It has been clear for some time that the UK's National Health Service's (NHS) electronic health record (EHR) program, also called the National Programme for IT (NPfIT) is in deep trouble, and getting deeper.
Just last month, Martin Bellamy, the NPfIT director of programme and systems delivery, decided after only nine months on the job to bolt to another government position, this time managing the G-Cloud government-wide cloud computing strategy. This in spite of him saying as late as March of this year that his was a long term commitment to making the NPfIT a success; he must have seen the handwriting on the wall.
For example, the roll-out of the pilot electronic health records in London region hospitals have been, shall we say, less than spectacular successes. Mr. Bellamy, a few weeks before he left, admitted that he was "not proud" of NPfIT's late delivery of EHR systems.
Bellamy's "not proud" assessment is not surprising, especially given that recently released UK government Gateway Reviews (risk assessments) showed that the NPfIT had failing marks from its beginning.
Adding to the feeling that the NPfIT ship is sinking, last week, according to E-Health Insider, UK doctors at their British Medical Association (BMA) annual meeting called for a clinical review of NPfIT, with some doctors complaining that even three years after the pilot EHR systems have been installed, there are still major difficulties using them.
The Insider story reported that:
"Dr. Paul Flynn from the BMA’s Central Consultants and Specialists Committee said he had been brought in to help doctors at the Royal Free Hospital in London following the implementation of Cerner Millennium."
"He told the [British Medical Association] meeting: 'I saw doctors who were enthusiasts for IT turning to complete despair. I have seen doctors almost in tears because of how frustrated they are at being prevented from doing their jobs by the IT system.' "
I think the original NPfIT spec called for the bringing of joyful tears to the eyes of doctors, not anguished ones.
Then on Monday of this week, BT, which is one of the two main NPfIT suppliers who hasn't quit (and took over Fujitsu's NPfIT work earlier this year after Fujitsu decided to move on to more profitable endeavors), is in such financial straits that it is now offering its workers a year sabbatical at 25% pay as a means for cutting its operating costs.
BT has reportedly had to write off at least £1.2 billion pounds on its NPfIT efforts already; again, not a big surprise, as the company was cited as early as 2005 in NHS Gateway Reviews for "poor supplier performance" in regard to its NPfIT-related work.
While BT says that it won't offer the sabbatical to front-line workers such as those working on the NPfIT effort (right now, anyway), its financial problems does make one wonder about what other cost cutting ideas are being considered by BT in regard to delivering its EHR systems to the NPfIT.
In fact, the pressure to cut costs on BT rose even more as of Monday afternoon after the Tories announced that, if they are elected, the nation's health records could be handed over to Microsoft (HealthVault) or Google (Health), effectively killing the NPfIT in its present form.
How this would work is as clear as mud on a spring day and it looks like there is about as much thought behind this idea as was exhibited by former Prime Minister Tony Blair when his government conjured up the NPfIT in the first place. There is a good starter list of questions here by Computing editor Brian Glick in regard to the Tory proposal, such as:
- Will people have to pay?
- If not, how would Microsoft and Google make money?
- What about security? What guarantees are there that a Microsoft/Google system is more secure than one run by government?
- How would private sector online applications be integrated with other NHS systems such as electronic prescriptions?
- Who would actually own the data and be legally responsible for its protection?
that need to be fully and honestly answered before going down this route.
Like Glick, I really do hate it when politicians think they are competent system designers of complex IT systems.
I strongly suggest that the Tories have the group of UK IT professors who called for an independent technical review of the NPfIT in 2006 (and who were foolishly turned down by the current government) undertake said assessment of their new plan.
Maybe so armed, the Tories will end up proposing something sensible.
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.