In article <[log in to unmask]>,
[log in to unmask] writes
>In a message dated 16/07/96  18:36:17, you write:
>
>>'m no great fan of RFA (quite the opposite in fact) but you seem to be
>>blamming it for things you shouldn't.
>>
>>
>Ewan,
>
>This is something that Microdoc have recently convinced me of . MOst of the
> problems with the software  seem to be that  the suppliers, the users and
>the DoH all want different things from GP computing. Some suppliers are more
>successful than others, some users are more fed up than others, but no-one
>seems to understand why the RFA says what it does. We have recently had
>someone from Quarry House speaking to our user group about the RFA and he
>felt that there were aspects of the rules that were not in anyones best
>interest, they were "this sounds like the sort of thing that GP's ought to be
>able to do" ideas.
>
>Can anyone own up to being on the committee that produced RFA 3, and did they
>agree with it. If not, why not?. The effect on the end product may cost the
>NHS 10's of htousands of UKPounds (or us!!)
>

The RFA is owned by NHS Executive IMG who run the Project Board that
controls RFA. Currently chaired by Dave Smith. Senior responsibility for
RFA lies with Ray Rogers - Director of IMG.

Suppliers originally supported the RFA and this remains the CSSA (The
trade association line), although suppliers are know pretty frustrated
and cynical about it. It was support because:

1       We hoped that it would encourage people to move from none RFA to
RFA accredited systems generating sales for those who invested in
meeting RFA.

2       We hoped it would exclude the cowboy element. There were a lot
around in the early 90s feeding of FHSA desire to get computers, any
computer in to practices to avoid being at the bottom of the league
table.

3       We hoped a higher proportion of better systems would help make a
better case for Primary Care computing and that more money would be
available if the NHS Executive could be confident it would be invested
in capable systems.

4       We hoped it would produce a level playing field amongst
accredited suppliers and create a consist approach across all FHSA
eliminating, often irrational, local variation.

5       We hoped it would enable a review of the rules concerning
reimbursement to bring greater simplicity and consistency.

Although modest progress has resulted in relation to 1 and  2. The
impact of RFA has been limited and disappointing. This is clearly
illustrated by the rapid reduction in suppliers going for RFA 2 and 3
compared to RFA 1. The main problems are a lack of a migration strategy
to give practices time to migrate to RFA compliant systems and then
through the various levels of RFA; the lack of any guidelines bringing
RFA and reimbursement together and the lack of relevance to much of what
is in the RFA to the needs of GP practices, Health Authorities,
suppliers and even the NHS Executive.

The IMG has tried hard to get broad input into the RFA and reconcile
conflicting interests. Too many interest groups have tried to use RFA as
a way of getting their pet project implemented in suppliers systems
where no business case for it exists. Others, particularly GP
representatives have tried to use it as a wish list and pressed for
trivial items to be included that have no place in the RFA. Some have
tried to use it a surrogate for producing their own system without
taking the risk that real entrants to this market have had to take.

The RFA has certainly distorted suppliers priorities and move resource
to providing facilities that no one will use at the cost of changes that
are  higher on GPs agenda. This with other changes has certainly move
the focus of who the customer is away from the GP towards the NHS
Executive and Health Authorities.

However, some suppliers have used the RFA as an excuse and it been more
of a whipping boy than it deserves.

I think IMG have done a well as one might hope it difficult
circumstances, but the result is that to a significant extent the RFA
has lost its way.

Im not sure there is a place for the RFA in the future. If there is it
needs to:

Limited its scope to three areas - gross functionality, standards and
safety.

The first is about defining the basic elements that a GP system must
provide to deserve the title. This should be at a macro level (e.g. EMR,
Prescribing, Health Authorities links) and should not get in to detailed
functionality.

The second should focus on the implementation  of standards necessary to
ensure that systems can fit and work in the overall framework of NHS IT
strategy.  This will mainly be interface standards to allow data
transfer. It should keep out of system internals. (although sometime
interface requirements will force internal change).

The third area is concerned with safety  critical features like the
quality of prescribing systems and issues of data confidentiality,
integrity and medico-legal validity.

Whatever is in the RFA there MUST be a business case that justifies its
cost to the NHS and Suppliers. You can have any feature you can think of
in your system along as you are willing to pay for it.

The consultation process needs to be more transparent

RFA has no place as a wish list. It should not be used as a tool to
create homogenous systems, UK GP computing has gain greatly from
diversity and competition.

Those who think they know better than suppliers how to write a GP system
should either send existing their suppliers their  CV or raise the money
to develop it and join the fray.

Ewan Davis
[log in to unmask] - Bromsgrove, UK

Managing Director AAH Meditel Ltd - Supplier of EMR Systems.
[log in to unmask] Voice +44 (0)1527 579414 Fax +44 (0)1527
837287


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