The ill-fated electronic patient records system has suffered further delays and will not be fully operational until 2014-15, according to the public spending watchdog.
According to the National Audit Office (NAO) "serious delays" in applying new software for the National Programme for IT in the NHS had occurred.
It went on to accuse the government of having underestimated the challenges involved in developing and introducing the £12.7bn Care Records Service.
In a progress report, the NAO concluded that while all elements of the £12.7bn programme are advancing and some are complete, the original timescales were "unachievable, raised unrealistic expectations and put confidence in the programme at risk".
In particular, the software planned for the North, Midlands and East areas, called Lorenzo, has taken much longer than planned, forcing some trusts to take an interim system, the report found.
The IT programme involves four main projects: a centralised electronic medical record system for 50 million patients; an online "choose and book" system for booking hospital appointments - deployment of which, according to today's report, is nearly complete; electronic prescriptions; and fast network links between NHS organisations.
It is expected to link more than 30,000 GPs in England to almost 300 hospitals.
The report added that it was essential that NHS staff were convinced of the value of the programme in order for it to succeed.
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