPfIT) was at the time of its launch in 2002 dubbed the most ambitious and expensive civilian health information technology (HIT) project in history.1 Then Prime Minister, Tony Blair, championed the project, with the aim of creating a digitised, interoperable, health infrastructure that would transform healthcare delivery, achieve major improvements in health outcomes and, at the same time, substantially reduce government expenditure on healthcare. The study by Franklin et al2 represents the long-awaited independent academic evaluation of the Electronic Prescription Service (EPS), a core component of NPfIT that aimed to reduce the need for patients to manually transfer paper prescriptions provided by their general practitioners to dispensing pharmacies and, more importantly, diminish medication errors and thereby improve patient outcomes. Franklin et al evaluated the impact of electronic transmission of prescriptions between prescribers and pharmacies, but found no benefit. In fact, the study found an even higher prevalence of labelling errors in prescriptions transmitted electronically, but this was mostly accounted for by the practices of a single pharmacy. Notably, most prescriptions were already being generated electronically even before the study of EPS.2

As with earlier evaluations of NPfIT functionality, Franklin et al found major delays with implementation and adoption of the HIT, substantial usability challenges—reflecting both design limitations and inadequate attention to the redesign of clinical workflows—and unrealistic expectations about the speed and scale of the anticipated benefits.3 Moreover, this and the related body of work reporting on evaluations of other NPfIT functionalities—namely the NHS Care Records Service,4 Summary Care Record …