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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."
More common than you think:
http://fredsherman.ca/news/ontario-families-continue-to-pay-for-dalton-mcguinty%E2%80%99s-billion-dollar-ehealth-boondoggle/
Yo Grark
Canadian Bred with American Buttering
Very simple: You get the contract by being cheaper than the competition. Then you make sure to use the least competent personnel you have, so you can milk the cow until dead.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
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
Quebec is suffering the same issues. Canada established the Canada Health Infoway (https://www.infoway-inforoute.ca/lang-en/about-infoway) in 2001, has spent more than a $1B (CDN) to date, and just earmarked another $500M in 2010. None of this includes the $600M+ that Quebec has spent (let alone what the other provinces have spent) on Electronic Health Record systems...
The Canada Health Infoway is simply a framework and each province is responsible for setting up its own EHR system to link into it (health care is a provincial jurisdiction in Canada) . Overall, it's been a huge moneypit for Canadian taxpayers in most provinces (http://www.cbc.ca/news/health/story/2009/05/27/f-electronic-health-records.html).
All I can say is good luck to the UK in their quest for EHR...
I can no longer read Dilbert. It's too depressing, because it is too real. -- Hyperhaplo
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.
Your example could hardly better contradict your point:
Universal healthcare in the UK (the NHS) was implemented nationwide in about 3 years, covering 50million people with comprehensive and free healthcare (give or take a modest prescription fee at the time). It replaced a complex network of private, state (county) and charity organizations, and came up against bitter opposition from the vested interests in private healthcare at the time. It has its limitation, but public support for it is consistently very strong.
I appreciate your point on IT systems is probably true, and this project is clearly a disaster - but expanding it to general provision of healthcare ignores every functional single-payer system in the world.
'This writing business. Pencils and what-not. Over-rated if you ask me. Silly stuff. Nothing in it' - Eeyore
Actually, having spoken to a Doctor in a senior position in a large NHS Trust his conclusion wasn't too far from yours, but without the physical USB stick: Instead of a central massive do-everything system all that should have happened / be happening is to specify a set of formats and protocols and then each provider from giant hospital campus to small outreach surgery can use whatever system suits their needs, so long as it talks the language. Also the NHS already has its own secure backnet (fibre and the like, though I expect a good deal of it is VPN too) so it's not like there'd be web services ripe for the hacking hanging on public IPs.
If you don't risk failure you don't risk success.
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)
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.
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!
It seems pretty popular. The FBI had a massive e-records flameout as well.
A lot of it seems to be due to expecting AI. Wanting the system to not just store the records in a logical manner but to index and search arbitrary record formats (known and unknown, usually not actually documented). If the project shows a hint of being completed with that, someone decides the records should be automatically linked together even when a human can't figure out from context what goes with what.
Somewhere in that the process shifts to maintenance mode. Not maintaining the softwere, mind you, contracters maintaining the flow of cash and managers on the government side maintaining face. Nobody wants to be the one to declare that the project has turned to shit and become the natural scapegoat.
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".