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Biggest IT Disaster Ever?
lizzyben writes, "Baseline has a major story about a major IT disaster in the UK: 'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion, and two Members of Parliament say the project is "sleepwalking toward disaster"... In scale, the project... (NPfIT) is overwhelming. Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies.'" An Infoworld article from earlier this year sketches some of the all-time greatest IT meltdowns.
Well, I recall the FBI's Virtual Case File system that took 2-3 years to develop and costed $170 million to produce an absolute failure. In the end, they found a "suitable commercial replacement." Probably at a fraction of the price.
So, $170 million/3 years = $55 million/year while the article seems to imply an oversight of one billion per year on the NPfIT which is outrageous. I'm confused how one would even spend that much money on an IT project for a country the size of England--were they laying expensive new shiny fibre wire devoted for medical records only to every facility?
My work here is dung.
Those three words together are the new definition of the word "duh."
When doesn't government go overbudget? Government is the combination of bureacracy, inefficiency, monopoly use of force and the free use of other people's money. Government agencies can never do anything under budget because if they do, they'll see their budgets cut. Each department of an agency is required to work just a little beyond budget since that is how government grows: "we only need a little more money/staff/time." Since each department does this, each agency of departments has bigger and bigger needs leading to more and more inefficiencies.
When a competitive free market group of companies goes after work, they have to balance their profit versus their ability versus the good use of their time. If you bid a job and win it, there's no going back and asking for more. For big projects that my companies do, we get bonding insurance for double the bid package -- this protects our customers from our failures. Government, on the other hand, doesn't need bonding insurance: they just go and get more money in the form of various user fees, taxes, tariffs and inflationary fiat currency.
We should not be surprised here, either, since it is a health-care market. In the U.S., health care costs have skyrocketed since government has destroyed the free market of health-care provisions. The law provides write-offs for businesses that offer health insurance, but individuals don't get that write-off, so health insurance is pushed onto the company which incurs additional overhead. We also see people using insurance for basic healthcare costs, which means that insurance companies spend money on non-emergency situations, so the cost goes up. Combine that with the AMA's fraudulent restrictions on the number of graduating doctoral students and you see a limited supply of available doctors (cost goes up when supply goes down), and then throw in the bureacracy of Medicare and the price skyrockets. England is worse, since they are (I believe) a cover-all insurance scheme.
Imagine if we all went to dinner and had to pay our own meals. We'd all get what we could afford -- burgers for some, steaks for others, soup for the few. Now imagine if we decided to split the bill equally. At first, we'd still buy what we used to, but some people would realize they could now afford steaks for just a little more cash out of pocket. When other people subsidize your irresponsibility, you become irresponsible. Eventually, everyone's buying steaks -- and all our costs go up. In government-run healthcare, everyone orders steaks, but the added bureacracy means the costs are well over the average steak -- and everyone expects to pay for soup.
The toss in IT run by government, and you have a history and a future of ineptitude, inefficiency, lack of competition to drive down costs, and the rest.
I'm not even sure what the point is of this IT upgrade. What exactly do they need this system for? Doctors work fine with paper charts and files -- this is a ridiculous amount of money -- what is the benefit and how do the costs make the benefit still beneficial?
As I said before... duh.
Sidenote: One of my lady's best friends runs a huge network for a hospital chain that is in the process of combining with another hospital. She's told me repeatedly that the biggest costs for her MIS department is integrating all the bureacratic changes that the government requires -- paperwork, forms, etc. While she's a big-government Republican (the new style), she is blown away that 80% of her staff deals with those headaches, which are constantly changing and always need more people to do the job. It disgusts me.
At $12 billion, I think it still falls short of MS's disaster of the last six years.
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
The article:
It's unfortunate but common to look at "under-investment" as root cause. Britain's problem could have been vastly improved even as a paper system by just getting their arms around communication, procedures, standards, etc. (I'm not talking about IT standards here, they're about as worthless as the electrons they spin on.) And then to be tantalized by Gates himself that technology (probably especially Microsoft Windows, sigh) would solve the problem.
I've seen amazing organization and communication among systems with simple low speed modem and dialup connectivity. It's not the technology, it's the grasp of the subject matter and how to organize it. Britain's example looks to be one of classic "good money after bad".
Get a bunch of people in a room who know what they need (sounds like they didn't) and put them together with a bunch of people who know how to do it (sounds like they didn't). It really is that simple, and it's not as hard as they made it.
The evidence?:
Though in the next paragraph the "CfH" denies that (why is it always organizations "denying" something, come on someone, step up and take accountability), I'm guessing the accusation is accurate.
When projects like this get going and the emphasis should be on subject matter experts (SME), the projects usually get expendable high-level highly paid deadweight -- I've seen it too many times. One project I was on we got assigned two SME's, one was so oblivious to the statement of the problem we even wondered if he (or she) had ever worked in the industry.
Other evidence the project was ill-conceived and guaranteed a disaster?: from the article:
I'm guessing $24B spent to get an X-ray in one minute instead of four begins to be diminished returns.
Also:
This just reeks of cronyism and idiocy. If for no other reason, I'd vote Blair out of office for this -- it's insane. Bill probably walked away from this pretty happy though. Aside from the questionable broad brush technology choice, "Microsoft is develop
Things here in the UK always seem to be thought of as failing or disaster before they're completed. I'm sure we hate success as a nation. We also have a huge obsession with celebrity and magazines that publish how fat celebrities are, or how their lives are in a mess always do very well.
I say wait until the project's finished before kicking it to the ground.
Join the Free Software Foundation
A country-wide site license for Web MD? That's what all of my local hospitals and clinics use- and it already provides a number of ways for communicating perscriptions to the chemists (from printouts to faxes to e-mail).
SJW: a person who perceives an injustice, and while correcting it, commits a greater injustice.
'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion
I imagine if you're the company getting paid the $24 billion, the project is a tremendous success.
The theory of relativity doesn't work right in Arkansas.
NPfIT
Clearly all that NPfIT needs to increase political buy-in and remain on schedule and under budget is a catchier name for the act. A good catchy feel-good name can bury a lot of dead bodies. Take USAPATRIOT for example. When in the private sector, adding punctuation or coining a new non-cultural word has its benefits too. Consider Cue:Cat: and Flooz.
[
Four years, a couple of trips to hospital, and more than a handful of GP appointments and this is the first I've heard of it. Way to go, NHS(!). Perhaps a better way to spend $24m (or whatever that is in £real money) would have been to keep my local emergency department open, rather than sending me on a half-hour trip to the next nearest hospital...
In 2003 my "D" drive crashed, restore of backups failed, and I lost all my, um.... graphics.
-- www.globaltics.net
Political discussion for a new world
and see if getting a metric ton of vendors to make their various bits all work together in some new way to deploy mega-healthcare infrastructure gets close to working. One vendor typically does not want to know or care to know what the others are doing which makes for lots of daily progress.
Oh wait, then there's the legacy system vendors.
Easy, in fact, too easy to take shots at programs like this.
They stand such a high rate of failure that incremental change should have been adopted in the first place. The politicians behind this one have all disowned the project by now I'm sure.
http://www.maxineudall.com/2010/02/should-economists-be-sued-for-malpractice.html
In fact, the most successful large scale projects always seem to be grown out of combinations of smaller architectures rather than a single massive architecture. Look at the Internet for an example. The protocol was architected. The routing design was architected. The information delivery systems were architected. The network itself? Grown with tender loving care, and Lots'o'peering agreements.
If you want to solve an issue like modernizing Hospital IT, start small and work your way up. Design each technology independently, but not monolithically. Keep an eye toward standards rather than specific implementations. (Standards will allow you to plug in a few competing implementations, giving you "best of breed" options.) Then use those technologies to build out a few test sites. Work out the kinks, then start deploying at a few more sites. Keep doing that, and the economics of scale will begin to take hold. (i.e. The more you do of something, the less expensive it gets to do it.) With any luck, the project will get done within a reasonable budget and timeline.
Never mind what I just said. There's your answer right there.
Javascript + Nintendo DSi = DSiCade
C'mon. A few Dell servers in a datacentre, running Gentoo and Postgres, and all the docs hooked up over ADSL - I mean, it must be that easy, right?
Get your own free personal location tracker
I actually work on this project, an application called Choose and Book. We've had a lot of success: little downtime, significant uptake, and physicians seem pleased with the user interface. If you want to know, it allows people at their general practitioner to book appointments with a specialist at a hospital. It actually does a lot more, but I don't want to burden you with details. It's a J2EE application.
This project is far from being a "disaster" as the British newspapers (little better than tabloids) like to tout it as. And the project has very little to do with Microsoft or Bill Gates. Most of the software my company is delivering is C/C++/Java running on IBM AIX.
If you want the opinion of a software developer on the inside of this thing, take my word for it: this article is trash. Like any huge project, it's just moving along slower than anyone first anticipated.
In the end, the British healthcare system is going to be faster and cheaper because of Connecting for Health.
random underscore blankspace at ya know hoo dot comedy.
The biggest IT disaster every was due to choosing the wrong vendor for
sourcing software, in which
deliberate bugs were planted
Resulting in major collapses of Soviet infrastucture.
Some may argue it's not an IT disaster -- but the root of the problem was that people sourced buggy software from closed source vendors and couldn't get their bugs fixed. -- The same thing happens all the time on a smaller scale when people buy Windows.
.. was what I was thinking, even before I read the article. Disappointingly I was wrong. EDS was the company responsible for a large number of failed or messed-up government computer projects. So the question is, given that another company entirely screwed up, are these projects just to sprawling and optimistic to actually work? My money is on yes.
I know the reason that this project, and others like it, will fail. This project cannot attract great IT people to work on it because its boring and run by bureaucrats. I'm a strong IT developer but I'd never work on a project like this. Life is just too short. I'd look for something a lot more fun that will attract great people to work with.
The behind-the-scenes IT operations for UPS (well, and the public-facing stuff) completely eclipses something like this, and it runs more or less like clockwork... substitute merchants for doctors, integrated warehouse operations for pharmacies, and half the civilized world tracking shipments in the second half of December... and then COMPETE with FedEx or DHL, and you get: success. Socialized stuff like this chokes because it involves people who don't quite have the fire lit under their asses the way that they would in a more competitive setting.
Don't disappoint your bird dog. Go to the range.
"The front page lead in [November 1st] Guardian explains how personal medical data (including details of mental illness, abortions, pregnancy, drug taking, alcohol abuse, fitting of colostomy bags etc etc) are to be uploaded to a central NHS database regardless of patients' wishes.
The Government claims that especially sensitive data can be put into a "sealed envelope" which would not ordinarily be available... except that NHS staff will be able to "break the seal" under some circumstances; the police and Government agencies will be able to look at the whole record -- and besides, this part of the database software doesn't even exist yet, and so the system will be running without it for some time."
Security Research, Computer Laboratory, University of Cambridge
Reduce, reuse, cycle
This might be the most expensive boondoggle, but a disaster is where peoples lives are lost. There are better examples of computer disasters.
Dominant Meme
...sleepwalking toward disaster...
Seems the UK tends to sleepwalk often these days...
worst thing is, only government and academic projects are ideally suited for very-large-scale (not commodity products like apache) open source-efforts, since for-profit businesses cannot afford a large staff of developers working without a chance of recovering the resource costs. So the very worst engines of ineptitude may well end up controlling the open-source developer careers of many.
If it were done when 'tis done, then t'were well it were done quickly... MacBeth
Windows troll?
Obvious. Droll.
Redmond tops neither
The IRS hole
Or a clean and sparkling soul.
Burma Shave
Get thee glass eyes, and, like a scurvy politician, seem to see things thou dost not.--King Lear
I have been programming 25 years now and I see a different problem at the root of these massive failures.
The current state of development tools is hideous. We have some very nice powerful languages, Java, C#/.Net, some very powerful databases, but we still have to spend hideous amounts of time making them work together.
These large applications (the FBI and this Health Care system) take soooo long to spec out and build that by the time they are done the requirements have changed, the technology has changed and the developers are always having to restart the process. I will admit, I do not like web applications. They are very limited in robustness. Developers resort to hacks like AJAX to make them somewhat useable. And it makes me mad that in the 21st century I have to resort to using a text based editor to design Graphical UIs. How dumb. Yes there are some WYSIWYG editors but they NEVER get you to where you want to go. Any good web application (of which I guess there 3 or 4) had the HTML written by hand. I had hoped XAML was going to change that. It will not, at least initially. It provides much better user experience potential, but in order to develop a real application you are still going to have to code text by hand.
What went wrong? The dBase III of the 80s was a far better development environment than what we have today. We have taken several steps backwards. Yes the end products that we develop today by hand scale enormously, but they take too long to develop. We spend at least 80% of our time coding plumbing that we shouldn't even had to think about.
If you can cut the development cycle, then maybe you can get a large application developed and delivered before it is out of date. Vendors need to wake up. If someone ever comes out with a real dBase/Notes/Delphi/early VB type product that can deliver large scale applications (hopefully not on web) they would put the others out of business.
Flash: Here is your chance!
slashdot troll = you make a compelling argument I do not like the implications of.
Huge waste of effort time and money. All in the name of making sure of something or other vaguely related to another Enron. We spend billions every year furiously auditing and managing compliance for essentially zero net improvement in security.
(massive govn't project + taxpayer money)^(at least cubed for govn't bloat) + corporate contract = One VERY happy corp.
Equation is defined in the domain {All big govn't}
Then again, maybe not.
I wasn't on the CONFIRM side -- I was doing tech support for Hilton and Budget's existing systems, which were being managed by AMR as part of the project. (Definitely one of the coolest jobs ever, BTW, even if it did mean waking up at 5am to talk to Bahrain and then staying until 6pm to troubleshoot problems in Brisbane.) But when it all came crashing down, I was close enough to hear the thud. From one of the links in the Google search above:
I still have some extremely unofficial documentation -- a satirical look at the unfolding and eventually unravelling project, written with the people and organizations represented by pseudonyms. For example, Mary Ott = Mariott. When Mariott pulled out of the project, character Mary Ott died in a tragic elevator accident, IIRC. They started out on an internal bulletin board that bore a surprising resemblance to what I'd later know as Usenet. They still exist in the form of printouts in my drawer... I'll have to transcribe them some day and put them online, now that all the players have moved on and the lawsuits have -- probably -- all been settled.
Stressed? Me? Of course not. Stress is what a rubber band feels before it breaks, silly.
I was involved in the early stages of this. Even from the beginning it had screwup written all over it - so bad that many of those who looked and examined it walked away. Rather than define standards it defined a monolythic entity that was then broken into 6 blocks, given to separate contractors, and then they were told they had to fit together. Then they held a competition to force prices down, played even more tricks to force the price even further down, and gave it to the lowest price bidder. The few weeks around that time were nuts with people taking the most shiny, most optimistic assumptions to beat the competition. 20% off best and final tells its own story.
We haven't even got to the part yet where things really go wrong, they are further down the line. However we already have large firms doing anything to get out and taking large losses to do so.
It is a huge disaster in the making and should be canned as soon as possible. What will be delivered will be an embarassing mess in comparison to what anyone here would expect from a 21st century health system. I'm trying to make sure my data goes nowhere near it
With 300 billion spent in the US alone fixing it, it seems like a significant "disaster" even if most people managed to avoid it.
I Browse at +4 Flamebait
Open Source Sysadmin
For more information about electronic medical records, and the efforts to create national medical databases, I would suggest an article that appeared in IEEE Spectrum's October issue entitled "Dying for Data." The article describes some of the monumental challenges in creating such a system, profiles the British effort, and highlights the success that the Mayo Clinic has had in moving to electronic records for all its patients.
[I can't link to the full text of the article, because that issue is not longer current. IEEE members can log in and view it, however.]
Among the problems the project has encountered:
One key health-care software subcontractor, IDX, was dropped from the program in April 2005 after one of the project's prime contractors, Fujitsu, "lost confidence" in its abilities, according to the NAO. IDX failed to respond to requests for a comment.
Come on, doesn't anyone have some type of enhancement pill they can prescribe for Fujitsu in its time of crisis? Or doesn't anyone want to comment on that either?
He who knows best knows how little he knows. - Thomas Jefferson
In health care, you don't have to computerize 10 documents or even a hundred, its in the thousands and thousands... Docters are set in their ways and can be slow to change... Health care is governed by a complex interlocking set of rules, regulations, etc...
Add to this complexity all the efficienct and results oriented forward planning of a government bureaucracy and you can be almost guaranteed that you will be building a boondoggle.
IMHO this is totally expected. If the system worked, that would be reason for a big headline.
so if I understand the summary right, they've basically done what the DNF dev team did - they want it to be the latest and greatest, so when they are just about done, they decide to upgrade the hardware or programming language, causing a need for the other to be upgraded (code a wont run on hardware y, or hardware x wont run code b) - therefor skyrocketing costs...
There's a bit of skew on this, though. You never hear about major IT disasters at private companies because 1. it's competition sensitive information anyway, and 2. if it's a major disaster, the company is snuffed out of existence. Remember, too, that most companies are nowhere near the size of a big government ministry because they don't have the huge customer interface: millions of customers, and millions of different types of contacts.
For a proper slice of the 12 billion pounds I'd be tempted to put up with the boredom for a year or two...
~Pev
"I was involved in the early stages of this"
What exactly failed. What hardware/software was chosen. Who were the contractors. What kind of network topology. How does a power cut in the north of England cause a distributed data base fallover in kent. Has something on this scale ever been done previously. If as you say they force prices down then where did the $12 billion go exactly.
was Re:Big surprise...
davecb5620@gmail.com
How could anyone screw that easy task up?
Terrible karma and aiming lower, which in this environment of one-sided reason, is higher.
And what if you get cancer, then what? Chemo drugs will drain that 10 grand in an instant - trust me I know. You can be as healthy as an ox and still have a health crisis bite you in the ass. I was prepared for it, sounds like you are not.
Y'know, I was one of several interviewers interviewing a candidate who answered an impossible question, with something along the lines of "I wouldn't do that", or something else indicating that he would give up rather than flog the dead horse. I thought it was the correct answer, but the other interviewer thought it displayed lack of dedication. Anyway, that person wasn't hired and the project failed. It really would have been better to give up early. C'est L'vie.
All ideas^H^H^H^H^Hprocesses in this post are Patent Pending. (as well as the process of patenting all postings)
...this is around £200 / 400USD. Ouch - kinda puts it into context...
~Pev
(though I wasn't involved in the project -- it was a completely different division. However, I did pay attention to news and rumors). I won't mention which company, but they actively sought out another company to acquire them, due to their faiure on this project.
Anyhow, I wasn't surprised when the company failed it, and I'm not surprised that the project is a failure.
This New Labour government happens to be the most corrupt in history. :-
In fact Phoney Blair and his cohorts make Robert Mugabe look like a saint.
Here's how Billions upon billions of UK taxpayer money is stolen from the public
1. Announce a project of your liking (Millenium Dome, Wembley, Terminal 5, London Olympics, NHS IT restructuring...)
2. Declare that the project will last only 5 years and cost the public only e.g. £100million
3. Decide how long you you think you can safely stretch it out to
e.g. stretch out Project X to at least 10 years and inflate the costs 10-fold
5. appoint your own no-bid contractors who have especially set up bank accounts in the
Channel islands etc and who can then easily transfer monies into your offshore accounts
4. keep coming up with excuses - and at the last resort blame contractors so you can get as much taxpayer money as possible.
It has wokred for them time and again. UNTIL NOW...
Once people wake up to what is happening - we can make the necessary changes.....
The Inquirer is running a report http://www.theinquirer.net/default.aspx?article=35 685 in which it is claimed that the leader of the project failed his computer science exams at university. What is really funny is that it is his mother who let this cat out of the bag.
Choice quote: "The retired teacher, who hasn't spoken to her son for ten years after a family row, said yesterday: 'I can't believe that my son is running the IT modernisation programme for the whole of the NHS."
(You might wonder why she is attacking her own son: she did so in protest at the closure, or threatened closure, of a local health facility, the cost of which is dwarfed by the amount that has sunk into the black hole that this project appears to have become.)
I work in the NHS. I hope to one day practice clinically for the NHS. I usually like to espouse the benefits of a nationalised healthcare system, but fuckups of this magnitude piss me off. Aside from the fact that other organizations can do better with less (see NASA, etc), these kind of things normally come back to the same mistake: failure to plan (design) properly.
Even looking at some of the touted features in the summary, I can see bad decisions:
"...allow for the electronic storage and retrieval of patient medical records..."
We have this already. It doesn't work. Well, I can't speak for hospitals - the only IT system I've seen in use in hospitals is what looked like an old version of Unix. That said, it looked like it (mostly) worked. In the surgeries I work in, we use GPASS. It doesn't work. When it does, it runs like a dog. Case in point: yesterday, we had the server in our practice go down. ALL STAFF (clinical and clerical - doctors, nurses, admin staff, receptionists) were unable to use their computers until the server came back up. It takes 20 minutes for the server to come back up, so fortunately it happened towards the end of the day (and not during a busy 'flu clinic), so disruption wasn't as bad as it could have been.
So essentially what they want to do is replace a barely working decentralised solution with a nonfunctional centralised one. Can anyone say "single point of failure" ?
"...permit patients to set up appointments via their computers..."
Haha! All I can say is "yeah, right". We currently have a booking system designed to minimize defaulting an appointment, which has the result that the doctors have less time wasted, and therefore more time to see patients. And still we get complaints. A patient led system would be chaos. I can see the benefit for hospital referrals, which are usually made comparatively well in advance, although the departments normally send out appointments themselves.
"...and let doctors electronically transmit prescriptions to local pharmacies"
This doesn't help that much, since the physical copies still need to be sent for verification. Scripts can be phoned through, which is convenient enough. Perhaps this could be of more use to hospital doctors, although they don't normally act completely independent of GPs - care is normally shared (letters exchanged, phone calls if necessary, etc) anyway.
It all comes back to bad decisions - first the politicians make the bad decision to announce a new nationwide IT system that will bring the NHS into the 21st century. Then the managers make bad decisions on what features to implement to make it the 'ultimate IT upgrade'. Finally, some ill-concieved, vague spec is handed to the software engineers and those putting the hardware together. The result... well, doesn't work.
And all it cost was £12B. Or maybe double that...
Sorry for the rant, but I have to work with some systems which are pretty abysmal in some respects (mousewheel scrolling our appointment list causes errors, to pick one off the top of my head). I'd like some choice, like being able to use linux/*bsd/solaris/whatever on a *server* instead of windows. More importantly, I'd like a NHS IT project that actually worked for a reasonable sum.
If anyone working in the NHS has a more optimistic view than me, I'd really like to hear it. And if any of the GPASS devs read /. : get a new project manager!
If all you have is a grenade, pretty soon every problem looks like a foxhole -- MightyYar
'We've been working on this for years,' a spokesman burbled, 'honestly, we'd like to thank EDS, Lockheed, Siemens, Microsoft and BT who've been laying down the groundwork for this cockup for years now.'
To what do they owe their success?
'Pacing, it's all about pacing. We started small with screw-ups in the Magistrates system, Air Traffic Control and the Child Support Agency, then we could take on more ambitious schemes.
'Frankly we never thought we'd top our work on the Passport network or the Department of Work and Pensions - I mean it's hard to beat ruining people's holidays or taking away their benefits. But somehow, we managed; personally I think it was getting a guy who failed his computing courses to run the project that sealed the win. We're thrilled, no one anywhere can boast of a track record like this, it's good to see Britain taking the lead in this exciting new field of technology.'
So will this mark the culmination of British government IT failures?
'Not for a minute!' the spokesman laughed, 'you ain't seen anything yet. Wait until we get to work on ID cards - we think we've got the perfect combination, a PM who couldn't spell Internet if he tried, a government department described by its own head as 'unfit for purpose', snakeoil biometric technology, a ludicrous budget, no specification and best of all, the guy who nearly bankrupted Sainsbury's with their IT system! Stay tuned!'
Remember, too, that most companies are nowhere near the size of a big government ministry because they don't have the huge customer interface: millions of customers, and millions of different types of contacts
Hence my citation of UPS (www.ups.com). They DO have millions of customers and hundreds of integration schemes, and it has to work, around the clock. They're a great example of doing it right (as is FedEx). You're right that the really spectacular failures put private businesses OUT of business... but that's part of why government projects are so horrific. Those fail, and there's no conesequences (except to the taxpayers). So, they just do it all over again.
Don't disappoint your bird dog. Go to the range.
I worked on a state child support system project that was regularly denounced in the media as a "disaster".
I'm not going to go into all the details here, but most of the stories were just bunk. The users, who had despised the old system when it was rolled out, suddenly loved it and hated the new system. So they went to the media with their complaints. Nobody wanted to hear actual *reasons* for anything.
Ever since I take any story like this with a HUGE grain of salt.
I'd hardly hold up UPS as a model. I've had the counter staff at the UPS customer service center tell me not to bother checking with the on-line tool because it never matched reality during the holiday season. Operations that seemed to work fine during the rest of the year, like having a delivery held for pickup, took two or three tries to take effect, resulting in a couple of wasted visits to the center. Never mind the fact that UPS refused to leave packages at my apartment complex office and then would never show up for the next delivery attempt at the time they claimed on the slip they left at my house. This year, I'm going to shop locally. It may be a pain to travel between stores, but that is nothing compared to the frustration of dealing with UPS.
======
In X-Windows the client serves YOU!
What an asinine analogy!!! Lets put it another way:
Imagine if we all had cancer and had to pay our own treatment. We'd all get what we could afford -- chemo for some, surgury for others, nothing for the few (ie middle class and below).
I myself am worth quite a bit of money and wouldn't subscribe to this rubbish. I'd also bet if you were seriously ill, you'd die due to lack of funds. Its why Anarcho-capitalists are fools, they can't live by their own philophosy.
Parent describes a sensible methodology for working on any big project- define your needs and tackle it piece by piece. It makes you wish they'd just given a few tens of thousands of dollars to consultants and had some experts draft out a plan for them.
Much Madness is divinest Sense --
To a discerning Eye --
Much Sense -- the starkest Madness
It is a project paid for by the government but not a government project.
From TFA:
"Accenture proved the big winner ... Computer Sciences Corp. (CSC) was awarded Northwest with West Midlands; BT beat out IBM to get London; and a Fujitsu-led alliance won the Southern region. BT was also given the contract to build both the N3 network and the National Spine, while yet another vendor, Paris-based I.T. services provider Atos Origin (formerly SchlumbergerSema), was commissioned to provide Choose and Book."
If anything, this is an argument for bringing these projects in-house (a true government project). There is no way it can be said that outsourcing saves money and they couldn't afford to do this in-house - $24 billion buys you a lot of good staff.
Am I the only person who is bored of hearing people whine about the failures of government when it was actually private companies that destroyed the project? We're told by much of the press that governments are wasteful but when a trillion dollars is lost in the dot-com bubble of the private sector, this demonstrates the efficiency of free markets...
--- "We've always been at war with Eastasia."
The government has also passed legislation that will allow anyone on the system to release confidential information about a patient when it is seen to be in 'the public interest' (a deliberately vague term). Previously personal information could only be released under specific circumstances with the consent of a patient's GP or specialist. You can imagine how insecure this will be and what a tempting target for blackmailers and scum-sucking journalists looking for dirt.
Despite these concerns the government is proceeding to upload personal information on to the Spine using a system of 'implied consent' - that is, if you don't opt out, your data will be put on to this privacy nightmare. Once the information is on the Spine you cannot ask for it to be removed, nor amend it where it is found to be incorrect. The Guardian has produced the most readable to this meltdown and has also published a guide to ensuring your personal data is not put on to the spine.
"Excuse me, Your Majesty, but 'nipflot' is over budget again..."
"Off with his head!"
No project which employed more than 20 techies ever really worked.
Which may seem a strange comment from someone who has been involved
in 500 plus people projects that came in.
This was entirely due to project managers who picked the 20 best
techies and worked them to death while giving the other 480 busy
work.
Obviusly given that EDS, Accenture etc. are involved the top
0.1% in this project just werent good enough.
Old COBOL programmers never die. They just code in C.
Although many people are not aware of it, the Veterans Health Administration (otherwise known as the Veterans Affairs/VA hospital network) in the United States has progressed from a backwards, poorly-kept system in the 1980s to the best, most advanced medical organization in the nation. Read more here, here, or this reprint from Time Magazine.
It's proof that government + healthcare + technology does not always equal disaster.
$nice = $webHosting + $domainNames + $sslCerts
I worked for Healtheon back in the proverbial day. They had all of the software that the UK wanted to deploy up and working back before 2000. Lameness!
Oh well. $24B in venture funding could have produced one hell of a great electronic health care system...
Wiki sez:
The project which was meant to cost approximately $119 million ended up costing over a billion dollars to implement. Documents obtained by the Canadian Broadcasting Corporation now estimate the program cost at $2 billion.
I don't get how it can cost so much when its just a simple database app that most of us could write in a day. However I have heard that noncompliance of gun nuts was a cost. Eg flushing rolls of toilet paper to cause a flood.
Just to clarify...
the UK consists of 4 countries (England, Scotland, Wales & N. Ireland).
Please don't refer to UK or GB as "England". The Scots & Welsh get very upset. They benefit from the NHS, too. In fact, the Scots make the money (from oil rigs) for the "English" government to squander on IT projects and making the South-East a nice place to live...
"the English government" ?? "England's entire National Health Service" ??!? Has England split from the rest of the United Kingdom again and formed it's own government? And taken the NHS with it? When did this happen? Or is this a sly attempt by the rest of Britain to distance themselves from the project ? :P
"er.. yeah it was them dozy English - never happen in Wales/Scotland/Norn Iron (delete depending on where you live)"
Disclaimer: yes Wales, Scotland and NI (sometimes) do actually have their own assemblies. This post is provided for your entertainment only, and is not intended for use in a serious debate! Also, don't eat the yellow snow, or run with scissors (or hire Accenture unless you have heaps of money to burn).
That statement also sounds like U.S. too.
Ant(Dude) @ Quality Foraged Links (AQFL.net) & The Ant Farm (antfarm.ma.cx / antfarm.home.dhs.org).
nb: I've used Torex software, and my distant cousin is the exCEO of iSoft... but what I'm saying isnt biased, as I've never met him, but yeh.
Having worked with Torex software, at a GP surgery, I can say that the software is effective, but very dated. It works tho. You can get pathlabs direct from the local labs direct to the patients file, however, the software is hugely short sighted in user interface issues and in administration. For example - with GPs ordering, quite often, blood chem and heam at the same time, for many different patients, it's not unlikely that a surgery will see some 200 results in their labs "inbox". Sadly, the interface "did" not allow this information to be directly attached to a patients record. I had to setup a rather unstable mouse macro to perform a task that, realistically, should have been done automatically without the need for review (the only exception being exceptional records where patients cannot be matched to a record, temp NHS registrations for example)
What can individual GPs do about? Nothing. They simply must purchase software that uses an outdated GUI interface that is less effective than the green screen VTs they used. Most of the work that needs to be done should be simple dump and store. There was no way to contact iSoft/Torex (nee Torex Systems ?, they split from Torex at the take over I believe), even tho they had a development office only 8 miles down the road, and I'm related to their CEO.
The approach taken by the NHS was disastrous - they reused a company they knew had poor and outdated software. By allowing relatively inexperienced companies to bid on such a huge rollout was short sighted. Not allowing them any cashflow and making them penalize their supplies is down right fucking stupid. Anyone who has taken basic business or even filled in a tax form knows you cant run a business on cash advances - the balance sheets will never add up. No wonder providers pulled out when the saw astronomically negative balances. Torex compounded the issue with accounting "errors" in attempt to push the financial burden to the following year, thusly avoiding immediate fallout and allowing them to renegotiate the NHS contracts.
The NHS can save face, but only if they rethink the plan.
Oracle must provide the database backend.
The NHS must provide redundant datacentres in conjunction with GPs.
The backend must include onsite-databases (ie: each surgery has a copy of the patients records). When a hospital requires them, they are pulled in a relatively short time (seconds or minutes) from the holding surgery (GPs hold patients here, and they always have)
Nightly updates should be sent to the master datacentres.
A single server OS must be agree upon - all the old SCO systems should be replaced with something a little more modern. Solaries and enterprise Linux offerings are out there...
A single "office setup" must be agree upon. MS Office seems logical.
A single, standalone appointments system needs to be constructed, and simply "inform" the database backend via the internet
Likewise, labs must use similar standalone systems that copy the data to the backend.
Fundamentally, the whole backend should be internet based, IPv4 - encrypted yes. While at the same time as rolling out the system over IPv4, the backend that the NHS and politicians desire should be constructed (so that means wires laid across the length and breadth of the country), so that in the long run, endpoints can switch to a free interconnection medium.
Most the information a GP is going to interact with is too highly specific to normalize properly. They will deal with information about a patient, blobs. Nothing expensive is require to convert blob formats because, as blob/files, they can be read by the specific packages, and on update/write of blobs, individual packages should interface with a freely available API that can be tailored to update the master database. (yes, think OSS plugins for automagical Save-As!)
I have to stop thinking about this. It'
For a project like this to succeed, it will need leaders who are doing more than your contribution of 'put up with the boredom'. Could you really look the hiring manager in the face and say you are excited about contributing to the project?
You sound very mercenary to me. When I hire people I make sure I avoid hiring mercenaries.
The battle between the US and European nations.
The UK screwed up by spending X amount of money!
Oh yeah? Well the US screwed up by spending Y amount of money!
Will it ever end?
You're comparing purposefully designed flaws done by the CIA with Microsoft incompetence? THat's kind of a stretch.
More importantly, perhaps, was the fact that the CIA was also screwing with the HARDWARE at a manufacturing level.
Frankly, your entire argument doesn't make sense at any level. If the Soviets had the people to check the software in-house, it would have been far more reasonable and realistic for them to make the software in-house too. Instead, the entire REASON the KGB was stealing this software was because they COULDN'T develop it themselves.
For god's sake, the KGB was stealing American technology and the CIA introduced purposeful bugs to counter them. That's got abso-fucking-lutely nothing do to with IT and everything to do with spycraft.
Only an absurd zealot would be in able to connect that somehow to Microsoft being bad.
"It is possible to commit no errors and still lose. That is not a weakness. That is life." -Peak Performance
Taiwan has a population of roughly 22 million, whereas England has about 50 million. They managed to distribute and implement (and, last I checked, it's in perfect working progess) a smartCard for National Health -- i.e., an ID card with a nifty chip on it that stores medical information, etc, for under $2 million. Linearly, the UK's budget shouldn't go over $5 million or so -- but what went wrong?
At the moment in London there's a couple of contracting (freelancing) assignments in my area of IT in "governmental institutions".
They're all paying about half what the investment banks around here would pay for the someone with the same skill-set and about 2/3 of what the rest of the industry pays.
Today there was even an urgent request for a senior developer offering less than most non-urgent assignments out there for junior developers.
Here's a sugestion:
Stop wasting money on studies of studies of studies, layers upon layers of management and feeding the blood-sucking big IT consultancies and their "all talk no action" "consultants" and instead invest on getting good people to manage the projects and do the work.
PS: It'll never happen - governments are the worst kind of monopoly and as such they're big, fat, have enormous overhead and are extremelly susceptible to influence peddling and feeding all sorts of private industry leeches (leeches like the kind of "consultants" from the big IT consultancies whose real work is producing vaguelly worded documents about how more study is needed before a solution can be found and to get the client to pay for even more salesmen-consultants and for projects solving problems that don't exist).
[I've worked for a consultancy AND also been on the other side. They do have some people that do a great job, but their business model, business practice and mindset - especially in consultancies with a "big name" - is to send high-payed consultants with instructions to "stay there as long as you can" and "bring us more projects from that customer". I also know (from inside) how much selling services to governmental institutions goes around "knowing the right people", "having a big name" and "giving them the light and mirrors show"]
The U.K. Office of Government Commerce (OGC) are the guys who invented ITIL and PRINCE2.
So now they don wan't to use their own IT management products? Maybe they aren't working?
Weird.
The NHS is the largest employer in the world, except maybe for the Indian and Chinese militaries.
You probably do have to have an IT system this big, if you are going to have an organisation this big.
Sensible people see this is one of many reasons not to have an organisation this big. But not the British Government. They really like big centralised organisations. They are the solution.
Now, what was the problem?
Read the wikipedia article I linked on it, it only says England and, in fact:
It's a four headed beast feeding on the trough in medical care.
You already mentioned doctors, with the AMA and medical schools restricting supply. This gets even worse in specialties. Actual plain doctors aren't making nearly as much as they used to, but the specialists are raking in a lot still.
Drugs companies are a primary culprit. It is no coincidence that this is the most profitable sector (percentage wise) of them all, I think they average a 10-20% profit. Combine that with the ugly fact that 40-80% of drug company expenditures are advertising, and, well, that becomes a lot of money/cost real fast.
Lawyers. Malpractice insurance exists because of these guys, and it is expensive. Part of the problem is the doctors and their old boys network that protects the incompetent. But most of this is greedy lawyers.
Finally, the insurance guys. They only make a 4-8% profit under most circumstances, but the merits of economic competition producing a more efficient management infrastructure isn't very true here. First off, most insurance companies have merged and scaled up so that there is an effective cartel in action. Second, they get most of their revenues from the government, so their goal isn't to be efficient with the government, their goal is to be efficient at getting the government to give them money. Exactly like how Enron assfucked California for 3-6 months.
I suppose you could add the government itself to this equation. After all, it takes your tax dollars and imposes a huge administrative clusterfuck on the world. But being antigovernment in this case isn't constructive, just like water and electricity are regulated utilities (again, look at what happened with Enron and the California deregulation to see how utilities are best kept regulated pseudo-governmental entities).
I would be remiss to omit the steady aging of the most self-centered generation of all time: the Baby Boomers, who partied, drugged, fucked, and consumed with no restraint in the 60s, 70s, 80s, and 90s, and now expect us to clean up the mess. A big Fuck You to those people.
Whenever any debate about health care comes up, each of these point to the other ones as the culprit. Since stupid Americans can't figure out that all of these are the problem, they just get frustrated and tolerate the current shitty system.
Hey, I'm just your average shit and piss factory.
In every case when I have the ear of the business process reengineering gurus with their petri nets covering virtually entire floors of office walls -- I suggest that what they first attempt is simply scanning the paper (that people are shoving around) into CDs (that people are shoving around) and viewing at their workstations (this should include recordable phone calls of course).
Then, once people are comfortable with that digitization process, occasionally -- just for a day or so -- pretend that the digitizers are broken so the organization is forced to go back to shoving paper around just to make sure the "paper trail" is still there and that the backup system works. The next step is obvious: move the scanned images around around on a network rather than moving the CDs around and occasionally pretend the network is broke so the organization is forced to go back to shoving CDs around. You keep incrementally abstracting your process making sure each step is positive return on investment without putting the whole system at risk.
During all this you take statistics on the flow and cost of various things to get an idea of the _real_ business process -- how critical various backup systems are and how much you can afford various kinds of redundancy where.
You really can get positive ROI this way but few want to do it for some weird reason.
After witnessing enough of this nonsense (it pervades the public and private sectors and is now going multinational with NGOs) I decided to drop out and just go to the root of the problem -- stupidity -- by promoting the Hutter Prize for Lossless Compression of Human Knowledge since that looks more likely to create the level of intelligence required to stop stupid people from taking over business process reengineering pork and only to drag entire processes into chaos and disaster with them as they leap into the abyss.
Seastead this.
i'm amazed at how little common sense some folks have. Deming had it right - Plan, Do, Study, Act...
...
those who lack common sense omit the Study and Act part - and everyone else foots the bill for their incompetence.
This kind of project is insanely simple - if done right.
1. Plan: start small (with an eye for massive scaling, of course).
2. Do: complete a small increment of the work - perhaps start with one hospital.
3. Study: what did you learn? what were the problems? what was the user feedback?
4. Act (on what you've learned): take what you learned and implement improvements.
5. Plan: add in a local pharmacy for the prescription module.
6. Do: set it up
7. Study: what did you learn? what were the problems? what was the user feedback?
8. Act (on what you've learned): take what you learned and implement improvements.
9. Plan: Scale in a second hospital or, perhaps, a whole region of hospitals
you get the idea.
start small and make lots of manageable incremental improvements along the way.
they could better control the purse strings and they will get timely feedback.
my guess is they blew billions before they even had a clue something was wrong.
management - make getting competent a high priority. take pride in your work. go home with a sick feeling when you fail so miserably. have some pride, some dignity. respect your obligations and th epeople who pay you to get the job done.
Several weeks ago, Ross Anderson and his colleagues set up a wiki containing all the material they've collected on the NHS IT project, and the problems it's facing. Check out his post here: http://www.lightbluetouchpaper.org/2006/10/10/new- website-on-nhs-it-problems/
And the actual wiki here: http://nhs-it.info/
We in the UK are masters of taking great ideas and implementing them embarrassingly badly. The NHS is a wonderful thing run by idiots.
The current government has more than doubled the NHS's budget, I believe. Is healthcare twice as good as a result? Is it hell. Why is this?
Maybe this little anecdote will give you an idea.
About a year and a half ago I got a call from a recruitment agent asking me if I'd be interested in doing some work on this NHS mega-project. She told me a bit about it, I said "yeah, fine, put me forward". Immediately, without asking what my daily rate was, she said "Now, we can't pay you more than £350 a day, will that be OK?" Ooh, I'll struggle by, I said. Let me tell you, my usual daily rate at the time was rather less than that. I didn't get the job, by the way.
The thing is, that £350 I would have been getting would be paid to me by a company who would also have had to pay the agent a fair amount of money. This company was itself a subcontractor for Fujitsu. Who were a subcontractor for BT. Who were being paid by the NHS.
Now, by the time everybody's had their cut, how much do you think my £350-a-day work would have been costing the NHS? A grand, maybe?
Ooh, I wonder how they went so massively over budget?
And of course, the reason for all this pointless sub-sub-subcontracting is simply that when the shit hits the fan, everybody can point the finger at somebody else. I can't help thinking that if they thought less about passing the buck and more about Getting The Job Done, it would cost a quarter what they're paying.
actually work on this project, an application called Choose and Book. We've had a lot of success: little downtime, significant uptake, and physicians seem pleased with the user interface. If you want to know, it allows people at their general practitioner to book appointments with a specialist at a hospital. It actually does a lot more, but I don't want to burden you with details. It's a J2EE application.
Choose and book is a perfect example of why this project is way way over budget and, I'm sorry to say, ill-conceived. I know people who work with it.
The system searches all the records in the UK for patients instead of the ones actually at the GP practice in question (no possibility of privacy problems there is there?), is very slow, and doesn't focus on what the doctors wanted in the first place. The drive for this kind of system should come directly from the clinicians. How many GPs have you spoken to about it, and did they actually come up with the requirements?
The old system was the GP would choose a hospital from the few near the patient (based on their judgement of what was best for the patient) and call the specialists there to arrange an appointment. Many patients only have one or two hospitals which are realistic options anyway.
The new system is they have to use this computer system (many of the hospitals aren't working properly with it yet anyway), cajole the patient to choose something, and then call around anyway to check it's all ok. In addition, the patients have NO IDEA which hospital is best, best being the one which has the best specialists for their condition, the shortest waiting times, and a myriad of other factors. So their choice is in fact the illusion of choice, and many simply say 'well, whatever you think doctor' - quite sensibly I might add. The whole idea of choose and book has been foisted on the GPs by a govt. and management consultants more interested in sound-bites and keywords eg 'Patient Choice' than in patient care.
If you truly think everything is going swimmingly, it might be worth reading some of the articles in the medical journals on choose and book. Now maybe you delivered the system as designed, but it is broken by design. Doubtless it's not the biggest IT disaster ever, but there have been serious problems of scope and ambition in this entire IT upgrade project (ie an attempt to be all things to all people) which are architectural problems, and just won't go away at this stage.
Thinking that only the IRS or FBI could botch a large project.
Here is why large projects fail. First, you need complete buy-in from management. Second you need to accurately assess the risks/failure points and plan accordingly.
The risks need to be analyzed and can be anything from a bad app, to a vendor not being able to deliver when required.
These are things that government in general does very poorly.
This is my favorite. The error started from a single key-in mistake --> more than $230 million dollars in damage. How would you like to be directly responsible for one of the largest slides in the Tokyo stock exchange for 2005? http://www.physorg.com/news8901.html
Microsoft did do something similar in the past. Windows 3.1 (AFAIR) would check if it was running on top of DR-DOS, and if so would randomly fail.
Michel
Fedora Project Contribut
So....you are saying my Aunt Betty is a Microsoft Word using communist spy?
Look into the Health Savings Account. It's similar to the old Flex style savings, but it works more like an IRA. Yearly tax deferred contributions up to the amount of your deductible (although there may be another IRS imposed hard limit that's lower than your $10,000 deductible.
The best part is you can deduct tax free and without penalty from the HSA for any health related expense (including paying the deductible). There's no "use it or lose it" aspect, because it works just like an IRA. If you never touch it, it just keeps accumulating. I also believe the mandatory withdraw after 67.5 (I think?) does not apply to HSAs. Finally, as I understand it, you can withdraw for non-health related fees (taxed) after the retirement age.
I'm VERY happy with mine, although my deductible is only a mere $1800. The way I see it, it's an extra $1800 I'm putting towards my retirement. My old insurance was a copay (80% on most stuff), and was costing me as much each month as my current monthly HSA contribution ($1800/12) plus my current monthly insurance premium. If I have to claim my insurance, I end up breaking even. If I don't use insurance (and I haven't in 10+ years), then I make an extra 1800/year. It's a win-win for me. To put it another way, if I'd been using HSA for the last 5 years, I'd have put over $10,000 into retirement instead of the insurance company's pockets.
Of course, for this to work you have to treat medical insurance like insurance. This won't work for people who go to the doctor monthly. Big expenses only! It helps if you're young, too.
Just FYI, my HSA is through ExanteBankHSA.com. I'm not horribly pleased with their rate structure, but they are the one who was supported directly by my Health Insurance agency. If anyone has a better HSA provider, please let me know!
Motley Fool HSA Introduction
No. I'm comparing Microsoft's deliberate incompatability with competitors to the CIA's deliberate incompatability with Soviet infrastructure.
You should learn more about Microsoft's business practices before dismissing it that quickly.
- Apple alleges that Microsoft created intentional incompatibilities in Internet Explorer 4 and Windows 98 which break QuickTime
- Microsoft VP deiscussed their plan was to plant code into Windows which would "put competitors on a treadmill" and cause the system to "surely crash at some point shortly later." (from the same link)
- Microsoft publishes limited specs about their filesystems so if you want a reliable Database on Windows you either need to use SQL Server or write your own filesystem like Oracle did.
- Microsoft continues to plague the Samba devels with incompatabilities that can only be deliberate.
They have a long history of sabataging competitor's products - and have been convicted for it once. How is this not similar to two competing countries doing it to each other.Wait till the National Identity Register gets going. Your one-stop identity theft shop.
Fingerprinting and iris scanning the entire population, extracting DNA from as many people as possible arrested but never convicted for offences like Driving While Black, your current and all previous addresses recorded, being fined for not notifying the police if you move house: your bank account details and employment history collected centrally, and your details sold to any commercial agency that wants them (to recoup the ever-escalating costs of this mad scheme): all dependent on the oh-so-reliable and cheap biometric collection technology and data entry done by underpaid disgruntled civil servants who'll sell personal info to husbands looking to find their runaway beaten wives or to stalkers.
And the system set up by the lowest bidder. EDS or Capita are the usual suspects, both having walked away with millions from previous UK government IT fiascos. This time round, they'll pocket billions.... Think of the film Brazil, but not so optimistic.
Nurse! Time for my medication!
About the plans for UK ID cards, that is. While their plans are awful and broken and will damage civil liberites irreperably and lead to all sorts of trouble, at least I know that they are incapable of implementing those plans, or indeed *any* IT project.
Passports, courts, air traffic control, health, fire/police radios. the list of failed UK government IT projects is endless.
~~~~~ BigLig2? You mean there's another one of me?
so did you count the managers in the redundent 1 out of 15? (hint a lot of times you will find that keeping the manager busy is a great way to get stuff done)
Any person using FTFY or editing my postings agrees to a US$50.00 charge
Real Problem: Profit vs Waste
Which provides a better cost to benefit ratio?
Any organization well administered will run just fine. (paraphrasing Ben Franklin)
Specifics play a big part as does the culture as to how the well a system is run.
(idiot with linux vs god with windoze)
Like making a complete decision tree for chess, you can't have rules solve everything but they are necessary for the game.
Healthcare has high administration costs and MANY if not MOST those rules the public wants (for their own well being, as protections for themselves against errors. This IS life or death.)
UK healthcare has a low cost and high benefit ratio. The USA does not.
Its not just that they have less administrative costs (just 1 vs 1000s of layered competing orgs) the UK has the other big expenses that they minimize. They can waste trillions before they tip their ratio to where the USA is.
Fans are often irrationally behind their preferred systems.
Democracy Now! - uncensored, anti-establishment news
COI: I have worked on IT projects, and was involved in early focus groups for the NPfIT. I am a practising clinician and left these projects due to disillusionment and an inability to make change.
1. Clinical involvement has been very poor. At even early meetings, it was very clear that the specifications for the new systems were already fixed and unchangeable as they formed part of a formal OJEC notice already posted pending bidding under the European procurement rules.
2. Technology has been used to enforce/encourage/force change on the ground. IMHO, technology should facilitate change, but not impose it. Many of the processes involved in the NPfIT have been top-down, often politically driven, rather than clinician led. These new IT developments have been used to drive change and force a different way of working.
3. There have been numerous worries regarding patient confidentiality and the number of people/organisations having access to centralised data. Many of these issues have been ignored, to be dealt with "at a later date".
4. Systems such as choose&book are poorly thought out and are often used to enforce local political will. For example, local Trusts can refuse to take referrals, actually limiting choice compared to more traditional doctordoctor referrals.
5. The rationale for a centralised data record has not, in my opinion, been fully proven. Data quality held centrally is known to be very poor, and even data held by GP surgeries can be of dubious quality. This will mean clinicians will ignore centrally-held data, in favour of getting the truth from the patient. The "spine" (the centralised patient record) will become a white elephant.
6. There are several sub-projects that, in my mind, are much more straightforward - "low-hanging fruit" so to speak. Development of medical IT needs to be iterative and slow, with a focus on specific task-orientated projects rather than a big-bang, top-down approach. For example electronic prescribing can cut transcription errors, aid doctor-doctor/nurse/pharmacy communication and prevent medical incidents.
7. Procurement needs to be task-driven, small, highly focused, rather than the poorly defined, "do-everything", suits no-one project it is becoming.
8. Newspapers and the media fail to report the fragmentation within the United Kingdom. England's IT strategy is different to that of Wales and Scotland.
9. Dividing England into five separate regions for procurement was a huge mistake. These regions are not small enough to ensure that development is led by front-line staff, and yet there are five regions all repeating the same solutions/mistakes, often procured from the same supplier. It should have been a task-driven, focused, iterative procument.
10. There are a number of posters (mainly from the United States) shifting the discussion to that of public vs private healthcare. This article is not about these issues, and the NHS in the UK is very different to the United States.
Rant over. I could go on all day!
Apologies for posting anonymously.
Choose and book doesn't sit on the main NPfIT backbone as far as I'm aware. In the hospital where I work, we've had a few issues with it's implementation, but on the whole, it works after a fashion.
Now the core NPfIT product (I take it you've had your training; The product is pretty shoddy. I managed to register several patients in the same bed (woo hoo, except you really don't want that happening), registered a male with a diagnosis of prolapsed uterus (all from the point and click menus for god's sake), crashed the front end application several times, and picked holes in their data model on several occasions.
Their system of data aliases is broken. Relying on a hospital to have a working internet link to even access their own patient data is nuts! Now a simple snip of a couple of fibres can stop a hospital in it's tracks. No local data caches.
This project was never truly specified correctly, and it's implementation is broken (did you know a few hospitals have refused to go live yet because of too many outstanding failures in the product, which the consultancy company has had to raise it's hands and say "You got us. Yes, it's broken.".)
So, speaking as a front line implementer (I'm one of the systems admin team for a hospital rolling this stuff out), I'd say there's a lot of meat in this article. NPfIT scares me.
Posting anonymously for the obvious reason that I'd rather like to keep my job.
Right. Because choosing to work on a project that will be used by hundreds of thousands of people across the country couldn't be even the least bit rewarding in itself. Nobody could ever consider that job as anything but boring, and clearly indicates that I only took the job because my skills are inferior to those of every other software developer in the nation.
Frankly, it's been my experience that the fewer self-important amusement-obsessed people like you there are working on a given project, the better it generally tends to go.
the coolest club on
Fucking troll. Go away.
The usual figures for Medicare vs. private sector overhead are 2% and 20-25% respectively.
One Medicare overhead analysis disputed this, estimating 5.2% for Medicare with some hidden costs accounted for, and 16.7% for the private sector.
This seems to be an exception to the usually reliable rule that government is less efficient than the private sector.
I have to deal with Accenture on almost a daily basis through my company's contract with the U.S. Government. I just want to say that they are the biggest bunch of assholes I have ever met. The People Soft based IT system that they "deployed" is useless to say the least and I swear to God they have more lawyers and contracting managers then they do developers. Every time I turn around they are shifting blame from their own incompetence onto the company I work for and the Government people who are overseeing the contract have no technical know how to call Accenture out of their own web of lies. Whenever I hear the words "Accenture" and "Government contracts" I now immediately think of a large toilet flushing with Tax payer dollars in it
How about Skynet, that was/is/will be pretty bad.(Not sure were we are in the timeline)
"Any large, complex system that actually works has evolved from a smaller, simpler system that works".
There are lots of accurate insightful comments in this thread about the mistakes on this project. Above and beyond all of those, trying to do something this size in one bang is a near guarantee of failure.
You'd think everyone working on the project would have done a little better than most teams because of all those crazy amounts of cameras watching them all the time over in Britain cuz of that psychological effect that makes people work harder when they know they're being watched. But I think I speak for everyone here when I say it's obviously the non-IT upper management's fault!
Google's Super Secret Search Algorithm: SELECT @search_results FROM internet WHERE @search_results = 'good'
I know of one large UK Univerity (no names, but the stored program digital computer was invented there...) that wasted millions on a new ICON email and calendaring system, only to find that it did not scale to the size of the whole university. The money wasted is alleged to be so vast that instead of the online calendaring system all the academics could have had a PA with a cell phone and a filofax following them around for several years scheduling their meetings with each other and telling the academic where they needed to be.
I'm not being self-important, just self aware. I know what I like to work on. I like to work on small teams of bright people who are following their passions. This project does not qualify for me because it does not tap my passions. You are right that some people are passionate about this health care system and I hope they make this project a success. Its just no my cup of tea.
I don't use it, will never use it. Going way way way out of your way to interoperate with a microsoft product like the samba project does is *insane*. I know I don't want to share my files with a windows machine, nor do I want to network in their neighborhood. People who do should just go ahead and bite the bullet and USE microsoft everywhere and learn to use it adequately if that is what they want. Frankly, I sincerely doubt the true open source mindset of any project that has interoperability with MS as their primary goal (mozilla for another glaring example, FF is 99% a windows product, developed for the windows accessory market, they are low paid serfs of microsoft in other words)(and yes I think this sucks really bad, too, and wish there was a way around it I wish there was an open source only GPL browser project that had as much mindshare as that windows browser trying to pass, it is as ludicrous as michael jackson trying to pass as a white woman, it's crazy in other words).
You are either with the terrorists, or not, no middle ground there. Want another-lie down with dogs, arise with the fleas. Birds of a feather flock together. You can't be a "part timer" with the mafia, you either work with them or are a competitor. You can't be "a little bit pregnant".
And my favorite, working with MS is a sure way to get cooties, so no bitching about it when you GET cooties.
I have no sympathy for anyone who uses any MS products, or links against them, or interoperates with them, none. Let them suffer, who cares, let them beat their heads against the wall trying to make MS play nice in the world, because nothing else will work. And it is because MS is a crooked business, run by crooks, in a crooked manner, and always has been. Goons, thugs, liars. I personally won't associate with them at all, and boycott places/orgs/projects who do, as much as I can pull off in our compromised society.
Beware: is also happening in the US, except on a regional level rather than nationally. Most states now have at least one "RHIO" project whose goal is to put all patient records online. In some juristictions, explicit consent is required, in others, patients must opt-out.
A Compassionate Conservative is riding in the back of his limousine when he sees a man eating grass by the roadside. He orders his driver to stop and gets out to investigate.
"Why are you eating grass?" he asks.
"I don't have any money for food," the poor man replies.
"Oh, well, you can come with me to my place to eat!"
"But I have a wife and two children."
"Bring them along too!"
So they all climb back in the limo. As they're driving along, the poor man says "Sir, you are too kind. Thank you for taking all of us with you."
"No problem, I'm glad to do it," says the Compassionate Conservative, "The grass at my place is almost a foot tall!"
GCHQ Quantum Insert installed. If only our tongues were made of glass, how much more careful we would be when we speak
"Welcome to Lake Wobegon where the children are all above average." Since this is obviously impossible, your statement is actually true and unavoidable.
Some unfortunate economic realities:
1) The economic system must include sufficient incentives to motivate people to produce more. Otherwise you just end up with a situation where the top producers lose motivation because the extra work and surplus they generate doesn't provide them any benefit. Without other incentives, it's more to their benefit to work in a more "relaxed" manner. As a result the standard of living slowly declines because productivity declines. Witness the USSR.
2) In any system of incentives, different people are motivated to different levels of effort by similar incentives depending on various other motivations such as the physical or mental difficulty, danger, or enjoyment of the work to be performed. This results in two behaviors: 1) extra incentives need to be paid for work for which workers perceive extra risk or effort, or for which fewer workers qualify, and B)a distribution of incomes where some people receive more incentives than others.
3) The people who have less than average income have less ability to purchase items produced within the economy. If this ability falls below an arbitrary level defined within the society, the people are called impoverished. One reason immigration to the US and Europe is so high is that our definition of the poverty level is higher than many of the surrounding economies.
We are the 198 proof..
That's what they are called,"republicans in name only" and they took over the R party in 1964 (they sabotaged their own campaign to force out the last real republicans like goldwater) and have run it ever since, although the bulk of the grassroots has to this day not even noticed it. They own the name, but they are really just rebranded trotskyites.
...instead of Nukes, Tanks, Fighter Jets, and Battleships?
//Nothing to see here, please move along.
Microsoft did do something similar in the past. Windows 3.1 (AFAIR) would check if it was running on top of DR-DOS, and if so would randomly fail.
A couple of corrections:
1. The "Microsoft Genuine Compatibility" check was only distributed in a public beta of Windows 3.x, not in a final product.
2. It never actually did anything but pop up a warning telling the user that they were using an unsupported operating system and that it would probably be less stable because of it. The idea was to make the user nervous about using DR-DOS and go out and buy MS-DOS.
My first computer was a 286-12, and the first software I bought was DR-DOS, Windows 3.1, and Leisure Suit Larry.
Windows 3.1 wouldn't randomly fail. It just wouldn't start under DR-DOS. A few months later DR-DOS sent out a patch and then it worked; never had a problem after that.
Good thing I didn't need Windows 3.1 for LSL.
This interesting site (at the moment only showing a "coming soon" message) has had years of development and a budget of 45 million euros. It should become a portal of tourism for Italy, but its launch has been postponed several times and I wonder what incredible technology it will include to justify its price-tag. The project is being carried on by three enterprises (Tiscover, Ibm and Its). Strangely enough, the minister promoting the project (Stanca, from Berlusconi's goverment) had previously worked for one of them (Ibm). Might the whole operation be just a way to promote money flow in a certain direction?
Yet another problem with government social programs.
It's very new but, being backed by NO2ID, will likely run and run. I'm trying to get them to call it "Boycott the Medical Database"
http://www.nhsconfidentiality.org/
Please forward this info to everybody you know.
I'll bet UPS didn't build their system in one go though. And they probably didn't outsource it, either.
no taxation without representation!
It's freshly printed money, they don't have to raise any taxes to pay for it all...
Deleted
is: outsourcing IT support to India. Period.
I worked on a project where required features and time were the fixed items, not cost or people. At the peak, we were spending over $20M a month in consultants alone. After the project was a little over 18 months old, it was canned just prior to the 2nd functional release. I'd only spent $1M on hardware for my little part and we had 60 developers when I was trying to figure what they'd do with 5. Outsourcing at its best - just higher 10x more Indians fresh out of college rather than a few folks with 10+ years of industry experience. Don't get me wrong, I'm sure they are sharp folks, but their is no substitute for experience.
Strangely, the leaders weren't canned, just the 500+ consultants.
Ok, so after everything is added up - hardware, software licenses, consultants, storage, networking, and my $82/hr - spend was somewhere over $550M.
Again, this is nothing compared to some of the big government failures that we all pay for via taxation.
I have a friend who used to work for the NHS, in a kind of admin role; he was responsible for collating statistics on certain things across a whole region, so that official figures could be produced which would be used by the Government (local and national). The whole setup was a joke - he relied on individual surgeries to supply their own data, but most didn't record the data he needed and those which did all did so in different ways. When his superiors were told of this, and how it was basically impossible to collate the required data, he was told, effectively, to guess. He reckoned the resulting statistics bore no relation to reality whatsoever.
When he told me this I was a bit shocked, but not that surprised; I've also worked on government contracts in the private sector (ie. for private companies supplying government) and in the last of such roles was amazed what we charged for our products, which were basically glorified searchable databases. In many cases the work could have been done in the same timeframe, with much the same results, for 1/10th or less of the cost, but we charged 6-figure sums and got away with it not because our product was so good, but because it was sold as being unique in the marketplace. It may have been unique in how it worked, but not in the results it gave - but it didn't matter. Our whole business plan was based around it, and it worked (as a business plan). I actually felt slightly ashamed to be associated with it, as a taxpayer. What amazed me was how such huge figures were never questioned by the clients - it was just assumed that it must be brilliant because it cost so much and was designed by clever people (which it was, for what that's worth).
And if you think they're isolated examples, google for the Air Traffic Control system which was supposed to be the next best thing in government IT projects.
How about this one? Sure seems to beat the FBI example.
I'll bet UPS didn't build their system in one go though. And they probably didn't outsource it, either.
Actually, they do work with the consultants employed by a lot of their system vedndors... but I'll bet that, regardless, they never lost $12 BILLION in the process. And that system is probably quite a bit more substantial than they UK's medical IT needs. They manifest billions of packages on hundreds of thousands of trucks and aircraft, with interfaces through thousands of offices and millions of user desktops and direct plumbing into 3rd party systems of all sizes... it's quite the thing, really, and a larger beast than most government IT systems. My point is simply that it's doable, and they simply can't afford to lose the way that government projects can (since career government IT people and the managers that budget and run their projects are essentially unfireable).
Don't disappoint your bird dog. Go to the range.
The greedheads just keep making these same mistakes over and over:
1. Doctors have their degree in medicine, not business management, and many hate doing the management side of the business. An opportunity? Perhaps, but don't forget the rest of these points when evaluating that "opportunity."2. Doctors aren't as enamoured with technology as you think they are.
3. Doctors don't have as much money to spend as you think they do.
4. Most practices do not have on-site IT experts, so things like maintaining a local web site or web tie-in server is next to impossible. Most practices can't even keep their regular backups straight. If you sell them their practice software, YOU are their IT department. If you can convince them that what you offer is worth the inflated maintenance contract price you'd have to charge for all these features, great, but Good Luck, because:
5. Doctors don't have as much money to spend as you think they do.
I have been interacting with Soviet electronics and chip design bureaus in late 80s/early 90. For the most part those western-sourced componets were not actually used for production purposes, but rather mostly for reverse engineering of technology and algorithms. Critical production components were build internally and scrutinized quite hard for correctness and reliability. Actually my doctor's theses was about these testing/screening systems and processes
Basicly, this entire story you are quoting is bogus.
That's over $45,200 PER USER for software that doesn't work yet? The contractor should be drug out of his office and shot in public.
Strictly speaking, it killed the USSR -- an empire. Russia is still quite alive, and doing rather well according to recent economic data. Something about huge oil reserves or something.
They suck at technology.
Because it's totally different. The CIA was sabotaging their own equipment to damage a competitor. That has nothing to do with Microsoft's interoperability crap. The CIA deliberately fed the Soviets garbage. That would be equivilant, rather, to a developer who works with Microsoft networking secretly being a Samba developer and stealing code, and so Microsoft secretly feeding the Sama developer deliberately buggy code to crash Samba in retaliation.
That would be similar to Microsoft deliberately sending sabotaged versions of their software out through industrial espionage channels.
That's not what's happening. Microsoft fiddles with their software to reduce to make it less compatible, but they do not sabotage the base functionality of the system.
There's a very, very significant difference there.
"It is possible to commit no errors and still lose. That is not a weakness. That is life." -Peak Performance
What is with these 10-15 year plans they are implementing?
:)
:( I can't imagine what I would have thought up for a 10-year plan that would have remotely resembled reality, hehe.
What kind of equipment do they use that will be acceptable 10-years from now? We got rid of our minicomputer 10 years ago and (finally) moved to PC. If we were still trying to build anything with what we replaced it with (486 and with a pentium 100 server? running dos) I imagine we would have all kinds of IT problems too.
Although the old Wang did run for 10+ years itself, green screens in the SVGA era was kinda depressing. Portable media (13MB) that wouldn't fit in a briefcase. 512k for the entire office to share
10 years later we have what would have been supercomputers then and can fit several 40GB tapes in my pocket. I can't imagine having to span that period with one IT plan.
Me thinks they need smaller shorter upgrades in pieces or you never get to the endpoint
You're comparing purposefully designed flaws done by the CIA with Microsoft incompetence? THat's kind of a stretch.
They are quite different. Microsoft crapware has done far more economic damage overall. The CIA was handicapped by the need to confine the damage to the enemy.
That Veterans health project is on a completely of different scale though.
The NHS (British National Health Service) is among the world's top 5 largest employers and a yearly budget of just under $200 billion, providing free health-care to 60 million people. The current project is not much short of a complete overhaul of its I.T. systems. At its current state it doesn't look like it will be a disaster, just a lot more costly and slower to develop than first acknowledged.
It's not that "government + healthcare + technology" = disaster, but "any massive and unique IT project" = disaster! Massive projects almost always cost more and take longer than initially stated, its just how the game goes.
...they had outsourced it to India...
The biggest IT disaster was when Al Gore invented the internet and gave birth to global warming.
It isn't the mix of government and healthcare that is disasterous...not government plus ANYTHING. Governments ALL BY THEMSELVES have a penchant for creating disaster. By and large, anything that can be done to put a limit on how big or far reaching a govenrnment can get is the best thing for a society.
This isn't to say socialised medicine is automatically a bad thing because I see problems in leaving something that directly important to our well being completely to profit-oriented corporations. In the same vein, healthcare is much too important to leave in the bumbling, corruption-prone hands of national/federal governmenta AT ALL COSTS. Anything that closely affects individuals should be at the closest/most local levels of government. Services like healthcare and education very directly touch the lives of individuals and thus government involvement should be at the most local level possible. Things like foreign treaties, macro-economic policy, national defence and so on affect everyone but at a much more removed level...and that is what national-level govenrnments should be limited to as it is only these things they can manage competently.
Imagine if we all went to dinner and had to pay our own meals. We'd all get what we could afford -- burgers for some, steaks for others, soup for the few. Now imagine if we decided to split the bill equally. At first, we'd still buy what we used to, but some people would realize they could now afford steaks for just a little more cash out of pocket. When other people subsidize your irresponsibility, you become irresponsible. Eventually, everyone's buying steaks -- and all our costs go up. In government-run healthcare, everyone orders steaks, but the added bureacracy means the costs are well over the average steak -- and everyone expects to pay for soup.
That is a fairly poor analogy of how government-provided services work. The thing is, when you give up the responsibilty for paying the bill you also give up the freedom to choose what to eat. The rich steak-and-lobster diners might gladly entertain the equal-bill-splitting proposal but the soup-and-salad eaters would quickly protest as they'd be stuck overpaying (and no, you can't assume everyone has a large steak-and-lobster appetite). Since this is a democratic group of diners they'd end up negotiating a fair price for a meal somewhere around the median price, or a bit lower, and designate someone to place the order and pick up the food. Because this negotiation can get a bit acrimonious this designate would decide that in the interest of fairness and simplicity, each and every diner would get the same meal.
THAT is where big government programmes start to fail--when everyone gets bacon-cheeseburgers and fries for dinner. Then the whole plan goes out of whack when one person is a vegan, another is an observant Jew who only eats kosher, another has high cholesterol and cannot eat the high-trans-fat fries and another is allergic to cheese. So many people with differing needs and wants start demanding that they be accomodated, and soon the poor dinner-gopher is having to track people's special orders and go to a half-dozen places to get the meals and you inevidably end up with a BUREAUCRACY. It is NOT people being "greedy and irresponsible" that drives up the cost...it is simply that people are unique and crave choice.
Sidenote: One of my lady's best friends runs a huge network for a hospital chain that is in the process of combining with another hospital. She's told me repeatedly that the biggest costs for her MIS department is integrating all the bureacratic changes that the government requires -- paperwork, forms, etc. While she's a big-government Republican (the new style), she is blown away that 80% of her staff deals with those headaches, which are constantly changing and always need more people to do the job. It disgusts me.
As I said, I'm not against all government...just for LIMITING the scope of government. Sometimes reducing choice and providing a degree
The great 10-day MCI/Worldcom Frame Relay outage of 1999, caused by MCI engineers who implemented an upgrade, which the Worldcom engineers (whom they replaced) felt needed further testing.
s _1999_Sept_20/ai_56028620
http://www.findarticles.com/p/articles/mi_m0UKG/i
Hence my citation of UPS (www.ups.com). They DO have millions of customers and hundreds of integration schemes, and it has to work, around the clock.
And thus our many large failed government software systems should be using the technology of successful corporations like UPS, FedEx, Wal-Mart, etc., should they not?
But are they? Do we taxpayers think giant software consulting firms are going to do anything but bleeding edge failures? We taxpayers should know what the cost of that failure is, anyway.
rd
From the article:
But the country's oversight agency now puts that figure at $24 billion
So that's exactly the job of the oversight agency isn't it. Yes, the extra $12 billion, that was an oversight.
(since career government IT people and the managers that budget and run their projects are essentially unfireable).
But again, you missed his point. These failures are outsourced, not done by unfireable government employees. The corporate successes are done by the corporation who, sure, often bring in lots of contracting help, but it's done by the corporation, not outsourced.
Success requires inhouse people committed for the long term.
rd
Basicly, this entire story you are quoting is bogus.
:)
I don't know what he quoted, I glanced at some mention of it and didn't see oil pipeline and moved on. I read in an historical account recently that the CIA slipped some bad code in a microcontroller design that they were on to Russia stealing through corporate espionage.
The story is that the controllers were used by the Russians for their Siberian oil pipeline and the defective code caused a huge explosion, damaging the pipeline. This was cited as a success in psychological warfare by the CIA in making the Russians distrust what they were stealing.
I don't know. Comes from the Reagan era, and knowledgeable insiders are just recently mentioning it. Probably the CIA believed it anyway.
rd
Just the execution and implementation of the programme were lacking.
Given that offshoring has impacted the displaced, it sure does qualify as a disaster to IT - and some people insist on compounding the problem instead of creating a solution.
Twitter supports and protects racists - by smearing their critics with the "Hate Speech" label.
I was still young and fresh, one of those people plucked from regular industry during the pre-internet hype expansion days when anyone with a brain and a liking for computers could get into IT.
So of with a 2 month training I was detached to a big project.
Content (a dutch temp agency) and Schoevers (a dutch training agency) had ordered one system to replace part of their backoffice systems. Warning sign 1. A product being asked to do two things that are NOT related. This was now in a two year state of development by Rocade Industrious, the dutch version of that company every country has that keeps getting the big contracts despite never delivering what was promised, and always going overtime and overbudget.
My task was to write the tool that would convert the data from the old systems to the new system. Simple enough you say?
Well perhaps if you got:
Sorry, nope. Never had it, never got it. Worse even after two years the database scheme was still constantly changing so that even when I had it figured out the hardway what everything did (the database design was a mess of fields with more then one use, a mix of triggered functions, business logic and presentation logic), it all would change with the new release, with ofcourse no such thing as a changelog
Nope. Never arrived.
Actually i did have that. On a magnetic backup tape. Only problem, never ever managed to get my hand on the player.
Happened finally months later after I had carefully pieced together the meaning in the dump I had finally gotten with the meanings presented on screen by the system through the help of the girls who content had pulled from the temp agency's offices to test the new system. Oh and then the developer was totally aware of the many things that had apparently happened between the original design and years of use. Some fields could hold as many as 8 different values often totally unrelated.
I was from a small company that had been hired by content to do the conversion. They had been told to make sure the conversion was another item to be added to the contract (with more money to be paid offcourse)
Was on AIX and they had fired their ONLY unix man. For a while I was the closest thing to it and one day as I came into the office I was asked by the director to start up a production database so the proffesional (expensive temps) offices could start the work. Once they hired a unix admin he voted me as the only other person he would grant access. Not exactly a compliment, I was just the only person he considered even remotely capable of not blowing it all up.
Well, the final dump was if I remember it correctly over 1 gig off data. This was in the days of Win NT 4.0 and my machine was not exactly specced out to handle this. For instance by lacking the HD space to actually hold the file let alone the memory to operate it. I ended up taking the CD's home, chopping up the file on my home system and then working in the office on a small sample. It wasn't until months later and a new interim director took over I finally got a capable system (wich had been in storage for months collecting dust).
So what does all this have to do with your comment? Well it is simple. While content ended up paying much more then they intended the problem for Roccade industrious was that they actually los
You seem unfamiliar wtih Microsoft's history. You write "That's not what's happening. Microsoft fiddles with their software to reduce to make it less compatible, but they do not sabotage the base functionality of the system" -- but that's exactly what the courts found they did to DrDos -- detect if the competitor's product is installed and if so randomly at later times crash with misleading error messages. Read any of the links in this sub-thread and you'll see the similarities.
NHS IT chief failed computer studies course. http://www.theregister.co.uk/2006/11/13/it_chief_r evelation/
In the hospital I worked at, anyone with a hospital ID badge could get in to the patient records room, go and get any set of records and do what they wanted with it - there was no way of checking whether a member of staff really needed to see the patients records. I don't really see that this system is much more insecure than the current situation.
If someone rocks up to the NHS IT project interview and says they're excited about the project then they're either lying or they have no imagination. Neither of these traits are thing's I'd like to see in project staff. I'd rather have someone honest that acknowledges that its dead boring but is willing and capable of staying on the ball and bringing it to completion well. Motivating factors in that case are only going to be money or a strong belief that re-vamping the NHS systems is worth doing right.
You're a poor judge of character then if you infer that from reading a single sentence. A skilled recruiter would have looked back through my history on
~Pev
I talked briefly about this with somebody from a hospital. They need all the information available when somebody is wheeled in to Accidents & Emergencies - and fast, and without red tape. This does that.
"In the hospital I worked at, anyone with a hospital ID badge could get in to the patient records room, go and get any set of records and do what they wanted with it - there was no way of checking whether a member of staff really needed to see the patients records. I don't really see that this system is much more insecure than the current situation."
I suppose they can read the medical records of people who live hundreds of miles away, too? No?
Then the new system (as it is currently, without the "envelope" functionality) is less secure.
biggest IT disaster was a long time ago when one night, father Gates forgot to take the necessary protection...
The avionics for the nimrod AEW3 was probably a bigger UK software disaster.
There are endless domains for software, and healthcare is a really hard one for everyone. I've been working in healthcare industry for about 6 years now, and I have to say that, in terms of requirements, it is one of the worst domains. (I've worked on e-business and erp systems before healthcare). Not only the requirements are very hard to capture, but also the requirements usually contradict with the laws and other requirements in the care chain. There are millions of things that I can write, but to make it short: healthcare is very complex, and I have never seen projects with very high hopes succeed. IF UK had not set so wide targets, and followed a more focused path, by prioritizing the targets, chances are high that they would be in a better position now. I have seen the same thing in most large scale health projects: everyone thinks that everything is connected (mostly true) and doing things step by step, project by project would increase the overall cost, and things should be done in parallel.
Everybody, especially the vendors (oracle, sun, ms you name it) pushes through a complete solution, and governments fail to see the increasing risk in such an approach. Especially in large projects integration between different parts becomes a huge issue. Different companies, different technologies, different users etc. In healthcare there are many issues which no one has ever solved. Think about electronic health records, a security model for access to patient data etc. there is only discussion about these issues, and no silver bullet exists. Take a look at HIPAA. Did it really work in USA? Starting a project with so many issues that may cause problems, is the real mistake.
Many of these issues arose from unforeseen requirements and regulations, and the size of the project made it impossible to estimate the risks accurately. If the budget has been much lower and targets have been smaller, maybe things would be much more under control.
I am about to get involved in a very large scale project in healthcare, and it makes me have nightmares even if I know it is nothing compared to this one. I'll do whatever I can to set the goals as logical and feasible as possible, otherwise I know that no one will be able to follow the whole process in detail. I think the same thing happened in UK
"Chosen Reject" posted:
I'm interested in learning how good the health care in the UK actually is. The only first-hand experience I've heard was from a Belgian friend of mine who lived there for a few years, and he thought it was awful.
I've seen too much of it recently, and IT disasters (and medical ones too) are no longer a surprise. IMHO the NHS is largely (mis)managed in the hands of a faceless and unaccountable bureaucracy, for whom truth is a scarce commodity, and organisational politics their main activity. (Example: a local NHS trust issued a statement this year announcing tens of millions pounds worth of cuts in a range of its services, including complete closedown of domiciliary care provided from one of the main hospices in the area, and they still managed to claim in public that the cuts were not going to have any adverse effect on patient care.)
NHS spending in many areas is big on big-sounding projects, but often cheap at the point of providing useful actual service. Here's an IT example that I saw:-- in spite of all the big-bucks IT projects, a main regional hospital at the end of last year lost all of its computerised patient data -- they were back to paper and pen. The IT providers and their hardware were housed remotely from the hospital on an industrial-estate site, right next door to a very large fuel depot (that should have made it cheap to rent): the depot went up in flames, taking the data centre with it. Hospital IT services were down for weeks, they clearly had no backup that they could deploy quickly. And that was for a big regional hospital's patient data! Cheapness at the point of service delivery also applies to many in-patient hospital services, with many wards staffed mainly by overworked healthcare workers who are recruited in numbers that are too low, and at levels of both pay and qualifications also too low for the work they are asked to do. The medical results I've seen are another story, OT here.
-wb-
The Comair failure left people stranded around the holidays a few years back, because their system couldn't handle all the crew changes after a big snowstorm.
2 212&from=rss
http://it.slashdot.org/article.pl?sid=04/12/26/05
This was a significant operational failure, as opposed to a project management failure.
Which is why we get very upset when you beat us at association football
Never rub another man's rhubarb
My mistake. So it's more like how binaries generated by the Intel C compiler would refuse to turn on the SSE codepath when executing on AMD processors - pretend your competitor is not compatible.
Michel
Fedora Project Contribut
*sigh*
Was drDos stealing Microsoft's product? No? Then it's not the same!
"It is possible to commit no errors and still lose. That is not a weakness. That is life." -Peak Performance
In summary:
Sure there are some differences - like the languages spoken and the courts that they perpetrators answer too -- but from an IT sourcing point of view it's exactly the same problem. A technology vendor trying to cripple the infrastructure of competitors.
CIA.gov has more, if you consider that a trusted source: https://www.cia.gov/csi/studies/96unclass/farewel
You write in late 80s/early 90....
It seems in late 90s the CIA declasified their version
of the history of these operations:
http://en.wikipedia.org/wiki/Farewell_Dossier
I'm curious if you followed up on the story after those docs were released and if their version of history is consistent with yours.
Have you ever heard of Medicare or Medicaid? For a person with those types of diseases, all you have to do to is apply.
Yes, I have.
I have Asperger's. I've applied -- twice -- to SSD. Both times they claim to have lost my appeal after turning me down. Both times the county's doctor has examined me, determined that I have a textbook case, and recommended that I get disability support. Both times they've turned me down.
I'm now trying to find a good advocate to help me, because whatever it is, I clearly cannot get this on my own.
Medicare/Medicaid? If I get SSD approved, then I'm covered. If I don't, I'm not. So I have to just manage to stay healthy with no coverage.
Mod parent up
Comment from inside the programme is restricted by a number of things, but two significant ones are essentially that the contractors' contracts prevent them making public statements not authorised by the customer (the Department of Health), as I remember it, and the Official Secrets Act.
There are a number of things preventing the UK government introducing change in the NHS:
... so the NHS is not in a position to say "do this" and have it done. It's just not a command-and-control organisation. There are a number of types of change that the NHS has been trying to make for over ten years. The Connecting for Health programme (formerly the NHS National Programme for IT) could be described as an attempt to achieve organisational change by the introduction of IT changes. Manifestly, effecting organisational change by introducing technical change is, to put it mildly, difficult and expensive. So for those in charge of any part of the programme there is a perception of a high risk of failure. Justifiably so, in many people's opinion.
So, there are a number of options on proceeding in an environment as risky as this. You could take an approach where you pilot an idea to see if it is workable before proceeding to full-scale rollout. This happened for example with electronic prescriptions. That pilot was cancelled at around the same time that the NPfIT programme was launched. Another way of tackling the risk would be to find a small number of large suppliers and let a number of contracts to them, with mind-bogglingly punitive financial penalties for lateness, unavilability, nondelivery and so on. This is the approach that the UK department of health took. So vast is the scale of the potential penalties that many potential suppliers were disqualified simply because they did not have the financial stature to sign up to those. Other bidders had the stature but not the stomach for that (I suspect Lockheed Martin was in this category).
So, what does a contractor do when faced with vast potential penalties?
Those factors mean that the NHS passing on the risk of the programme to the subcontractors would always mean that the contracts would be mind-bogglingly expensive. Moving things out of scope means that even though the contracts are expensive, there are many activities that aren't covered. That means that the NHS has to spend still more money on those activities. The media then acts surprised that having let billions of pounds of contracts, the NHS spends still more. Look at it this way: if an organisation spends X pounds on new IT syetems, how much money will they need to spend on related costs (rollout, training, organisational change, costs associated with upheaval, parallel running, data migration, data cleansing)? I'd say that 2X pounds of additional costs would be an underestimate. Bear in mind here that the NHS has about 800,000 employees (direct and indirectly employed healthcare workers).
The scope of the
The healthcare of the NHS isn't quite free. There is a modest prescription charge (about £6.60 at the moment) for example.
GrimRC
There's an idea for a slashdot poll: Have you been on a project that crashed & burned / was thrown away and done over / etc.
I'm not sure if it should be a yes/no, or if it would be better to offer ranges of projects that have crashed and burned: 0, 1-3, 4-6...