It wasn't unexpected, nevertheless, the short announcement by the UK National Health Service (NHS) outlining the demise of a centerpiece of government health and IT policy for nearly a decade still was a bit surprising to read:
"The Department of Health review of the National Programme for IT has concluded that a centralised, national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured."
With those words in an NHS press release yesterday, the political and technical vision creating the NPfIT, which was vigorously defended even as it was obvious to all that the vision and especially its implementation were severely flawed, ended.
The NHS press release continued:
"A new approach to implementation will take a modular approach, allowing NHS organisations to introduce smaller, more manageable change, in line with their business requirements and capacity. NHS services will be the customers of a more plural system of IT embodying the core assumption of ‘connect all’, rather than ‘replace all’ systems. This reflects the coalition government’s commitment to ending top-down government and enabling localised decision-making."
"The review of the National Programme for IT has also concluded that retaining a national infrastructure will deliver best value for taxpayers. Applications such as Choose and Book, Electronic Prescription Service and PACS have been delivered and are now integrated with the running of current health services. Now there is a level of maturity in these applications they no longer need to be managed as projects but as IT services under the control of the NHS. Consequently, in line with the broader NHS reforms, the National Programme for IT will no longer be run as a centralised national programme and decision making and responsibility will be localised."
The new direction for NPfIT means that it will still cost a significant sum - £11.4bn instead of the originally planned £12.7bn - government Health Minister Simon Burns said in the press release.
In addition, it still appears that the controversial summary care record will be rolled out as planned, privacy and security concerns notwithstanding. Without it, the new "connect all" NPfIT strategy is pretty worthless unless a new mechanism to simply and quickly exchange health information is developed.
Given this, I suspect there will be many more stories concerning the "new NPfIT" roll out for several more years yet.
It will now be interesting to see how BT and CSC, the two prime contracted suppliers of electronic health records to the NHS, react to the changes. Both of them have had problems delivering their EHR solutions to the NHS on time and budget and with acceptable quality, and now largely as a result of these problems, they have lost their respective guaranteed NHS EHR market shares. It makes the decisions by Accenture and Fujitsu to exit the program a few years ago looking like the right ones.
One lesson for the US effort to roll out a national health information network is that it is much, much harder and more expensive than it looks, no matter how compelling the business case for it is.
Robert N. Charette is a Contributing Editor to IEEE Spectrum and an acknowledged international authority on information technology and systems risk management. A self-described “risk ecologist,” he is interested in the intersections of business, political, technological, and societal risks. Charette is an award-winning author of multiple books and numerous articles on the subjects of risk management, project and program management, innovation, and entrepreneurship. A Life Senior Member of the IEEE, Charette was a recipient of the IEEE Computer Society’s Golden Core Award in 2008.
