National bowel screening programme’s IT systems a key risk

The National Bowel Screening Programme’s IT infrastructure is a key aspect of the screening programme and a key source of risk for it, according to the findings of the independent review of the programme.

The review panel has undertaken an in-depth review of the screening programme’s two IT programs, the Bowel Screening Pilot Information Technology System enhanced version (BSP+) and the National Screening Solution (NSS), and the assurance documentation provided by the Ministry of Health.

It found that this work has been robust to date and the Ministry of Health continues to make enhancements to the BSP+ to support the integrity and safety of the system.

The review found that, despite these updates, the BSP+ still presents a risk to the NBSP due to its limited functionality, and that it was necessary to continue to monitor and manage the ongoing risks presented by the BSP+, as well as to support the DHBs using the system.

The panel was satisfied that the Ministry of Health conducted a robust and comprehensive process in procuring the NSS. It also supported the strategic intent of the NSS. Using the system across screening programmes will provide a comprehensive view of a participant’s screening history and create significant efficiencies, the review’s report said.

The panel was concerned, however, that, in common with other large-scale IT projects, the IT solution brings a risk that it may not be achieved within the timelines proposed, or that the final deliverable may not meet the expectations of all stakeholders.

It said that adequate oversight of the NSS development, together with sector engagement, was needed to maximise the functionality of the system, including prioritising integration with primary care systems.

The panel identified the following risks:

• There is a risk that the NSS design, build and roll-out will not be achieved within the tight timeframes or within budget.
• NSS implementation may be delayed due to complications resulting from the considerable amount of work required to integrate the NSS with other IT systems.
• Public concern may arise about the use of cloud-based IT solutions and data sovereignty, which may delay the implementation of the NSS.
• The validity and reliability of the National Enrolment Service data have not been adequately reviewed, which may impact on the ability of the NBSP to undertake participant follow-up.
• There is a risk around the level of resource required to support eight DHBs using the BSP+ at the same time as developing and implementing the NSS.
• Further invitation issues cannot be ruled out, due to inadequacies with the BSP+ IT system, including the need for manual workarounds.

The review panel made the following six recommendations:

1. Urgent consideration should be given to real-time integration with primary care practice management systems as a way of increasing participation in the programme as intended through primary care’s access to a participant’s full screening progress.
2. The Ministry of Health needs to continue to monitor and manage carefully the ongoing risks presented by the limited functionality of the BSP+.
3. DHBs, primary care and the National Coordination Centre should be appropriately involved during the design and subsequent phases of the NSS.
4. The Ministry of Health should continue to strengthen project management during the design, build and implementation of the NSS to ensure deliverables are met within the planned timeframes. IT governance arrangements should be reviewed to ensure they are fit for purpose.
5. Contingency plans for potential delays in the NSS roll-out should be strengthened and more clearly articulated.
6. The Ministry of Health should undertake a review of the functionality and operation of the population register, to increase its accuracy and completeness. This includes a review of the ability of the National Enrolment Service to provide participant contact details.

Source: Independent Assurance Review for the National Bowel Screening Programme, 8 August 2018

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