Lives on the line: ICT flaws identified in bowel cancer screening programme

Lives on the line: ICT flaws identified in bowel cancer screening programme

Key IT systems and processes need improvement to support bowel cancer screening program national rollout

Disconnects between IT systems are dogging the rollout of a national screening programme for bowel cancer

Disconnects between IT systems are dogging the rollout of a national screening programme for bowel cancer

A review of the National Bowel Screening Programme has found ICT failures contributed to issues that left some target patients in a pilot unscreened.

It also carries strong recommendations about IT systems to be used in the national programme rollout.

The review, led by Professor Gregor Coster, Dean of the Faculty of Health at Victoria University of Wellington interviewed over 60 individuals, received eight written submissions and reviewed over 200 documents relating to the Bowel Screening Pilot and the National Bowel Screening Programme.

The programme was piloted at Waitemata DHB before a planned national rollout. However, data quality and technical failures meant some eligible people were not invited to participate.

"Work is ongoing to improve the coverage and quality of data within the register," a report on that pilot found.

"However, the health and disability sector continues to have concerns about data quality and the potential to exacerbate inequities through poor capture of contact information.

"It is necessary to undertake further research and investigation into the data quality, as well as to explore ways to actively enrol individuals with the register."

The new review of the found further issues with ICT systems to be used in the national rollout of the screening programme.

Among other findings, the review found a key IT system called BSP+ that supports the program and was also used in the pilot has limited functionality.

"Despite improvements to the BSP+, the IT system still has limited functionality, which impacts on its ability to handle the population register, invitation process and clinical data," the report found.

"The Ministry of Health has undertaken work to improve the functionality and to reduce the need for manual workarounds, where possible.

"The panel has been assured that the upgraded version of BSP+2 has the technical capacity to support the invitation process for the initial eight DHBs; however the functional limitations remain."

The Ministry of Health is providing DHBs with IT support and training to use the BSP+, in order to maximise functionality of the system and to mitigate against known risks, the report said.

Annual funding is also an issue, the review found. A "multi-year funding pathway" is required to embed the programme throughout the sector.

"This should include resourcing for planned workforce increases, IT integration with primary care and health promotion," the report added.

The review panel has undertaken an in-depth review of the BSP+ assurance documentation provided by the Ministry of Health and found that a thorough review had been undertaken and that the Ministry continues to monitor and enhance the BSP+ to support its integrity and safety.

Meanwhile a new solution, the National Screening Solution (NSS), is being procured.

"The panel supports the strategic intent of the NSS. Using the system across screening programmes will create a comprehensive view of each participant’s screening history and will lead to significant efficiencies," the report added.

"The panel wishes to reiterate the importance of adequately overseeing the NSS while it is designed, built and implemented. The level of oversight must reflect the level of risk inherent in an IT procurement process of this scale and complexity."

The review panel recommended that the Ministry of Health involves DHBs, the primary care sector and the National Coordination Centre in designing and testing the NSS, to help maximise functionality.

"The panel notes that integration of the NSS with IT systems has been considered as part of the NSS design phase," it said.

"The panel advises the Ministry of Health to seek maximum interoperability of the NSS with other health IT systems, to maximise its functionality. This includes giving urgent consideration to ‘real-time’ integration with primary care IT systems."

This form of integration would help increase participation in the programme as intended through primary care’s access to a participant’s full screening progress.

"The panel considers that failing to deliver the NSS on time would have significant implications for the National Bowel Screening Programme," the report added.

"It recommends bolstering the contingency plans for using BSP+ for an extended period if the detailed design of the NSS takes longer than expected."

Health minister David Clark said today that screening programme save lives.

"This review confirms that despite some issues with the pilot programme, over all it performed well," he said. "It also found that the national roll-out of bowel screening is progressing well."

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