Monday, March 22, 2010

The National Program for Healthcare IT in the United States, 2015

Here is what I predict the the National Program for Healthcare IT in the United States will likely resemble in 2015 - namely, the National Programme for IT in the NHS in 2010:

Delays with £12.7bn NHS software program bring it close to collapse
Sunday 21 March 2010 18.47 GMT
Simon Bowers

The government's ailing £12.7bn IT programme to overhaul paper-based NHS patient records in England is close to imploding, potentially triggering a deluge of legal claims against the taxpayer running into billions of pounds, which could start to emerge weeks before a general election.

The Guardian has discovered that mounting chaos and delays in installing core care records systems across the country is reaching a tipping point, with intense political pressure from Whitehall now falling on Morecambe Bay NHS Trust and a software "go-live" deadline set for the end of this month.

Morecambe Bay is intended to be the first acute trust to take a new patient administration software package called Lorenzo, which has been delayed for four years. After a string of missed deadlines, the Department of Health set a deadline of March 2010 for Lorenzo last April. "If we don't see significant progress... then we will move to a new plan for delivering infomatics in healthcare," Christine Connelly, the Department of Health's director general of IT, said at the time.

Problem #1:

A problem of leadership. As I mentioned here, Christine Connelly knows as much about "informatics" as I know about candy making.

She was previously Chief Information Officer at Cadbury Schweppes with direct control of all IT operations and projects. She also spent over 20 years at BP where her roles included Chief of Staff for Gas, Power and Renewables, and Head of IT for both the upstream and downstream business.

Candy experience? More than Willy Wonka. Experience producing gas? Plentiful. Medical informatics expertise? Not so much. Predecessors also lacked genuine medical informatics expertise. This lack of appropriate expertise is all too common in healthcare leadership, and no exception is made for healthcare IT.

Preparatory testing at Morecambe Bay is believed to have failed some weeks ago, though iSoft, the firm behind Lorenzo, last week insisted testing was "on track" and dismissed as "media speculation" suggestions that the deadline was in jeopardy.

Problem #2:

Claiming everything is going just fine. This initiative has been a debacle from the start, partly due to it being rushed for purposes of governmental grandstanding. Don't take my word for it. Take the word of these people:

  • The UK Public Accounts Committee report on problems in the £12.7 billion national EMR program is here.
  • Gateway reviews of the UK National Programme for IT from the Office of Government Commerce (OGC) are here (released under the UK’s Freedom of Information Act), and a summary of 16 key points is here.

Back to the article:

The BMA (British Medical Association) echoed calls for greater public scrutiny of contracts. "Changes to NHS IT should be driven not by financial or political expedience, but by a commitment to improving clinical care. If any new system is rushed through too quickly, there can be a negative impact on patient care."

Problem #3: The obvious as stated by clinicians is ignored by project leaders and politicians.

Failure at Morecambe Bay could see the largest regional contractor on the 10-year programme, US outsourcing firm Computer Sciences Corporation (CSC), come under renewed pressure to book heavy provisions against the value of three £1bn NHS contracts – a move likely to send the group's share price tumbling.

It would also be bad news for iSoft, the Australian firm formerly called IBA Health, which in 2007 acquired crisis-stricken iSoft plc, the British firm behind Lorenzo, and took its name. It has told investors: "iSoft expects the milestone at Morecambe Bay to be met according to the timetable agreed between its partner CSC and the NHS, and expects this achievement to trigger a cash payment to the company."

A Morecambe Bay delay could also push mounting tensions between the Department of Health and CSC into the hands of lawyers, as a squabble breaks out over who should foot the bill for seven years of underperformance since the National Programme contracts were signed in 2003. The government is already facing a reported £700m legal dispute with CSC's fellow regional contractor Fujitsu after the Japanese consultancy firm walked away from a £1bn contract to supply and install IT systems at NHS trusts across the South of England and the West Country three years ago.

If CSC, an $11bn (£7.3bn) Virginia-based group listed on the New York stock exchange, were to enter into a parallel legal battle, it would leave 80% of care records IT contracts – the heart of the National Programme – in the hands of lawyers. After the departure of Fujitsu, and Accenture a year earlier, the only remaining regional contractor aside from CSC is BT, responsible for the London area. It was forced last year to wipe between half and 70% from the value of its £1bn contract with NHS London because of delays and software failings.

Problem #4 (if you can follow all that nonproductive but expensive mayhem that does little beyond consuming precious healthcare resources better spent elsewhere):

Too much outsourcing to a musical-chairs confederacy of management consultant firms rather than use of local expertise.

... Disappointing results from the National Programme – once a flagship NHS modernising push for then prime minister Tony Blair – have become an embarrassment for Labour, and the project has lost the confidence of many NHS staff. Up to now, however, ministers have sought to stress that the taxpayer has not lost out. Earlier this month, health minister Mike O'Brien told BBC Radio 4's File on 4: "Yes, there have been delays. These delays have not cost the tax payer. They have cost the companies – they have taken the risk... Some of these companies have been more ambitious than they should have been." [In other words, they promised far more than they could deliver with the talent on hand - ed.]

Problem #5:

Incompetence, talent mismangement and not knowing what they do not know about healthcare IT.

Read the rest of the article at the link above.

Also note the UK's healthcare system is far smaller, far more monolithic, and far more easily controlled by government than that in the U.S.

My belief is that the US program for health IT will likely resemble the UK's in just a few years' time, for the very same reasons. Unless, that is, major changes in the approaches to design and implementation occur, and soon, and the purpose of HIT reigned in to clinician support, not support of massive bureaucracies. I consider the necessary changes unlikely due to the intransigence of the IT culture and of the leadership behind the effort.

Again, don't take it from me, take it from the U.S. National Research Council and other writers at this link.

-- SS


Anonymous said...

Just wondering how many patients have died in this debacle of defective technology and an incompetent deployment. Does any one know if HIMSS was lobbying the NHS?

Anonymous said...

We in the US often think of any country in Europe as an equal in physical size and population. This is simply not true. France, the largest country in the EU, is about the size of Texas.

What we should be doing is looking at these projects in terms of size, and enlarging them to adjust for our larger population and geographic size. When you apply a multiplier, choose your own, the numbers become frightening. As noted in the post additional adjustments must be made for the complexity of our political system.

Those in Europe have as much technical skill as we do in the US. We should be looking at them for guidance and learning from both their successes and failures. Simply saying: “We are America,” does not change the outcome.

Pushing ahead to satisfy some political goal, or to support a lobbyist plan, will not serve us in the long run and we will find a similar outcome.

Steve Lucas

Michelle W said...

I think the biggest concern everyone should have for the US EHR program is time. With the latest certification NPRM establishing when we can start seeing a certification body set up, there's a very narrow window of opportunity for products to get certified and then out to medical offices, who will have to learn how to meaningful use the things.

While there are many laudable goals and worthy members of the ONC committees/workgroups, I think someone should realize what having to use a temporary program because a permanent one would take more time than they have says to the public: is it time to slow down?

InformaticsMD said...


I addressed rushing the project at the post here. Appx. 95 medical specialty organizations were also concerned. It seems to me that the "rush" along with a push for ominous reporting requirements are aimed at forcing physicians into buying and using "certified" EMR's. God only knows what will become of the data. Used to justify rationing? I cannot dismiss possibilities like that.

The government officials' push for "complex measures and high reporting thresholds needed to discourage EPs (eligible professionals" eligible for gov't EMR subsidies) from switching back to the use of paper", reported by the AMA and other organizations, is to force physician lock-in and is not entirely based on altruism towards patients, I am certain. Anyone who believes that it is, is simply being naive.

Furhter, I do not view "certification" as a valid terminology. It's a preflight checklist, not a safety evaluation as in, say, UL certification of an electrical appliance. The latter evaluation is the most critical. I know of deaths caused by HIT.

The correct terms should be "features qualification", not "certification"; and "good faith use", not "meaningful use", since the latter terms begs the question of whether HIT is truly beneficial or not.

The literature on that point is conflicting. See the case studies esp the 2009 articles at my Drexel site here.

-- SS

NHS CIO said...

Fortunately, the US programme investment will be in full flow by the time the UK's NPfIT Greek Tragedy's last act draws to a close. This will allow the likes of iSOFT and CSC to move from one trough to the next without moving their little legs too far.
The UK's programme is likely to collapse UK's IT spending for decades to come - spending circa£10,000,000,000 GBP for systems that aren't fit for purpose.

We'd have been better off using these funds to expand our prisons so we could accommodate the involved NPfIT decision-makers.

InformaticsMD said...

Re: NHS CIO said...

We'd have been better off using these funds to expand our prisons so we could accommodate the involved NPfIT decision-makers.

Our health IT industry's under investigation here by Sen. Grassley, ranking member of the US Senate Finance Committee, before the $100,000,000,000+ has been spent.

Hopefully it will be a reminder to the decision makers to act with some degree of caution.

However I fear an evolving Greek tragedy here as well, as per my post.

-- SS