NHS suppliers BT and CSC have until November to prove they can implement electronic health records.
The suppliers have been told if they do not succeed with this, they could risk having their contracts terminated. The same seven-month deadline has been set for Cerner and iSoft, the software suppliers.
CSC has been charged with rolling out the iSoft Lorenzo patient record system in a large hospital in northern or central England by November. BT has the same deadline for rolling out Cerner Millennium, a competitive system.
If they do not meet the deadline and it looked as if progress was "just going to slip and slip", then the NHS "will look at alternative approaches", says Christine Connelly, head of the £12.7 billion programme at the Department for Health, in an interview with the Financial Times.
Asked whether suppliers would have their contracts, worth over a billion pounds each, cancelled, Connelly says: "At this point, we are not ruling anything out." Nevertheless, this is thought to be a high-risk option as cancelling either BT or CSC's contract would lead to only one lead IT services supplier being left on the programme.
Faced with a raft of problematic rollouts, which forced a stoppage of the programme for several months as London hospitals struggled to implement the systems, the NHS has now devised an emergency plan to improve the rate at which the systems are going in. By latest estimates, the programme is four years late.
Under the new plan, local hospitals will finally be given the chance to configure systems to their own requirements. A catalogue of such adaptations will be created so that trusts implementing the system later can choose which is closest to their own needs. There will also be a repository of additional functionality from other suppliers, modelled on Apple's iPhone store, which trusts can access.
In the south of England, where Fujitsu was lead IT contractor until it left the programme last year, there will be a nine month competition to allow additional suppliers to bid for work at the trusts. This month, BT was awarded work at 12 trusts.
The budget of £12.7 billion, and the overall deadline of 2015 for all records to be in place, remained, Connelly said.