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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.
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
'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
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
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.
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 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
Those "three words" together are four words.
And excellent steak analogy, but you forgot to include the circumstances that prompt the need for a government managed health care system in the first place -- what happens when the restaurants sell so many burgers and so few steaks that they need to manipulate their pricing structure until those burgers become the price of steaks? Or when they decide to just stop serving burgers entirely and choose instead to offer a 'name brand equivalent' like maybe some ground buffalo, which tastes just the same, but costs a whole lot more? And what happens to the individuals who desperately NEED those steaks but can only afford a small side salad? There's a big difference between 'subsidizing irresponsibility' and sharing costs to help treat people with terminal and degenerative diseases who are incapable of generating a full-time income.
It never ceases to amaze me that there are people who will apply the "pull yourself up by your bootstraps" mentality to those suffering from Muscular Dystrophy, ALS, Leukemia and all of those others afflictions that obviously afflict far more than just the 'lazy' and 'irresponsible'. Is this compassionate conservatism in action?
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.
(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}
It never ceases to amaze me that there are people who will apply the "pull yourself up by your bootstraps" mentality to those suffering from Muscular Dystrophy, ALS, Leukemia and all of those others afflictions that obviously afflict far more than just the 'lazy' and 'irresponsible'. Is this compassionate conservatism in action?
I don't use an AMA Doctor in the States, I use an AAPS Doctor. He doesn't accept insurance, Medicare, Medicaid, or any third party payment, and neither does anyone in his clinics. They're all older doctors. He still makes housecalls. He charges me about $30 a visit for a basic checkup, and because he runs on a cash basis, he sees me for as long as I need him, and I just pay for the time. I'm in and out in 15-30 minutes. His housecalls are about $30 more. I believe he said that when he was still AMA-affiliated, his overall collections were about 40%, now he collects over 100% of his bills at the point of service (the overage is a tip, which I always give him for good service). I am significantly healthier (blood pressure down, cholesterol down, weight way down) and so is my lady (asthma gone) because of his dietary advice over medicine.
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.
The poor and sick have always had religious hospitals to help -- as well as hospitals sponsored by donations. Today, we pay 50%+ of our gross income to government, so few of us can support religious and charitably hospitals, although my family still gives the difference between our old insurance and our new one to a local charitable hospital in Chicago that runs 100% on donations and user fees.
Don't spin the "what about the poor?" stuff since it is the poor that are hurt by government health care. Try visiting any emergency room in Lake County, Illinois and see how long it takes to get service.
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
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.]
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...
Is this compassionate conservatism in action?
You forget. The compassion in compassionate conservatism is the lovely warm feeling one gets in one's heart when scattering breadcrumbs at Christmas to those poor, adorable, starving orphans.
Charity will help out the most needy, remember?
Fuck anyone who's suffering from an unfashionable or distasteful illness; they only brought it upon themselves. The good old mom-and-pop doctor will solve everything else - that's what capitalism is for!
Tedious Bloggy Stuff - hooray?
I have what I call the "oh, crap" words and phrases list. If I see more than two of those words in a project file, I know that the project will be a huge steaming pile.
The article has no less than eleven of those warning signs.
transform
Accenture
Gartner
government
Microsoft
management consultant
Computer Sciences Corp.
in the world
comprehensive
leading-edge
I am not at all surprised that this is a gargantuan boondoggle.
In the land of the blind, the one-eyed man is usually crucified.
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
England is probably the best place in the world to have a heart attack,
should you choose to have one.
If you keel over in London you should get a paramedic equiped
with defibrilator within 10 minutes, quite often an actual doctor
will be traveling with the paramedics. If its serious and traffic is bad you
get a chopper to the hospital where serious case are treated immediatly.
You can get to the operating table within an hour.
And all this without a single check for medical insurance or endless
calls to your HMO to get the treatemnt approved.
And its extaordinarily cost effective. The UK spends less per
head on medical expenses than any other G8 economy. %50 less than
the US for eqivalent service.
The major problem with the NHS is because people are treated according
to clinical priority (rather than money or quality of insurance) if you
have an ingrowing toe nail there is always someone worse off than you
who gets treated first.
Gotta be better than the mess in the USA!
P.S. If you are going to hospital I would recommend Denmark.
absolutely the best medical care money cant buy. Its free.
Old COBOL programmers never die. They just code in C.
I'm sorry but did you even take time to read the article? I ask because you make statements about saying stuff like this: 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. But that's exactly what the article talks about. Accenture was the prime, or at least had the majority of the contract and they screwed up spent a lot of the governments money and quit .
Then you talk about universal health care? What does that have to do with TFA? If I had to guess I would just say you read the title and picked out some of your favorite arguments that had nothing to do with TFA and strung them together to get a +5 insightful. Congradulations you know how to play to the mindless sheep.
500 dollar reward for tip(s) leading to the arrest of the person(s) who stole my sig.
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.
So what you are saying is that poverty must exist in order for you to maintain your high standard of living.
-matthew
"THERE IS NO JUSTICE, THERE IS ONLY ME." -Death
...this is around £200 / 400USD. Ouch - kinda puts it into context...
~Pev
(Side note: The US is the only industrialized country without national healthcare, spends twice as much per patient in healthcare, and yet is not a world leader in healthcare - it often ranks last among industrialized nations in certain categories. It seems that the statistical odds are at least against private healthcare right now).
I would normally agree with you (big government bad, free market good), but you're forgetting one small thing: The Veteran's Administration.
Here was a crappy, failing hospital system run by the US government that has completely transformed itself in the last couple of years. It has successfully deployed a completely electronic patient bookkeeping system (a nurse friend has told me that most of the (privately owned) hospital she works at runs off 3x5 notecards). The administrative overhead is comparable to private hospitals. It is able to negotiate much deeper drug discounts than Medicare and other private hospitals. It works closely with medical schools so its personnel costs are much lower, yet it has experts in many veterans-related fields (things like PTSD, making fake limbs, etc). It rates as one of the top hospitals in quantitative healthcare surveys (which measure things like, "For patients with X, how many of the standard operating procedures Y are usually followed").
In fact, it's done its job so well that - while the costs of private healthcare have *far* outpaced inflation the last couple of years - its budget has been increased at a *slower* rate than inflation.
Of course, like any other large chain of hospitals, there are surgery mistakes and lawsuits. The mistakes are much lower than the national average but, because it's run by the government, are much higher profile when they do happen.
The VA is a good case study of how the government could do healthcare much better than private industry. Its success should be analyzed, studied, and possibly replicated at a much larger scale.
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.
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
Interesting that you should bring up MS, since my frame of reference is with the same disease.
A friend of the family had a particularly severe form of multiple sclerosis.
Over roughly a decade, she went from walking with a stick, to using a manual wheelchair, to using an electric wheelchair, to having nerves in her legs cut to stop the spasms, to undergoing many, many operations and treatments to lower the pain and to keep her comfortable, to dying.
She was in her thirties. Everyone was amazed she lasted that long.
I seriously doubt the treatment from the NHS was remotely near perfect, but she had all necessary drugs, equipment and carers provided - her house was fitted with stair-lifts, bed-lifts, bath-lifts, ramps and so on, replaced as needed while her disease progressed. Many visits from carers to wash her, dress her, and later change her colostomy and catheter bags, supporting both her and her husband. (Somehow, they managed to turn a blind eye to the 'tomato plants' on her window-sills.)
Tedious Bloggy Stuff - hooray?
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.
A friend of mine and I ware having a discussion about healthcare.
He lives in Canada.
My proposition: So, you go out skiing and screw up your knee. Doctor pops a brace onto it and sets you up for a specialist, who recommends scoping the knee, fixing it, and a physical therapy regimen. How long until you get surgery in Canada.
His answer: 6 months.
If I wasn't out of physical therapy inside of 6 weeks I'd be finding someone to sue.
Our system in the US is way more expensive. It also works, it works quickly, and people don't go without. We don't let people bleed out in an ER because they don't have insurance. That's ILLEGAL, in addition to any moral/ethical issues. It'll flat get people thrown into jail. Stories of those things happening are either made up or they don't include the "oh, then the attending physician in the hospital went to PMITA prison for 20 years" endings.
Do we want to make our system more efficient? Yeah. How? By reducing government in it, not increasing it. By reducing the sheer volume of paperwork required to get payment from an insurance company, paperwork required by the feds, oh, unless it's a medicare claim, in which case the paperwork is significantly less. Yes, less. Why? The government doesn't have the time or personnel to handle the paperwork, but they force private insurers to do it. If medicare was held to the same standards as your insurance company and had to live within the same liability framework, medicare would be even more untenable than it is.
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
According to the AAPS website there are 9 physicians' offices in the country which practice free market medicine. It's great that you have one where ever you are, but it's totally unrealistic to expect any reasonable number of other people to find the same thing in their local area.
Check out my lame java blog at www.javachopshop.com
get this - Halliburton *has* a UK division, and they are actually the main project management company responsible - they received all the cash from the UK government, and are responsible for handing out the money to the subcontractors that build the various systems. I have been involved in the past in several different aspects of the tendering and scoping of parts of this project. It outright disgusting
People who think they know everything are a great annoyance to those of us who do.
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
Are you so sure about that????
3 07614.html
http://www.pittsburghlive.com/x/pittsburghtrib/s_
Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. "Britain has one of worst survival rates in the advanced world," writes Bartholomew, "and America has the best."
If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent. Again, reports Bartholomew, "Britain is at the bottom of the class and America is at the top."
More specifically, three-quarters of Americans who've had a heart attack are given beta-blocker drugs, compared to fewer than a third in Britain. Similarly, American patients are more likely than British patients to have a heart condition diagnosed with an angiogram, more likely to have an artery widened with angioplasty, and more likely to get back on their feet by way of a bypass.
When I used to do LIM systems, I once did one for a UK-based pharmaceutical R&D company. The work broke down to roughly 40% effort to make the software function correctly, with the remaining 60% going towards writing code to generate the reports required by the Home Office.
My boss was actually a little upset that I used a template-based approach, as he felt it would permit the users to modify the reports on their own (denying us a revenue stream). Then he found that the users would gladly pay to have someone else keep those reports up-to-date.
Just junk food for thought...
> If, as you maintain, more government == more disaster wouldn't it stand to reason that these socialist model health systems would be doing worse than the US system?
Only if they truly have more government. If you look at total cost of government there really isn't any nation in the world which is as expensive as the US. If you diligently keep track of your taxes--on your paycheck, at the cash register, at the pump, extras for sin taxes and luxury items, real estate, utilities, taxes on shipping which you indirectly pay in the cost of the products that you buy, on and on for every little nickel and dime hidden tax--you'll find that nearly 70% of total annual income for the average American is returned to the government over the course of the year.
Most of the socialist nations don't come anywhere near to taxing their citizens this much. The US truly has the most government and, therefore, the most bureaucratic disaster.
Hustlers exist solely through charity. I see their scams, lies, and deceit: I'm too charitable to outright shoot them.
Because our government provided health care is an unmitigated disaster because of the fact that it's shoehorned into, and forced to compete within, a "free market" environment which is wholly profit-driven. Removing the health care system from the world of profitability, and placing it into the umbrella of 'state-funded entities', creates an entirely different environment -- one where medical professionals won't be scared shitless to accept government insurance.
I hate to hammer a cliche, but America is the only industrialized country in the world which does not provide some form of universal health care to its citizens. Plenty of people with disabilities leave this country as a matter of necessity. While my opinion as to what the SOLUTION should be is obviously open to argument, these are concrete facts that support the impetus of my statement -- American health care is broken. Whatever your personal situation may be, or mine, there are plenty of examples all around the both of us that point distinctly to that conclusion.
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.
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.
They are trying to change this here in the United States by introducing the tax deductible health savings account, which is a step in the right direction but not completely effective until the government ABOLISHES the tax deductible benefit of employer provided health care. You see right now there is little incentive for the consumer to seek his own health care coverage in the open marketplace because the employer provided plan is a tax deduction already, meaning that the employee does not pay tax on his employer plan premiums, albeit with lower quality HMO care (but most people don't understand the difference until their life saving cancer treatment is denied as 'too expensive' by the insurance company at which point they raise holy hell, but hey you get what you pay for right?). The health savings accounts will not be effective in reducing costs, through market forces, until consumers are fully incentivized to take advantage of them.
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.
This is exactly right. The health care insurance industry is peculiar in that they pay SOMETHING on just about EVERYTHING and this serves to promote over consumption and drive up costs. One does not insure their home against the cost of mowing the lawn or their car against the cost of replacing worn parts, but rather against accidental serious, catastrophic, or total loss. The health care insurance industry should not be any different. If people used the health savings account and then paid out of pocket from their savings in the account then the prices would be well controlled by the market forces of people seeking out the best deal on perscription drugs, routine office visits, and other forms of routine non-emergency care.
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.
This is one problem that we don't have here in the United States because there are no government regulations controlling the number of people who chose to go to medical or nursing school. In the United States, provided that one is wealthy enough to afford the costs education or able to borrow the money, anyone who meets the necessary qualifications can attend medical school and be subsequently licensed as a practitioner in their home state of choice. The British people have some funny ideas about what should and should not be regulated and/or taxed, but that is another discussion entirely.
England is worse, since they are (I believe) a cover-all insurance scheme.
I think that in many ways the United States is actually worse and NOT because I think that the single payer government provided health care system is the way to go because clearly England has had major problems with the system. However, there is one bright spot, from a cost standpoint anyway, in the British system and that is the ability to ration care. If the government controls all health care payments in the public system then they can control costs by rationing care and/or denying treatments at the probable expense of public frustration and anger. In the United States not only can we NOT ration care since the health care system is not directly controlled by the government, but we create incentives for hospitals, lawyers, and insurance companies to escalate costs while removing any individual incentives to seek better priced and better quality ca
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.
Accenture is sufficient for a major fuckup. Been there done that and have the scars to prove it.
TCAP-Abort
And I'm providing a point that I have direct experience with this, I've not gotten any impression that you do. That you don't have anybody in your immediate family who is of working age and is unable to work because of a physical ailment, my wife has those.
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c tcareApp_English.pdf
If you are talking about intensive treatment, than I suggest you look around and tell me how much "intesive" treatment you get in other countries? You don't get intensive treatment, you get emergency treatment and a line for ailments. There is nothing really intesive about most social medical programs.
Here are the plain-jane facts: http://www.pittsburghlive.com/x/pittsburghtrib/s_
46% chance of dieing of breast cancer in UK, 25% in US
57% change of dieing from prostate cancer 19% in US
1/3 of heart attack patients get beta-blockers in UK, 3/4 of patients in US
UK has half the number of MRI & CT scanners per million people as the US does
36% of non-emergency UK surgeries wait for >4 months, only 5% of the US do
40% of UK cancer patients don't get to see a specialist
Having a loved one who has >8 doctor visits per month for the past 6 years, I'm well aware of the luxury we have in the US, and I have intimate knowledge of what "intensive treatment" means, and waiting >4 months for non-emergency surgery is not what "intensive treatment" means. Interestingly enough I know a person who does have MS, doesn't work, get's a government stipend and government healthcare. She gets her medicine free from the pharmacuticals, which basically every single one offers based upon income and her treatments are completely free. If you have no income, you can be very well covered, unfortunately few people seem to understand that, the people who are in the bind in the US are the people who are middle-class who get into trouble and don't have a fall-back plan. The ones who aren't poor and the ones who aren't rich, the ones that fall outside of the low income requirements and can't cover it themselves and don't have a job that covers it and run into a major medical condition.
Having being with someone so young and unable to work for so many years and constantly in doctors office I have a reasonable understanding of the situation as I too want to save all the cash possible on my medical bills and I have investigaged these different options personally. And FYI, the new medicare perscription plan should keep granny from having to goto canada for her drugs anymore (we aren't under medicare so I can't say for complete certainty, but if granny is on medicare d she should get most everything for like $10, once she figures out the plan that works for her).
If you have a family of 4x and you make less than $40,000 pfizer will send you stuff for free (even viagara), you do have to resubmit your income level every year (boo, hoo that's a terrible price to pay to get viagara) https://www.pfizerhelpfulanswers.com/assets/conne
I'm not going to say everything is perfect, but it is working much better than you think it is.
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
It's hard to learn if you don't have food in your stomach:
o grams/sbp.html- Big-Dividends-in-Boston-Schools.html
e frigeration.htm
http://www.frac.org/html/federal_food_programs/pr
http://www.schoolsk-12.com/parents/Breakfast-Pays
Some great examples of technological innovation putting food in peoples stomachs:
http://www.scienceinafrica.co.za/2004/september/r
http://www.fullbellyproject.org/index.asp
I've also read that the pot-in-pot refrigeration allows children to go to school, as they don't have to go to market to hawk their families produce everyday. The technology didn't make the creators all that wealthy, but everybody who uses it is hugely better off; in fact, more 'wealthy'.
Personally, I think the most universal measures of 'good' are wealth and self determination(freedom, liberty, whatever). A man who wakes up in the morning secure in his person, health and future has it all. The rest is just details; capitalism turns out to be a pretty good way to allocate resources(it rewards success, which is as good a way as I can think of to create more success.), and education tends to be a pretty good thing too, because it makes people more able to become self sufficient.
Nerd rage is the funniest rage.
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.