The best information systems in the world are of little benefit if the practitioners are unable or unwilling to use them, warns Richard Allan MP

So, we are about to enter a new era of NHS information technology with large budgets and new structures to ensure they are spent well. We are even to get our very own NHS IT "tsar" to oversee the whole process. Announcements of this sort have to be welcomed but the real question is whether or not the promised improvements will actually be delivered.

The history of NHS computing is generally seen as not being a happy one. There have been well known examples of large IT projects failing and some of the main elements of a comprehensive information infrastructure are still conspicuous by their absence. It is these key planks such as an electronic patient record, an online booking system and a network for the interchange of complex health data that the new strategy will seek to put in place.

The ability of the strategy to deliver will depend on the answers it puts in place to two fundamental questions. The first of these is can the right suppliers be found to deliver the systems for the various trusts and other health bodies? And the second is will robust standards be developed and enforced so that there is a coherent long term framework for health information rather than a series of disjointed projects that cannot be linked and fall rapidly by the wayside?

On the first point, we do need to ask searching questions about how the proposed system for procurement will work in practice. The suggestion seems to be that a small number of "big beast" companies will act as the primary IT service providers to health authorities and will implement packages supplied by other companies according to the purchasers' wishes. The role of the primary service provider throws up some issues that bear further examination. How will their relationships with the providers of the systems actually work? What exactly are they being paid for? Is it to offer added value, or simply to take on some of the risk? If it is the former, then how will they offer this added value if they are expected to be neutral between the potential system suppliers? The temptation may well be there for each primary service provider to develop its stable of preferred systems and steer their clients towards these. A careful eye will have to be kept on the views of the supplier community as the proposals are worked up to see whether the model can be implemented as cleanly as it looks on paper.

The second point about standards is one which has dogged NHS computing for years. The fact that many of the key elements of the infrastructure are not in place may be seen to be an advantage if the opportunity is now seized to agree open standards and then enforce them rigorously. The recent development of the NHS Direct IT has shown how good systems can be put in place in a greenfield environment using modern technology and standards. There are huge legacy problems in respect of many systems in other areas of the NHS but these should not be allowed to block necessary development. A particular suggestion in this area would be to look at the Open Source model for some of the software development. Proprietary systems are likely to be needed for many applications in the future but the data models underlying the applications should be opened up as far as possible. An open data model with open source for key software elements such as electronic data exchange would allow contributions to be made from the whole developer community for mutual benefit and more rapid development.

Finally, even if the new strategy is able to create the right framework for technical solutions to be developed, the make or break issues are likely to be on the human side of the equation. The best information systems in the world are of little benefit if the practitioners are either unable or unwilling to use them as part of their working practices. There have been examples in the past of NHS systems that are technically correct but whose implementation depended on highly variable take-up by staff on the ground. If we are to spend a lot of public money on a new round of IT purchasing then this must go hand in hand with a determination on the part of the NHS management to drive any organisational changes that may be necessary to make the most of them. This is perhaps the toughest part of what is going to be attempted. We should all, as people interested in IT, but even more so as people interested in improving the NHS, hope that the whole package can be made to work.