Lessons From the UK NPfIT Debacle Still Being Learned

The decision last year to finally cancel the UK’s National Program for IT (NPfIT) effort to implement a nation-wide integrated electronic health record (EHR) system because of its spiraling cost and complexity  is looking better all the time. According to a recent  story in Computer Weekly, roughly 60 percent of London National Health Service (NHS) hospital trusts are operating without IT disaster recovery systems in place. The startling news was delivered at a health informatics conference by a program manager at the London NHS Commercial Support Unit. The speaker said her group is trying to determine why such a high number of hospitals don’t have these basic systems in place, and whether the trusts that lack them are planning on implementing any of them soon.

In a related story, the Guardian reported earlier in the month that the North Bristol NHS trust’s effort to roll out its Cerner-based electronic health record system has overrun its budget by nearly 100 percent. Apparently, the trust severely underestimated how challenging the data migration effort would be, not to mention the level of staff support needed to operate the system once it was in place. Issues with the EHR roll-out led to a series of clinical incidents; the trust cited the Cerner implementation ”as the causal factor” in 16 of them, the Guardian stated. Fortunately, none of the incidents created a hazard for patients.

The definitive history of the failure of the NPfIT has yet to be written. The closest that exists is the Dossier (pdf) of concerns that professor Brian Randell of Newcastle University has compiled over the years. Now, another useful historical contribution has been written by professor Geoffrey Sampson of the University of South Africa, who provides his own view of the debacle.

Like Randell, Sampson was one of the “Gang of 23” computer professorswho wrote an open letter to the UK government in April 2006 questioning its NPfIT strategy and implementation approach, and calling for an independent technical review of the effort. The letter caused a stir at the time, but ultimately did not cause the government to change its NPfIT approach one iota, other than to double down in its defense of its plans. As in most situations of denial of the obvious like this, all that was needed for the approach to fail was time.

Sampson’s observations of the NPfIT debacle are interesting, especially in regard to the lessons that those involved in government IT need learn from it. He writes, for instance, that:

“Government and computing are bound to mix badly, because the two domains are founded on contrary assumptions. In the government world, it is a given that sufficient authority will elicit any desired action. In the world of informatics, authority is impotent. Bring as much pressure as you like to bear on a flawed software system, and what you will get is a worse-flawed system.”

In addition:

“If governments hope to make IT serve their purposes, as since the turn of the century they have increasingly been aiming to do, then they have got to learn to defer to information-technology realities. Human beings bend to government will. Software development does not take orders.”

Maybe Katie Davis, the interim Managing Director of NHS informatics, should keep that in mind the next time she thinks about reiterating her claims about the future of the NHS and technology. For example, insists that NHS has an 80 percent chance (if not better) of having “world beating” health informatics in place across the country within the next 5 to 10 years, although that statement is based on nothing more than the "enthusiasm" the government has for health information technology.

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