Friday, February 22, 2008

EMR Recipe for Disaster: Leadership by Delusional Bureacrat, the NHS example

My webcast on an "irrational exuberance" over clinical IT (electronic medical records and associated applications) was recently posted to the website "Government Health IT" (of the U.S. government, that is). I have also had an educational web site online for almost a decade on the topic of health IT difficulties entitled "Sociotechnologic Issues in Clinical Computing: Common Examples of Healthcare IT Difficulties".

Over the years I have noticed many hits from the domain "" (UK National Health Service). Why is that relevant? Read on.

My web site points out the myriad false assumptions, underestimations, misplaced beliefs in technologic determinism, and the major differences between business computing -- descended from the IBM punch card and plug-panel tabulating machines widely used to manage manufacturing and mercantile businesses decades before the electronic computer -- and clinical computing, descended from the creative work of medical computing pioneers using stored-program computers as a "canvas" to paint works of art.

(An aside: ever wonder why the so-called first "modern computer", the ENIAC, was programmed with patch cords? Think of the people who were acculturated via such machines, who set the tone for today's management information systems profession, and compare to the culture of clinicians. Meanwhile, foreign nationals with much better ideas on computation have largely been written out of the computing history books for some reason.)

My health IT website also illustrates how these false assumptions and underestimations, and leadership by bureacrats lacking clinical and biomedical backgrounds (and oftentimes, it seems, basic competence), result in problems ranging from major difficulties to catastrophic HIT project failures.

Now, here is a poster example of what I call "irrational exuberance" over health IT, at the highest levels of government. My comments in red:

Blair Rushed NHS IT
Posted: 13:00 18 Feb 2008

Tony Blair repeatedly sought to shorten the timetable for the
NHS IT programme in a move that would have brought results for patients in time for a general election in 2005, Computer Weekly has learned. Papers obtained under the Freedom of Information Act show that the Department of Health drastically underestimated the time it would take to make electronic patient records available online. [Did I see the word "underestimate?" - ed.]

papers presented to an NHS IT meeting at Downing Street , the Department of Health promised systems would provide "seamless" care across the NHS by 2004/05 - less than half of the time now allotted to the scheme. The meeting, on 18 February 2002, was attended by IT suppliers, policy advisers and health experts.

But Tony Blair made it clear that he regarded even the 2004/05 timescale as too long. He asked repeatedly for it to be shortened, which would have brought visible benefits in time for a general election in May 2005.

Blair told the meeting that implementing the programme faster than planned would underpin the government's reform agenda and provide evidence of NHS modernisation to the public.

But the timetable in the Department of Health papers has proved hopelessly optimistic. Access by patients and doctors to national summary care records are only at a trial stage. And contracts for the delivery and implementation of new national systems run until 2013 - eight years later than the timetable presented to Downing Street [after many billions of British pounds have likely been thrown down to loo due to the rush - ed.]

The Department of Health awarded a series of contracts in record time under the NHS's National Programme for IT (NPfIT) in 2003, but some suppliers complained they were being given too little time to consider their proposals.

The main part of the programme - a national electronic health record - is running three years behind the original timetable, in part because the idea is more difficult than first thought to put into practice. [Oh - wait - you mean, automating medicine is harder than automating the production of widgets? - ed.]

The papers raise questions about whether the timetable for the NPfIT was geared towards a general election, rather than the practicalities and complexities of the scheme - and whether the Department of Health put politics before realities in promising the programme in less than three years. [Need I answer that? - ed.]

Paul Cundy, GP IT spokesman for the British Medical Association, said it appeared that the Department of Health had been "wildly, even delusionally, optimistic about the timetable for the NPfIT in order to secure funding". [Might I add "irrationally exuberant" and "suffering from the syndrome of inappropriate overconfidence in computers"? - ed.]

Vince Cable, deputy leader of the Liberal Democrats, said the Downing Street papers showed that the NPfIT was launched after a discussion that stood out for its "amateurism, naivety and a lack of consideration of the practicalities". [Indeed - ed.]

Health IT can accomplish its many stated goals, but only if done correctly. If not, it will be an annoyance at best, and a hazard as a tool for payer and governmental abuse of clinicians and patients at worst.

There must come a time when medicine's professionals stand up for their profession and stop permitting politicians, business interlopers and other parasites from attaching themselves to medicine's back and sucking the blood and sweat of its practitioners, and siphoning off capital better used to improve health.

Recklessly tranferring massive amounts of money from the healthcare sector to the IT sector, so that politicians can get re-elected, clinicians can be the development lab and beta testers for inept software companies, and so that information technology personnel who faint at the sight of blood can have nice jobs in hospitals and healthcare organizations, is not the way to accomplish this mission.

Unfortunately, those in the know (the healthcare informatics community) either are too timid to speak out politically about the abuses in the health IT industry, too conflicted financially, or too academically orientated to make any difference (i.e., after major system disasters are described by the principals, the evidence is written off as "not scientifically grounded.") Lastly, those who do try to report on such problems receive much pushback and/or become marginalized.

Scott Adams once observed a number of categories of irrational thinking. One of them was this:

Example: I always get hives immediately after eating strawberries. But without a scientifically controlled experiment, it's not reliable data. So I continue to eat strawberries every day, since I can't tell if they cause hives.

The UK NHS IT experience is one big, stunningly red strawberry. Will the medical and healthcare informatics communities learn anything from it?

I have my doubts.

Finally, who at has been reading my website over the years? Did they understand it? Did they try to use it and related writings by others in pushback against artificially rushed schedules? Or were such writings dismissed as the rantings of luddites?

Inquiring minds would like to know.

-- SS


Anonymous said...

We recently had a hospital VP state his goal for the hospital was to be 100% computerized. I could only think it wasn't much of a goal for a hospital. We need to change the IT's frame of reference to the patient's point of view. If we gave each patient a bill for the cost of their digital chart would they prefer to carry a paper copy? Rather than trying to change the entire chart we need to carefully look at each patient process. In our clinic the goal is to minimize wait times and errors. When we reexamine a process, we include the IT steps in the process for the patient then decide if it's worthwhile to make it digital. If it slows us down, cost to much and/or doesn't change the quality of care it may not be included. Obviously we need to build the digital infrastructure to allow these steps but IT needs to be part of the team; not an island of pet projects. Wait Times Blog

InformaticsMD said...

We recently had a hospital VP state his goal for the hospital was to be 100% computerized.

This is known as the "syndrome of inappropriate overconfidence in computers", a.k.a. "technologic determinism" and perhaps "drinking the I.T. Kool Aid."

I enjoyed your posting "Technology, Change and Wait – Project Failures."