MPs have slammed the delays and lack of progress in rolling out a national system of electronic patient records, a key plank of the government's £12.4bn NHS IT project.
The NHS care records service will eventually consist of a national summary care record containing basic patient information that can be accessed in emergencies, and a more detailed local care record containing more comprehensive clinical information for each patient.
Some pilots of the summary care record have now started, but a report by the Health Select Committee found the scope, capability and timetable for the more detailed local record to be "vague and inconsistent".
The MPs criticised Connecting for Health, the agency responsible for the National Programme for IT in the NHS (NPfIT), for a lack of local involvement in the care-record project.
The report said: "Hospitals have often been left out of negotiations between Connecting for Health and its suppliers, and found themselves, as one witness put it, at 'the bottom of the food chain'."
The MPs said they are "dismayed" by the lack of clarity about what information will be held on the summary care record and what the record will be used for, and recommended the implementation of a single, standardised front-end screen to display key health information vital for emergency care.
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Implementing a local detailed electronic care record is the "holy grail" for the NHS IT programme, but the report said it is still not clear what information will be recorded and shared on the systems, or which range of organisations will be able to share the information.
The only estimate for delivery of the local electronic patient record system is 2010, just for London, and the report said the shared records system "remains a distant prospect".
MPs blamed over-ambitious timescales that did not take sufficient account of the complexity of replacing existing systems and a failure to give hospitals responsibility for implementing their own systems.
Despite the problems the report said the local care records can improve safety and efficiency and "vastly increase" the effectiveness of clinical communication, adding that the overall success of the NPfIT should ultimately be judged on delivering this.
Earlier this week, a review of the 2002 Wanless report into the modernisation of the NHS called for an independent external audit of the NHS IT programme.
