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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.
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.
For those who RTFA, it's linked in the blurb.
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.
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'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.
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...
Because that would be way too easy.
Either way, I'm not sure how things work in the UK but in the US, if WebMD were to suddenly gain the US Government as a customer, the government would require that WebMD suddenly adapt to a bunch of contractor regulations that they probably aren't following at the moment.
Plus, politicians could put one of two things on their campaign fliers: "...and strongly worked to get our great nation a site license for WebMD" or "...and strongly worked to build the national physicians communication network" or some such.
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
(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}
> In the end, the British healthcare system is going to be faster and cheaper because of Connecting for Health.
$24 billion better?
Oh look, the pigs are flying in such a pretty formation today.
Given that the NHS is now laying off Doctors and Nurses for lack of cash, I think there are better ways to spend that amount of money. And I'm not talking about PFI.
no taxation without representation!
From the article:
That last sentence made my jaw drop. How someone in his position could so blatantly avoid consulting anyone with any technical acumen is beyond me. Yes, it's possible, that no single vendor was capable of creating such a system alone. But the vast majority of a project like this is about creating a single process for every use case that the system is designed to handle. As such, the project shouldn't ever be broken down into groupings like number of patients in the system. Computers are great at handling really large numbers when the software is designed up-front to scale to really large numbers. The system should have been broken down into separate processes for which individual vendors would handle that single process (or grouping of processes) for everyone in the country.
The X-Ray example is a perfect one. Why would anyone in their right mind have 5 separate vendors all attempt to implement a solution for the problem that was only applied to the region they managed? At best, one region would end up with a solution that was better than every other region. However a competant management decision would have been to look for a vendor that could handle *only* the process of integrating the country's X-ray facilities with the country's high-speed data network. Another vendor would be responsible for supplying and maintaing that network. Still another vendor would be responsible for maintaining the huge data center (or centers) where information was housed. Just off the top of my head, GE could be responsible for the X-Ray integration (I know they have the necessary expertise), BT could handle high-speed network (among others, but why use foreign expertise when a UK company could handle it). And there are any number of competant vendors that could handle a high-availability server environment with a massive database.
Basically, had they had anyone with have an ounce of technical acumen, they would have devided the project up along functional boundaries of the application rather than regional boundaries of the country. That way, even if some of the projects went horribly over-budget, at least some of the project would be useful. Now, because of the inept management decisions, the whole thing is a train wreck.
"Don't blame me, I voted for Kodos!"
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
If it works. And if it couldn't have been done for less than $24B...
If all you have is a grenade, pretty soon every problem looks like a foxhole -- MightyYar
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
I second this.
The entire rationale behind Choose and Book is fallacious. It's a piece of window dressing for government policy - a service rooted in spin. The premise that "Patients want to choose which healthcare service to consume." is utter nonsense.
Patients in the UK, by and large, do not want to choose. They just want to receive treatment. Because of the prevalence of the NHS, and the relatively low takeup of private healthcare, there is no real perception of choice anyway.
Making the patient choose a service provider is just a means for the government to impress upon the populace that they are making changes to NHS IT systems. Choose and Book is a convenient example because it contains no potential compromise to patient confidentiality, and because it's a relatively easy project.
If it had been done properly, of course, people would barely know it was there. Things would proceed as they always had done - the doctor would use his judgement (which is far better informed than the patients), select a specialist to refer to, and use the system to place the referral. In short, it would be a streamlined replacement for an existing paper system. Of course, this is not a high profile, visible success for government IT policy.
PS ; My opinion as expressed in any public forum in no way constitutes an accurate or informative reflection on the actual motivations for government policy.