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UK's NHS Will Drop Delayed E-Records Project
Centralized, electronic medical records are touted as a means of increasing efficiency and patient safety. The "centralizing" and "turning electronic" phases, though, have some very rough edges. An anonymous reader writes with this excerpt from the Guardian about one such digitization project in the UK: "An ambitious multibillion pound programme to create a computerised patient record system across the entire NHS is being scrapped, ministers have decided. The £12.7bn National Programme for IT is being ended after years of delays, technical difficulties, contractual disputes and rising costs."
It is still unclear how much money the government has agreed to pay contractors in recent negotiations over cancellation fees for scrapping the project.
Transcript of those talks:
David Cameron: We would like our money back please.
Contractors: No.
David Cameron: Jolly good. Well, carry on then.
SJW: Someone who has run out of real oppression, and has to fake it.
Governments waste so much scarce money getting no-where. Would it be better if they didn't? Or if they got somewhere with it?
Sometimes I wish they'd just do nothing, take their money and shut up. it would be cheaper and better value for money.
it becomes hard to tell if they are the obstacle or the solution.
blog.sam.liddicott.com
This reminds of of a story from earlier this week regarding a poker company called "Full Tilt Poker," only difference being that this one sounds like it might involve a "Ponzi Scheme."
help me fix this "Terrible" karma, please!
Read up on EDS and Cap Gemini. One gets a contract and cannot deliver then it is given to the other who has not delivered on a contract elsewhere.
Summary of the system thus far:
http://en.wikipedia.org/wiki/NHS_Connecting_for_Health
I suppose it's peanuts now, but the guy who was in charge of the project decided not to charge the failed contractors £1 bln, and then went on to work for a consultancy.
Also, I'd been wondering from a programming point of view how the heck you can run up such an enormous bill:
http://programmers.stackexchange.com/questions/48117/how-do-software-projects-go-over-budget-and-under-deliver
First comment on the original article regarding getting their money back....
Oh, and here's a nice bit of dodginess:
"The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006, then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture."
But how you can mismanage such simple thing like creating IT system which keeps such e-records?
user@ubuntubox:~$ stfu This server is going down for shutdown NOW!
then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.
I bet I know who will be getting a nice high-pay/no-show job after he retires from government.
SJW: Someone who has run out of real oppression, and has to fake it.
There are plenty of big names in the electronic medical records world that are designed to integrate databases with each other. It looks like the NHS realized they were trying to find a solution for a problem that didn't really exist, because the private sector had already solved it. Sure, you have to pay extra money for the integration and translation programs from each company, but it's still probably cheaper for a hospital to pay the license fees to its own EMR provider for that software than it is to purchase an entire new system.
Occasionally living proof of the Ballmer peak.
So few tech ideas have actually been implemented on a national scale. Why? Because it's really bloody difficult to account for EVERYTHING before it goes into the wild.
When a new federal law is introduced, it takes nearly a generation for the states and municipalities to figure out how implementation is going to work. All they get is a mandate from on high. (Because, the guys below will figure it out... they have to, right?)
I always bring this up when it comes to Universal Healthcare in the U.S.: Massachusetts has a type of UH, so let's make sure that system is locked down and make room for expansion or create a parallel system for a neighboring state. After 2 years of preparation, push UH live in that state. Once that state is locked down, use the experience gathered from State 01 (Mass. being State 00) to prepare 2 more neighboring states. Again, after 2 years of preparation, push it live.
Why go with neighboring states? Because neighboring state frequently have similar values, societies, habits, and problems. You learn as you go, correcting for errors as you slowly implement a massively important system appropriate for the areas.
The same should have happened with the NHS system. Start in a single, smaller city (100,000) and build an expensive, perfect system. Then spread it to the neighbors while learning more and more about cities further out. This way, if the system ever just falls out (as it has), you still have SOME product that's genuinely usable and the potential for future implementation with a future contractor.
Been there, in detail, seeing several generations as viewed from the outside. The skin is all a game of politicised 'announcements', and this one is still in the mainstream. The 15-20% that actually works, mostly standardised intercommunication, will go on and will/must certainly deliver. All the rest is a kind of evolutionary broth - sometimes useful things pop out, usually the entrenched opponents subtly kill them. Money gets wasted big time, but that's oh-so-much easier to identify in retrospect. If the alternative were doing nothing at all, what exactly would YOU recommend instead? Woz sat at the table, and I did try.
Do you think that maybe they would just use a program that already exists? http://en.wikipedia.org/wiki/VistA The VA is the largest medical system in the united states (~8 million patients), and seems to have had this running for at least since the late 90s early 00s. I know they started deployment small with only a few regions and then scaled it up as they needed to.
then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.
I bet I know who will be getting a nice high-pay/no-show job after he retires from government.
Too late. Richard Granger long since left his post at Connecting for Health and now works for KPMG Australia. He was never really in government, as he was a civil servant rather than being elected. In fact for a while he was the highest paid civil servant in the country on £290,000 a year. The good thing about him leaving was that at least he did not get a golden handshake like most would have.
http://www.cio.co.uk/news/3141/kpmg-confirm-appointment-of-richard-granger-ex-nhs-cio
I dont read
The UK does some odd things sometimes. I work for a software company and about 15 years ago an agency in the UK Gov was interested in our software. They wanted 50 seats. Well our normal price is about $4000 but for that big of a sale we would have gone as low as $2000. Well they decided to write their own custom solution three years a two million pounds later they still didn't have a working system and asked us to consult for them and tell them what they did wrong. The offer was more than buying our system! We told them that that but they said that they want to waste all that development money.
Then you have the UKs bizarre love affair with the Nimrod sub hunting plane. I wonder if they are trying to convince everyone and themselves that the Comet really wasn't a failure. The UK could have bought the Grumman E-2 or even the Boeing E-3 AWACS but instead decided to try and convert the Nimrod into an AWACS. Well okay then the UK could have bought the Radar system from the E-2 and fitted it to the Nimrod. Well they decided to develop a new and better radar, Except after years of testing and Billions of dollars it was a failure. The RAF ended up using slightly post World War II Shackletons with World War II era US radar for AEW until 1991 when they bought 7 E-3s.
In 1996 the Nimrod sub hunter was getting really tired. Now RAF could have picked up updated P-3s from the US. Now the Orion is based on a 1950s airliner but then again the Nimrod is based on a 1940s airliner. Or they could have waited for the P-3s replacement which ended up being the P8. Instead they decided to update the Nimrod with new engines, wing and avionics. Well after around 4 billion pounds they killed that program in 2011. Oh and India just bought P-8s for one fourth the cost per plane than what the Nimrod MRA4 would have cost if they had delivered it.
Now we have this. I have to wonder if VistA would have worked for them. It is used by the US VA and is FOSS.
See my blog http://ilovecookes.blogspot.com/ for light hearted technical information.
Governments waste so much scarce money getting no-where. Would it be better if they didn't? Or if they got somewhere with it?
Sometimes I wish they'd just do nothing, take their money and shut up. it would be cheaper and better value for money.
it becomes hard to tell if they are the obstacle or the solution.
The nine most terrifying words in the English language are: "We're from the government, and we're here to help."
http://oscarmcmaster.org/
In theory, this should have been a great system from the patient and doctor point of view. All of our patient notes would have been available when needed - if we went to one hosiptal for a RTA, then later to another for a different issue, the consultant/dr would know about the RTA.
If you've moved around a lot, you could be on may different system - local GPs, local hospitals, local clinics, and no central store of your notes.
In practice, it turned into a massive system, far bigger than its orginal scope, with every vested interest having or making a change, it was replacing systems that may have been in production and continual development for 25+ years, and each hospital had its own policies and procedures that had to be accomodated (or not as the case may have been). The baby and the bathwater was being thrown out.
Possibly, all it really needed was for some sort of mandated electronic transfer protocol between hospitals/note keepers and a global catalogue of where a user has notes stored.
The local system builders/in house developers would have competed the compatibility and that would have been done.
try to make ends meet, you're a slave to money, then you die
For the same cost they could have filled a warehouse with medical records and hired a bunch of dropouts to ride around on Segways pulling files and using a high-tech fax machine to deliver medical records on demand to doctors the world over for the next hundred years until a system of electronic medical records that isn't fraught with problems was invented.
The UK (military at least) has a serious "not invented here" syndrome that it's really hard to shake. You can add the SA80 assault rifle debacle to the list above and too many others to mention (don't get me started on aircraft carriers). This has been compounded in recent years by the previous government (only time will tell if this is true of the new administration) being really good at negotiating deals that are really expensive for the government to back out of when they go hideously wrong.
Seriously. Basically $24 billion U.S. to unify database access?!?
Having to work for a living is the root of all evil.
From the security point of view, the system was a potential disaster. The centralized system implemented no access control whatsoever - all of that was to be handled by the client applications! That had a clear potential to become a privacy nightmare (not that we care about privacy anymore). I don't know any other details of the system, since my interests mostly lie in the area of security, but if that's any indication, I wouldn't be overly confident in sane design/correct function of the rest of it either.
Many places have no electronic medical records whatsoever. So you're looking at converting from handwritten notes and paper files to networked computers. That means you need to pay for the computers, the network, the servers, the database, the training, and all the zillions of customizations for every different hospital that has different procedures.
Our local health district (Saskatoon, in Canada) is just now in the process of converting to electronic records.
Well to be nice I left out the Tornado F.3 "Should have bought the F-15 it would have been in service years sooner and with working radar". The Carriers are tougher. I guess you could have tried working with France but that has worked so well with in past with the Jaguar and A400m. The UK could have tired to buy Nimitz class carriers but the math on that gets tricky,
Even if you are spending more in country than buying from the US some of that money gets "recycled". When you pay ship builders in the UK you get to tax them and they buy stuff in the UK with that money which puts others in the UK to work and so on. A large amount of that gets recycled back. When you guy an Aircraft carrier from the US all that money goes to the US and very little gets recycled back to the UK unless they use their pay to buy a lot of Land Rovers, Jags, and Triumph motorcycles.
See my blog http://ilovecookes.blogspot.com/ for light hearted technical information.
Continuing in the tradition of the Nimrod fiasco, you guys have a whole new MOD fiasco going: your aircraft carriers. On this side of the pond, we're told that you couldn't cancel the ships because penalties would have eventually cost as much as the completed ships themselves, and that you're going to sell off the first one you build. We hear India is interested. And we hear that the second one might be "shared" with France. Wow. Truly, Lord Nelson is rolling in his grave.
Life is hard, and the world is cruel
From the Wikipedia article:
"Granger's credentials were questioned by his own mother, a campaigner for the preservation of local health services in her area, who expressed her amazement at his appointment, criticising the whole scheme as 'a gross waste of money'".
If there wasn't so much evidence, Wikipedia's editors would likely delete that article for being so implausible. If I weren't a UK tax-payer, it'd almost be funny...
sig:- (wit >= sarcasm)
Wouldn't it make more sense, rather than huge, Cathedral-style* records management, to publish and then enforce standard record formats? That way, the base data (at least, if not all of your medical records) could fit on a card or USB key, and would be no problem handing your records to a new doctor when you move, or change medical coverage (I'm in the uncivilized US) and are forced to change doctors.
mark
Time to bring back drawing and quartering...
In case anyone was thinking that £12B is a lot for a database, what that money *actually* represents is providing a large chunk of the NHS's IT infrastructure for the next 12 years; or £1B per year for the IT needs of an organisation with 1.4 million employees and an annual turnover of £100B. The central data spine (which is the bit suffering the biggest problems and delays) is only one aspect of the system: it includes everything from making X-rays digitally available, to providing the network connectivity to individual GPs. Much of this is already in place and happily working.
Contracts are written for a reason.
Major f*ck ups, notably a contractor like Accenture which wasted about a billion £ on failed centralised database projects (Oracle?). Anyone else? Lets name and shame those useless IT contractors. This is public money flushed down the toilet!
What you are describing here are peasants of the IT/Tech world, and you are absolutely right.
Just to put that in perspective, thats £216 per person (children included).
Thanks government.
Australia you say? The country that just signed Accenture up to provide a national e-health IT platform?
No corruption there at all!
For a site about things like basic rights, Slashdot users sure do like to censor "dissent".
so two guys (so the story teals) have now one of the biggest website in the world with millions of daily user's and truck loads of data, (done some googling) and only spend $100 million. But some some crazy reason $1bn is not enough for some people to setup something probably half the size of the operations those guys have... they must be at the end of the toilet drain...
I wish I had mod points.
Yes, Australia is doing exactly the same thing, in almost the same way. It's on par with the what turned out to be the abysmal failure of accenture last time.
More info
http://forums.theregister.co.uk/forum/1/2011/08/14/accenture_snags_health_deal/
http://www.crikey.com.au/2011/08/18/roxons-health-records-system-a-massive-waste-of-467-million/
and lots of others. Big pie. Lots of slices. History repeating?
The UK does some odd things sometimes. I work for a software company and about 15 years ago an agency in the UK Gov was interested in our software. They wanted 50 seats. Well our normal price is about $4000 but for that big of a sale we would have gone as low as $2000.
:)
Might have helped to have given them a price in GBP
Governments waste so much scarce money getting no-where. Would it be better if they didn't? Or if they got somewhere with it?
Sometimes I wish they'd just do nothing, take their money and shut up. it would be cheaper and better value for money.
it becomes hard to tell if they are the obstacle or the solution.
I don't suppose any of the consultants and other IT professionals have anything to do with this failure, obviously it's all the evil government's fault?
To have a right to do a thing is not at all the same as to be right in doing it
The loyalty of the consultants and IT professionals is to their employer; and naturally, to gain as much revenue for as little cost as possible.
Ever since pharoah, those in authority have been too inclined to believe the court magicians who promise a technological solution to whatever problem ails them.
blog.sam.liddicott.com
Isn't every single IT project that is initiated by the goverment flawed in the fact they know jack shit about how to do anything. I mean how many experts are there really, involved in politics? I really think we need to have a think about how democracy should really work and get skilled people in charge - party politics should is simply ridiculous.
As far as getting something built, there really is a design that works, but it involves experts and nobody can build somthing that is constantly changing spec.
This whole project could have been offered to graduate as their thesis and awards given to the best solution / design. Offering them a student loan payoff for the winners and a few runners up could get 10K or somthing. In fact they probably would have saved money if they had of offered every IT grad in the county 10K for a solution that would work and picked the best ones to develop further - employing the grad that did it as an extra bonus. BUT NO THAT WOULD BE TOO EASY
I worked for the NHS as a emergency driver, whilst doing a software engineering degree. When I spoke to doctors and managers they all didn't really know what this new IT system was apart from a way of accessing patent records securely, just a mention of client server systems! This really showed me how little information was shared about specification and what the system needs to be able to do.
STEP1 - Build a prototype using dummy data...
Test on a few selected experts (this would be very cheap and allows doc's and nurses some feedback to improve the GUI and functionality). End up with spec that these are happy with and roll out to more people to test.
STEP2 - Get a skilled system architect to design the network topology.
Explain and cost exactly how the systems connect (securerly)
STEP 3 - Develop Software using appropriate language...
find a company that has most experience and offers most support to develop -
STEP4 - Implementation and maintenance...
Train up IT admins / outsource so that the systems can be installed and configured and the people can be trained.
I would have loved the oppertunity to work with the doctors and nurses to build a system that meets their needs, so patients don't get delayed because the doctor can't access their records (so needs to spend longer checking for other conditions before administreing drugs). Fuck our shit goverment with their bullshit underhand ways. Lets save money and cancel all the IT projects.
I wonder what stage they were at before the plug got pulled? UK citizens could save a lot of money if the admin for certain areas was more computerised... (NHS, IR, Courts / Legal) but they continue to work in the past and waste tax payers money.
Yea I guess the brits where too lazy to do a conversion themselves to save around 2.9 million dollars and have working software 3 years sooner. But I did get a trip to London and a nice bonus "consulting" to tell them what they did wrong. I think they only spent another million or so an took another year to rewrite the mess. :) Very nice city but I was amused at the their shock that I new who Lord Nelson was.
See my blog http://ilovecookes.blogspot.com/ for light hearted technical information.