Monday, June 29, 2009

UK's National Programme for IT in the NHS Known Doomed at Outset?

It would seem likely.

In May 2009 at "The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians" I wrote:

... I can add that if this initiative [the U.S. multibillion dollar ARRA push towards national healthcare IT by 2014] blows up as it has in the UK, then the only triumph will be the financial triumph of the trade group and its apparatchiks. The losers will be the administration, patients, clinicians, and everyone else in the healthcare system.

The UK situation is much worse than I thought. The UK's NPfIT in the NHS was suspected to have been doomed from the start, but proceeded anyway; see "16 key points in Gateway Reviews on NHS IT scheme" and the secretive Gateway Reviews themselves upon which the preceding article was based, released under UK Freedom Of Information laws. From author Tony Collins on Gateway Reviews:

... Gateway reviews are mini-audits at critical stages in projects. The reports in question gave a red, amber or green status at each stage to help the project’s senior responsible owner decide whether to move to the next phase.

The government’s policy on Gateway reviews is to keep them confidential. All copies of a review are shredded, with the supporting material, to ensure only two reports remain – one for the Treasury’s Office of Government Commerce (OGC) and the other for the project’s senior responsible owner.

Highlights of the secretive health IT program reviews, now made public:

  • the NPfIT was probably doomed from the start, in Spring 2002. As one Gateway Review put it, many dedicated people were working hard on building the components for a car that hadn't been designed. To some extent that's still true today.
  • people didn't really know what they were doing in the first critical months in 2002
  • the initial plan was for new IT - not for changes to the way people work. So the preoccupation was with IT and not patients. It was hoped that new IT would drive change. But that rarely if ever succeeds.
  • that the costs and complexity were initially underestimated - by about £7bn - because nobody had an understanding of what was needed.
  • that speed was unduly important. One gateway review suggested that key staff didn't have time to take action on recommendations or learn lessons.
  • the programme as a whole, according to one Gateway Review, was not assessed against a list of Common Causes of Failure, as published by the National Audit Office. Only individual projects were assessed against the list.

How many of these findings apply in the U.S. Health IT program in 2009?

Finally, about the aforementioned May 2009 post, Matthew Holt of the Healthcare Blog wrote that I had "gone loopy", i.e., crazy (see footnote to the above-linked May 2009 post). The Chairman of CCHIT Mark Leavitt wrote that concerns about health IT are expressed by "fearmongers" and should be "laughed off."

These cavalier attitudes are a major part of what has gone wrong in HIT, as well as our society more generally.

Not to draw a specific comparison with these individuals, but our society is crumbling, and it's in no small part due to clowns in leadership roles, rather than as performers in Ringling Bros. and Barnum and Bailey's Greatest Show on Earth.

According to Matthew Holt and Mark Leavitt, Health IT concerns are a laughing matter, expressed by crazy people.

I (and many like minded colleagues) don't find healthcare information technology issues a laughing matter, however.

-- SS

July 1 Addendum:

More analysis is at E-Health Insider at this link.


Anonymous said...

The problems are real and to acknowledge them will be to everyone's benefit.

Anonymous said...

Geoorge Will in a recent Washington Post piece Spanish lesson on tilting at wind power highlights the work of Gabriel Calzada an economist. The short version of the story is that after careful study, wind power and renewable energy, is not cost effective and in fact takes money away from more profitable ventures. We have to ask if staffing is suffering with funds being diverted to EMR's over patient care?

"But Calzada's report concludes that they often are temporary and have received $752,000 to $800,000 each in subsides - wind industry jobs cost even more, $1.4 million each. And each new job entails the loss of 2.2 other jobs that are either lost or not created ..."

What is important to HCR readers is this section:

"Still, it is notable that rather than try to refute his report many Spanish critics have impugned his patriotism for faulting something for which Spain has been praised by Obama and others."

I cannot help but feel the same mind set is taking hold regarding EMR's. With worldwide failures, the most recent being Ontario, proponents seem to find fault with not spending more money, even when corruption and incompetence is found in those holding leadership positions. While EMR's are certainly a desirable goal, we must look at the reality of current technology, and above all patient safety.

I cannot help but remember:

"Facts are the enemy of truth."

Steve Lucas

Anonymous said...


The mind set is that of HIT religion worshipping the goddess of CPOEtia.

OCH said...

Paul Taylor is the CEO and general counsel for Ozarks Community Hospital. Ozarks Community Hospital is a small health system headquartered in Springfield, MO. He has written the OCH White Paper on Healthcare Reform which is being distributed nationwide. Copies of his position paper can be downloaded at Discussion of healthcare issues featured in the white paper will follow on

Anonymous said...



My wife and I both have dealt with this obsession. Her OB/GYN of 20 years recently made a point of seeing her, after many years of dealing with her PA/NP. My wife and the PA/NP had a good relationship that always included a talk about work, stress, and a health issue discussion.

Not so with the doctor. Sitting at the computer and never looking up she went through a laundry list of test and screening my wife should have now, and could all be done and scheduled easily in the hospital, where this doctor is based.

Now, is this EMR being used to better serve my wife or generate profits for the hospital and her doctor? Our guess is profits, since the suggestions were specific to my wife's insurance policy and information was available on previous test done, or not done, through that medical system.

So now EMR's become a very effective tool in driving excessive testing and maximizing patient spending within a specific medical system.

Steve Lucas

Anonymous said...

Steve or any one else reading this,

If you or colleagues want to help protect the safety of patients and have specific cases in which patients have been injured vis-a-vis adverse outcomes associated with HIT, please describe. Get them to SS (the informatics guy who writes to eloquently on this blog) in private with (I presume his) assurance they will not be published without expressed consent by the person reporting the situation.

Unknown said...

I note that one of the two agencies to have the remaining copies of the "Gateway Reports" is the Treasury’s Office of Government Commerce (OGC), a Government procurement agancy.

This rang a bell. Back in April 2008, the OGC spent a lot of money commissiong a new logo. See (amongst many) the Daily Telegraph's report at:

(Note that two images are available at the top of the article). Sorry to be a bit scurrilous -- but it strikes me as somehow apt.
Ted Harding