Friday, September 10, 2010

National Programme for Health IT Declared Dead Due to 'Luddite Doctors' and Lousy IT, But Mostly Lousy IT

And poor leadership.

From the NHS Department of Health (also see "End of NPfIT to be announced today" at eHealth Insider.com):

9 Sept. 2010

The future of the National Programme for IT


A 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.

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.

Health Minister, Simon Burns, said:

“Improving IT is essential to delivering a patient-centred NHS. But the nationally imposed system is neither necessary nor appropriate to deliver this. We will allow hospitals to use and develop the IT they already have and add to their environment either by integrating systems purchased through the existing national contracts or elsewhere.

“This makes practical sense. It also makes financial sense. Moving IT systems closer to the frontline will release £700 million extra in savings. Every penny saved through productivity gains will be reinvested to improve patient care.”

Director General for [Medical] Informatics Christine Connelly [former CIO of Cadbury Schweppes, the candy-and-soft drink company, and before that Chief of Staff for Gas, Power and Renewables, and Head of IT at British Petroleum - ed.] said:

“It is clear that the National Programme for IT has delivered important changes for the NHS including an infrastructure which the NHS today depends on for providing safe and responsive health care. Now the NHS is changing [ostensibly away from central bureaucratic control and towards more physician autonomy - ed.], we need to change the way IT supports those changes, bringing decisions closer to the front line and ensuring that change is manageable and holds less risk for NHS organisations.”

The U.S. will painfully learn these lessons in years to come, it being clear that to date we've learned nothing from the UK's experiences.

Worse, our own government is ignoring the downside risks of the technology, bypassing science (and patient safety) for political expedience. At the same time, the EU is heading in the reverse direction, with the Swedish Medical Products Agency leading the way for consideration of HIT in the EU as a medical device to be regulated (see "Improving Patient Safety In The EU: HIT Should Be Classified As Medical Devices").

On ignoring science, see my July 2010 post "Science or Politics? The New England Journal and "The 'Meaningful Use' Regulation for Electronic Health Records".

Also see my prior calls for US restraint such as at "Should The U.S. Call A Moratorium On Ambitious National Electronic Health Records Plans?" and "Open Letter to President Barack Obama on Healthcare Information Technology".

In fact, a major American health IT vendor (e.g., at this link, items 5 and 6, Cerner Millenium) was explicitly blamed by the UK's government for many of the National Programme's travails.

The key experience of the NHS is reflected in this passage:

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.

The "meaningful use" requirements in the U.S. alone ignore local "business requierments and capacity" over the centralized diktats of bureaucrats.

-- SS

Sept. 10 addendum, from here:

... Said the co-director of the Royal College of Physicians Health Informatics Unit, “One of the dirty secrets of the NHS is the regrettable state of medical record keeping. Earlier reports have shown that this compromises patient safety and clinical care. If IT in the health service is going to regain the confidence of the medical profession, then more emphasis has to be placed by the Department of Health on making sure that the new systems accurately capture the dialogue between doctor and patient. Everything else flows from getting that right.”

Earlier reports ["earlier" with respect to...what? - ed.] "have shown that [poor electronic medical record keeping] compromises patient safety and clinical care?

You don't say?

-- SS

5 comments:

Marc said...

I live in the UK - it would be a mistake to think that all NHS IT has been a failure. Yes, the big bang approach as fatally flawed, but locally I can walk into my brand new primary care center in London, touch a screen to confirm my appointment, see any doctor in the practice who has all my recent history on screen, get requests for blood tests and prescriptions printed on the spot, and get test result printouts back from several acute hospitals in the area back at the primary care centre within a day or two. And it costs me personally nothing at the point for care, bar a few dollars for a prescription at any pharmacy.

Anonymous said...

Blumenthal has his dead down and is unable to see the dysfunction he has wrought on patient care, like this, from the UK NHS:

"If IT in the health service is going to regain the confidence of the medical profession, then more emphasis has to be placed by the Department of Health on making sure that the new systems accurately capture the dialogue between doctor and patient."

He needs to wake up from his stupor.

Scot M Silverstein MD said...

Marc said...

I live in the UK - it would be a mistake to think that all NHS IT has been a failure. Yes, the big bang approach as fatally flawed

That's my point. We're about to repeat the same mistakes here.

As I often write, health IT can provide benefits....when done well.

Your country wasted billions of pounds on not doing a lot of it well. Ours is unfortunately on the same path.

Sadly, the problems are predictable and avoidable, but irrationality reigns.

Cetamua said...

SS wrote:
"Sadly, the problems are predictable and avoidable, but irrationality reigns."

Irrationality? That's being kind. Unadulterated gullibility to propaganda would be more exact.

Here's an example that does not even bother to address the topic of safety; should we be surprised?

EHR mythology 101 by MARGALIT GUR-ARIE

http://www.thehealthcareblog.com/the_health_care_blog/2010/09/ehr-mythology-101.html

::Roll eyes::

Scot M Silverstein MD said...

Re: EHR mythology 101

Everyone's entitled to their own mythology.

(What I note are lacking in that version are that tool known as 'footnotes' or 'hyperlinks' to corroborating information, however.)

What other type of document often lacks such characteristics?

Those from marketers...

-- SS