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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.
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.
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.
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.
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.
Usng USA solutions elsewhere is really risky. I've seen several of my customers go down (ie cease to exist) ultimately because they chose a software solution built for US states (as opposed to a whole country). Example: one of my customers (a savings bank) wanted to completely refresh every software application they had, so bought an American integrated package that appeared to be pretty successful and pretty widely used. They ran almost immediately into severe performance problems - the elapsed time to process a whole day's transactions was 28 hours. On digging into why this was the case, they discovered that none of the other user sites had more than 100,000 accounts. My customer had 2 million accounts. The software package was simply not built to handle that, and the authors didn't care enough about one customer to rewrite the package. That savings bank now exists only as a brand name.
"Cock Up Your Beaver" does not mean what you think. This sig is intended to clog filters and annoy do-gooders
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.
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!
Source? Have a look at this, under the Access Control Framework section.
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".
Perhaps the complexity and importance of the data has something to do with it.
For a healthcare system, the results range from catastrophic to cataclysmic using US-oriented packages, The US packages all seem to be focused around billing, insurance, and stuff like that whereas in countries with socialised systems these sorts of things aren't even a consideration.
For a site about things like basic rights, Slashdot users sure do like to censor "dissent".
VistA isn't the usual US medical software. It was built for the VA (a government healthcare system with around 1100 facilities and nearly 200,000 employees) which isn't much concerned with billing insurance companies. VistA is open source, free software. It's used in other large deployments around the world, usually customized for local needs. It forms the backbone of the Finnish system's hospital software, and has done well there.
"Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery?" - Patrick Henry
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
I've not heard that. For the Royal Navy carriers the only plane mentioned has been the F35. There was some talk of a vertical lift-off version of the F35, but that appears to be being dropped as too expensive in favour of the standard catapult model. As time passes that might be downgraded again to something cheaper. F18?
The Eurofighter has been a bit of an embarrassment budget-wise, so I don't think the MoD buyers, however gullible they may be, would be allowed to buy a new-improved-carrier-Eurofighter.
Ah, I made the mistake of assuming you were a Brit.
Why? It was perfectly obvious he was talking about the UK from the perspective of someone from the US.
To have a right to do a thing is not at all the same as to be right in doing 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.
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
Not for the UK. They want to sell it to India.
But yes the Eurofighter is a good example of what happens when you do a joint project. Too many cooks and all that. Kind of like the F-35.
One wonders how the Eurofighter compares to say an F-15S,K, or updated Cs and Es. My guess is, more maneuverable, shorter range, less effective radar.
See my blog http://ilovecookes.blogspot.com/ for light hearted technical information.
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.