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.

Comments

maybe next the Air Traffic systems?

[yagu]

The article:

The inspiration to digitize this far-flung bureaucracy first surfaced in late 2001, when Microsoft's Bill Gates paid a visit to British Prime Minister Tony Blair at No. 10 Downing St. The subject of the meeting, as reported by The Guardian, was what could be done to improve the National Health Service. At the time, much of the service was paper-based and severely lagging in its use of technology. A long-term review of NHS funding that was issued just before the Blair-Gates meeting had concluded: "The U.K. health service has a poor record on the use of information and communications technology--the result of many years of serious under-investment."

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?:

The process for selecting vendors began in the late fall of 2002. It was centralized and standardized, and was conducted, Brennan and others say, in great secrecy. To avoid negative publicity, NHS insisted that contractors not reveal any details about contracts, a May 2005 story in ComputerWeekly noted. As a byproduct of these hush-hush negotiations, front-line clinicians, except at the most senior levels, were largely excluded from the selection and early planning process, according to Brennan.

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:

[from the baseline goals] Reduce the time it takes to send medical images, such as X-rays, from about four minutes to less than one minute.

I'm guessing $24B spent to get an X-ray in one minute instead of four begins to be diminished returns.

Also:

Gates is viewed as the godfather of the NPfIT because he reportedly sold Tony Blair on the benefits of bringing the digital revolution into every doctor's office and hospital in Great Britain. In the process, the British government signed an Enterprise Subscription Agreement (ESA) with Microsoft for 900,000 desktops for Office Professional Enterprise Edition 2003 and various client access licenses. Microsoft also is developing a common user interface for CfH. Gates received an honorary knighthood in 2005.

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

i work on this project

[alucinor]

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.

Re:i work on this project

[dyftm]

I've been involved in upgrading some computers just for Choose and Book. What I want to know is why on earth you people made Internet Explorer 6 a requirement?? I must admit I haven't seen it in action, but I find it hard to believe that you couldn't accomplish the same things without IE6-only technology. No-one can upgrade to IE7, or use an alternate browser to run this thing. So, you're forcing hundreds of thousands of computers with highly sensitive medical information on them to run without the maximum security available.

Re:Keywords: Government. Health Care. Disaster

[HeavenlyBankAcct]

My lady's brother had MS and died in a fire because of it. This same doctor's clinic treated him at home for no additional charge, and when he lost his job, they continued to care for him at no cost at their office (we drove him there). The doctors repeatedly tell me that most health care is cheap. I have insurance for emergencies only (with a $10,000 deductible now) and my insurance is cheap even though I am a smoker and have a pre-existing condition of kidney stones -- in fact, my lady and I pay less as a household for a year than most people do in a 6-9 months with their overriding policies.

Interesting that you should bring up MS, since my frame of reference is with the same disease.

My mother is a single woman who was diagnosed with MS when I was around eight years old. Her disease is a progressive one, and as such, she gradually lost the ability to operate for periods long enough to sustain a full-time income. Since she was unemployed (and married) at the time of her diagnosis, she was not covered by any private insurance fund, and thus, after her divorce, she fell into the questionable hands of Medicare.

Since that time, I've witnessed our family tossed into bankruptcy proceedings to cover hospital bills that Medicare claimed were out-of-scope. I've witnessed months and years where she was unable to pay for her medication and fell into serious regression. Most recently, I've witnessed her taking part in a completely bogus marriage to a man she barely knew simply so she could be added to his military insurance plan. These are the sort of things that the poor in our country deal with when they have chronic or terminal diseases.

Your friend and you are very lucky to find the sort of treatment that he did, but that's certainly not a commonality, or even a rarity. I would say that's a goddamn miracle -- and I certainly would not assume that because you were accepted for insurance with kidney stones that somebody with a terminal disease would have an easy of a time as you. I've been gainfully employed for years and have been frantically searching for a 'family plan' that would also covered my disabled mother and have been greeted routinely with incredulity and flat-out "no, we don't do that"s.

So, yes, I think I can justifiably use the "what about the poor" argument since that's the reality I know. I'm not sure how the system appears to those who don't actually need it -- I just know the dismal reality of attempting to get health care without money in this country. Regardless of what the rhetoric states -- it's not easy, or pleasant, and most of the time, it's impossible. I thank the powers that be daily that I'm now in a situation where I can provide financial support to my loved ones instead of expecting them to rely on a broken system to keep them intact.

Per capita...

[pev]

...this is around £200 / 400USD. Ouch - kinda puts it into context...

~Pev

So do I..

[Anonymous Coward]

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.

Re:Honorable Mention

[dulridge]

Sheer size. The NHS employs around a million people (882,000 for England alone) and you are talking about the records for nearly 60 million living people (and the digitised records of dead people - some clinical records are required to be kept for 75 years after the death of the patient). The NHS is 58 years old. That's a lot of data. Tax records are far simpler

Number of locations - every GP surgery in the country - even the ones in the islands 10,465 of them in 2004 (figures here) plus all the dentists (5-10,000 practices) opthalmic practitioners (8,000), the 10,000 contracted pharmacies (More figures), and so on.

ALL of these will need to be connected. There probably isn't much like it anywhere on that scale - and expectations of it are wildly unrealistic.

The backbone will be fun to build out to the islands where power is often flaky in winter - and the UK is rather longer than it is wide. I doubt adequate telco infrastructure is in place for quite large parts of the country - think everywhere where you can't get a mobile signal.

In practice for most NHS workers, all this stuff is taking huge amounts of money away from what really matters - care for the patients. The (7 year old) PC eating half my desk is only useful for receiving bureaucratic garbage - anything important gets done on the phone or in the wards. A huge amount of time is wasted, going through all the garbage that gets emailed to all and sundry, some of which actually needs reading but the vast majority doesn't. The problem is figuring out which is which without reading it first. My favourite one was the day that 10,000 people in got the email about the new lines being painted in a rural health centre car park (staff 8) meaning that there would be 2 less parking spaces that day.

Not to mention the fun stuff like wiring up 200 year old hospital buildings, GP practices and the like.