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United Kingdom Government Medicine IT

UK's NHS Will Drop Delayed E-Records Project 86

Posted by timothy
from the sounds-like-the-denver-airport dept.
Centralized, electronic medical records are touted as a means of increasing efficiency and patient safety. The "centralizing" and "turning electronic" phases, though, have some very rough edges. An anonymous reader writes with this excerpt from the Guardian about one such digitization project in the UK: "An ambitious multibillion pound programme to create a computerised patient record system across the entire NHS is being scrapped, ministers have decided. The £12.7bn National Programme for IT is being ended after years of delays, technical difficulties, contractual disputes and rising costs."
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UK's NHS Will Drop Delayed E-Records Project

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  • by elrous0 (869638) on Thursday September 22, 2011 @08:27AM (#37478970)

    It is still unclear how much money the government has agreed to pay contractors in recent negotiations over cancellation fees for scrapping the project.

    Transcript of those talks:

    David Cameron: We would like our money back please.
    Contractors: No.
    David Cameron: Jolly good. Well, carry on then.

    • by martijnd (148684) on Thursday September 22, 2011 @08:37AM (#37479066)

      First comment on the original article regarding getting their money back....

      Oh, and here's a nice bit of dodginess:

      "The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006, then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture."

      • by elrous0 (869638) *

        then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.

        I bet I know who will be getting a nice high-pay/no-show job after he retires from government.

        • by Ash Vince (602485) *

          then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with Andersen Consulting, which later became Accenture.

          I bet I know who will be getting a nice high-pay/no-show job after he retires from government.

          Too late. Richard Granger long since left his post at Connecting for Health and now works for KPMG Australia. He was never really in government, as he was a civil servant rather than being elected. In fact for a while he was the highest paid civil servant in the country on £290,000 a year. The good thing about him leaving was that at least he did not get a golden handshake like most would have.

          http://www.cio.co.uk/news/3141/kpmg-confirm-appointment-of-richard-granger-ex-nhs-cio [cio.co.uk]

          • by Kalriath (849904)

            Australia you say? The country that just signed Accenture up to provide a national e-health IT platform?

            No corruption there at all!

      • by djkitsch (576853) on Thursday September 22, 2011 @11:22AM (#37481262)

        From the Wikipedia article:

        "Granger's credentials were questioned by his own mother, a campaigner for the preservation of local health services in her area, who expressed her amazement at his appointment, criticising the whole scheme as 'a gross waste of money'".

        If there wasn't so much evidence, Wikipedia's editors would likely delete that article for being so implausible. If I weren't a UK tax-payer, it'd almost be funny...

      • First comment on the original article regarding getting their money back.... Oh, and here's a nice bit of dodginess: "The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006, then Director-General for NPfIT Richard Granger charged them not £1bn, as the contract permitted, but just £63m. Granger's first job was with A

    • by LWATCDR (28044) on Thursday September 22, 2011 @09:16AM (#37479506) Homepage Journal

      The UK does some odd things sometimes. I work for a software company and about 15 years ago an agency in the UK Gov was interested in our software. They wanted 50 seats. Well our normal price is about $4000 but for that big of a sale we would have gone as low as $2000. Well they decided to write their own custom solution three years a two million pounds later they still didn't have a working system and asked us to consult for them and tell them what they did wrong. The offer was more than buying our system! We told them that that but they said that they want to waste all that development money.
      Then you have the UKs bizarre love affair with the Nimrod sub hunting plane. I wonder if they are trying to convince everyone and themselves that the Comet really wasn't a failure. The UK could have bought the Grumman E-2 or even the Boeing E-3 AWACS but instead decided to try and convert the Nimrod into an AWACS. Well okay then the UK could have bought the Radar system from the E-2 and fitted it to the Nimrod. Well they decided to develop a new and better radar, Except after years of testing and Billions of dollars it was a failure. The RAF ended up using slightly post World War II Shackletons with World War II era US radar for AEW until 1991 when they bought 7 E-3s.
      In 1996 the Nimrod sub hunter was getting really tired. Now RAF could have picked up updated P-3s from the US. Now the Orion is based on a 1950s airliner but then again the Nimrod is based on a 1940s airliner. Or they could have waited for the P-3s replacement which ended up being the P8. Instead they decided to update the Nimrod with new engines, wing and avionics. Well after around 4 billion pounds they killed that program in 2011. Oh and India just bought P-8s for one fourth the cost per plane than what the Nimrod MRA4 would have cost if they had delivered it.
      Now we have this. I have to wonder if VistA would have worked for them. It is used by the US VA and is FOSS.

       

      • by Anonymous Coward

        The UK (military at least) has a serious "not invented here" syndrome that it's really hard to shake. You can add the SA80 assault rifle debacle to the list above and too many others to mention (don't get me started on aircraft carriers). This has been compounded in recent years by the previous government (only time will tell if this is true of the new administration) being really good at negotiating deals that are really expensive for the government to back out of when they go hideously wrong.

        • by LWATCDR (28044)

          Well to be nice I left out the Tornado F.3 "Should have bought the F-15 it would have been in service years sooner and with working radar". The Carriers are tougher. I guess you could have tried working with France but that has worked so well with in past with the Jaguar and A400m. The UK could have tired to buy Nimitz class carriers but the math on that gets tricky,
          Even if you are spending more in country than buying from the US some of that money gets "recycled". When you pay ship builders in the UK you g

      • Continuing in the tradition of the Nimrod fiasco, you guys have a whole new MOD fiasco going: your aircraft carriers. On this side of the pond, we're told that you couldn't cancel the ships because penalties would have eventually cost as much as the completed ships themselves, and that you're going to sell off the first one you build. We hear India is interested. And we hear that the second one might be "shared" with France. Wow. Truly, Lord Nelson is rolling in his grave.

        • by LWATCDR (28044)

          I don't know which side of the pond you are on or what pond, but here our carriers are the Nimitz class thank you very much and we do not sell or share them :)

          • by DesScorp (410532)

            Ah, I made the mistake of assuming you were a Brit. Regardless, there are negotiations going on right to between the UK and France on sharing that second flattop.

            • I think that's a temporary thing. The madness of the UK budget mess is, money for the carriers, but no money for the planes the carriers are built to carry, until x years from now.

              Huge cock up. But just one of many.

              • by LWATCDR (28044)

                Well now I hear that the UK is thinking of making Eurofighter carrier capable so they can sell it over seas. Which I find really odd and I worry how much it will end up costing before they cancel it.

                • I've not heard that. For the Royal Navy carriers the only plane mentioned has been the F35. There was some talk of a vertical lift-off version of the F35, but that appears to be being dropped as too expensive in favour of the standard catapult model. As time passes that might be downgraded again to something cheaper. F18?

                  The Eurofighter has been a bit of an embarrassment budget-wise, so I don't think the MoD buyers, however gullible they may be, would be allowed to buy a new-improved-carrier-Eurofighter.

                  • by LWATCDR (28044)

                    Not for the UK. They want to sell it to India.
                    But yes the Eurofighter is a good example of what happens when you do a joint project. Too many cooks and all that. Kind of like the F-35.
                    One wonders how the Eurofighter compares to say an F-15S,K, or updated Cs and Es. My guess is, more maneuverable, shorter range, less effective radar.

            • by LWATCDR (28044)

              No problem, I tried to be as international in my post as possible. A lot of EU folks take offense when people from the US while posting on this US based site, post US centric posts.

            • by tehcyder (746570)

              Ah, I made the mistake of assuming you were a Brit.

              Why? It was perfectly obvious he was talking about the UK from the perspective of someone from the US.

      • by Tasha26 (1613349)
        What you are describing here are peasants of the IT/Tech world, and you are absolutely right.
      • by mpe (36238)
        The UK does some odd things sometimes. I work for a software company and about 15 years ago an agency in the UK Gov was interested in our software. They wanted 50 seats. Well our normal price is about $4000 but for that big of a sale we would have gone as low as $2000.

        Might have helped to have given them a price in GBP :)
        • by LWATCDR (28044)

          Yea I guess the brits where too lazy to do a conversion themselves to save around 2.9 million dollars and have working software 3 years sooner. But I did get a trip to London and a nice bonus "consulting" to tell them what they did wrong. I think they only spent another million or so an took another year to rewrite the mess. :) Very nice city but I was amused at the their shock that I new who Lord Nelson was.

    • Contracts are written for a reason.

  • Governments waste so much scarce money getting no-where. Would it be better if they didn't? Or if they got somewhere with it?

    Sometimes I wish they'd just do nothing, take their money and shut up. it would be cheaper and better value for money.

    it becomes hard to tell if they are the obstacle or the solution.

    • by tehcyder (746570)

      Governments waste so much scarce money getting no-where. Would it be better if they didn't? Or if they got somewhere with it?

      Sometimes I wish they'd just do nothing, take their money and shut up. it would be cheaper and better value for money.

      it becomes hard to tell if they are the obstacle or the solution.

      I don't suppose any of the consultants and other IT professionals have anything to do with this failure, obviously it's all the evil government's fault?

      • by samjam (256347)

        The loyalty of the consultants and IT professionals is to their employer; and naturally, to gain as much revenue for as little cost as possible.

        Ever since pharoah, those in authority have been too inclined to believe the court magicians who promise a technological solution to whatever problem ails them.

  • by LordNacho (1909280) on Thursday September 22, 2011 @08:36AM (#37479054)

    Summary of the system thus far:
    http://en.wikipedia.org/wiki/NHS_Connecting_for_Health [wikipedia.org]

    I suppose it's peanuts now, but the guy who was in charge of the project decided not to charge the failed contractors £1 bln, and then went on to work for a consultancy.

    Also, I'd been wondering from a programming point of view how the heck you can run up such an enormous bill:
    http://programmers.stackexchange.com/questions/48117/how-do-software-projects-go-over-budget-and-under-deliver [stackexchange.com]

    • Well, my one big experience with a failed project lead me to these conclusions;

      1. Lack of Management of Expectations - Both the vendor and the client can get into a rather unhealthy situation of ever-rising expectations. "That deadline seems too distant..." "Oh if you can do that, then you can do this..." "We've got to throw more resources at this, because if we can get it going faster we can sell it to other customers" and the like. Me and my partner really fell for the last one. We saw dollar signs dan

    • Also, I'd been wondering from a programming point of view how the heck you can run up such an enormous bill: http://programmers.stackexchange.com/questions/48117/how-do-software-projects-go-over-budget-and-under-deliver [stackexchange.com] [stackexchange.com]

      very bl00dy easy when you have contractors billing £1000 a day for sitting on their thumbs waiting for others to give them the bits they're waiting for...

  • But how you can mismanage such simple thing like creating IT system which keeps such e-records?

      • by ITShaman (120297)

        Quebec is suffering the same issues. Canada established the Canada Health Infoway (https://www.infoway-inforoute.ca/lang-en/about-infoway) in 2001, has spent more than a $1B (CDN) to date, and just earmarked another $500M in 2010. None of this includes the $600M+ that Quebec has spent (let alone what the other provinces have spent) on Electronic Health Record systems...

        The Canada Health Infoway is simply a framework and each province is responsible for setting up its own EHR system to link into it (health

    • by gweihir (88907)

      Very simple: You get the contract by being cheaper than the competition. Then you make sure to use the least competent personnel you have, so you can milk the cow until dead.

    • by sycodon (149926)

      They are pretty much trying to go from Doctors scribbled notes in a patients folder to a complete, online, centralized system. Just from a PM's view, think of all the "players" that have to be dealt with, existing systems that would have to be integrated, data conversion, equipment procurement, networking issues, privacy issues, reliability issues, etc. What a nightmare.

      I would ask, why centralized? Just come up with a standard format for medical information and a simple application to enter and manage it.

      • by JustOK (667959)

        USB keys get lost. Put a chip in their head, also charge a credit card company to allow them to also use that chip for retail transactions. Good way to recover costs.

      • Actually, having spoken to a Doctor in a senior position in a large NHS Trust his conclusion wasn't too far from yours, but without the physical USB stick: Instead of a central massive do-everything system all that should have happened / be happening is to specify a set of formats and protocols and then each provider from giant hospital campus to small outreach surgery can use whatever system suits their needs, so long as it talks the language. Also the NHS already has its own secure backnet (fibre and the

        • by hmallett (531047)

          Instead of a central massive do-everything system all that should have happened / be happening is to specify a set of formats and protocols and then each provider from giant hospital campus to small outreach surgery can use whatever system suits their needs, so long as it talks the language.

          The standardised format and protocol idea exists. It's used for the summary care record (the spine [connecting...lth.nhs.uk]). GP software has been able to support it for quite some time now. Of course GPs want to carry on using the software they've been using for years, rather than ll move to a new software system, and all the data migration issues that entails.

      • by mmontour (2208)

        Just come up with a standard format for medical information[...]

        Here are a couple to get you started:

        DICOM [wikipedia.org]

        HL7 [wikipedia.org]

        See also: OpenEMR [wikipedia.org]

        • by sycodon (149926)

          Well...three standards isn't exactly a standard eh?

          • by Kalriath (849904)

            They're for different things. DICOM is an Imaging standard, HL7 is a communications/transport standard. OpenEMR isn't a standard, it's an application - and it looks considerably harder to use than pretty much every PMS or PAS on the market (and there aren't that many - iPM and Pathways are likely the biggest, and they suck).

      • by mikael (484)

        I doubt they could even do that - it's hard enough to some commercial databases to handle all the variations in addresses let alone medical ones:

        Old tenement blocks with the same address, but different flat numbers/letter eg. 25C Somewhere Street, 3F4, EA4 5GH. There are at three doors side-by-side each with the number 25, but differentiated by adding A,B or C. Each door leads to at least three floors with four doors on each communal hallway.
        There might even be four or more residents sharing each flat as th

        • by sycodon (149926)

          Parts of me thinks this would be a very cool and fun thing to do. The other part knows it would be the end of me.

          • by mikael (484)

            The advert of herding cats comes to mind ....

            One of the consultancies already gave up.

      • by hmallett (531047)

        They are pretty much trying to go from Doctors scribbled notes in a patients folder to a complete, online, centralized system.

        Not really. notes still on paper are pretty rare now in the UK.

        I would ask, why centralised?

        The NHS does things like health promotions, and does reporting based on records. Had to report on records that you don't have because they're on a patient's USB key.

        Hospital needs a copy?, Just use the same paperwork they do now to request patient records.

        This is the sort of issue the system was supposed to address. Except without the need to wait for paperwork, which might be a pain in you're rushed to A&E (emergency room).

    • by sjames (1099)

      It seems pretty popular. The FBI had a massive e-records flameout as well.

      A lot of it seems to be due to expecting AI. Wanting the system to not just store the records in a logical manner but to index and search arbitrary record formats (known and unknown, usually not actually documented). If the project shows a hint of being completed with that, someone decides the records should be automatically linked together even when a human can't figure out from context what goes with what.

      Somewhere in that the proce

  • There are plenty of big names in the electronic medical records world that are designed to integrate databases with each other. It looks like the NHS realized they were trying to find a solution for a problem that didn't really exist, because the private sector had already solved it. Sure, you have to pay extra money for the integration and translation programs from each company, but it's still probably cheaper for a hospital to pay the license fees to its own EMR provider for that software than it is to
    • by gpmanrpi (548447)
      I accidentally posted something similar as anonymous below. But this is really the key. There are several large scale EMR solutions already in place that would be low cost to deploy. I used the example of VistA below used by the Dept. of Veterans Affairs (~8-million patients), as there are some relatively free versions available. The "problem" of the electronic medical record isn't a real problem. It was solved in the late 90s. The only "problem" is data entry if you are going to convert hard copy med
    • There isn't a healthcare organisation anywhere in the world the size and complexity of the NHS. Perhaps those off the shelf solutions don't do what is required or aren't scalable enough.

      Developing a bespoke system isn't necessarily a bad decision. But where the UK government go wrong time and time again is getting in private sector consultants and contractors to do the project. The UK gov is big enough that they can employ there own permanent development staff, who would end up with far more experience of l

      • "There isn't a healthcare organisation anywhere in the world the size and complexity of the NHS."

        Nonsense. VistA was developed by the US Veterans' Administration, which serves about 8 million people and has potential obligations to about 1/4 of the US population. That's not far from the size and complexity of the NHS at all. Two thirds of the hospitals in Finland use MUSTI, a system derived from VistA, and many other large hospitals and networks of hospitals around the world also use customized versions of

        • Your example proves my point. According to Wikipedia, The VA is "providing care to over 4 million veterans, employing 180,000 medical personnel".

          The NHS on the other hand provides care to 51 million people, and has a workforce of 1.8 million full time employees.

          The NHS is an order of magnitude bigger than your example.

          Whether that means that VistA is unsuitable or not I don't know. But it's certainly a consideration.

          • 1.8M people who work in the same size units of the same types as the VA, doing the same things. A single or even 10 site program, you would have a point, but really the only big difference between the NHS and VA is the need for some more hardware and a relatively modest amount of customization compared to the vast system available free off the shelf, at least 80% of which will work unchanged and could have been in use within a year or two at a cost at least an order of magnitude less.

  • So few tech ideas have actually been implemented on a national scale. Why? Because it's really bloody difficult to account for EVERYTHING before it goes into the wild.

    When a new federal law is introduced, it takes nearly a generation for the states and municipalities to figure out how implementation is going to work. All they get is a mandate from on high. (Because, the guys below will figure it out... they have to, right?)

    I always bring this up when it comes to Universal Healthcare in the U.S.: Massachuset

    • by fl!ptop (902193)

      After 2 years of preparation, push UH live in that state.

      You used the word push a lot. Reminded me of what's probably going to happen, expect I was thinking more like shove. And it'll be shoved while we're facing the other way.

    • by rilister (316428) on Thursday September 22, 2011 @09:51AM (#37479964)

      Your example could hardly better contradict your point:
      Universal healthcare in the UK (the NHS) was implemented nationwide in about 3 years, covering 50million people with comprehensive and free healthcare (give or take a modest prescription fee at the time). It replaced a complex network of private, state (county) and charity organizations, and came up against bitter opposition from the vested interests in private healthcare at the time. It has its limitation, but public support for it is consistently very strong.

      I appreciate your point on IT systems is probably true, and this project is clearly a disaster - but expanding it to general provision of healthcare ignores every functional single-payer system in the world.

  • Been there, in detail, seeing several generations as viewed from the outside. The skin is all a game of politicised 'announcements', and this one is still in the mainstream. The 15-20% that actually works, mostly standardised intercommunication, will go on and will/must certainly deliver. All the rest is a kind of evolutionary broth - sometimes useful things pop out, usually the entrenched opponents subtly kill them. Money gets wasted big time, but that's oh-so-much easier to identify in retrospect. If
  • by tubs (143128) on Thursday September 22, 2011 @09:31AM (#37479690)

    In theory, this should have been a great system from the patient and doctor point of view. All of our patient notes would have been available when needed - if we went to one hosiptal for a RTA, then later to another for a different issue, the consultant/dr would know about the RTA.

    If you've moved around a lot, you could be on may different system - local GPs, local hospitals, local clinics, and no central store of your notes.

    In practice, it turned into a massive system, far bigger than its orginal scope, with every vested interest having or making a change, it was replacing systems that may have been in production and continual development for 25+ years, and each hospital had its own policies and procedures that had to be accomodated (or not as the case may have been). The baby and the bathwater was being thrown out.

    Possibly, all it really needed was for some sort of mandated electronic transfer protocol between hospitals/note keepers and a global catalogue of where a user has notes stored.

    The local system builders/in house developers would have competed the compatibility and that would have been done.

  • For the same cost they could have filled a warehouse with medical records and hired a bunch of dropouts to ride around on Segways pulling files and using a high-tech fax machine to deliver medical records on demand to doctors the world over for the next hundred years until a system of electronic medical records that isn't fraught with problems was invented.

    • by nitrowing (887519)

      For the same cost they could have filled a warehouse with medical records and hired a bunch of dropouts to ride around on Segways pulling files and using a high-tech fax machine to deliver medical records on demand to doctors the world over for the next hundred years until a system of electronic medical records that isn't fraught with problems was invented.

      Needs modding up!!!

    • by sgt scrub (869860)

      Your solution is good for 240 years, including constant phone access to all employees in order to write notes on demand for care givers, and adds 5,000 new jobs. You must be subtracting the usual $2.8 million personal yearly bonus.

      My numbers:
      $20,000/y (same as walmart employees except in the UK they will have the benefit of medical coverage)
      5,000 employees

  • Seriously. Basically $24 billion U.S. to unify database access?!?

    • Many places have no electronic medical records whatsoever. So you're looking at converting from handwritten notes and paper files to networked computers. That means you need to pay for the computers, the network, the servers, the database, the training, and all the zillions of customizations for every different hospital that has different procedures.

      Our local health district (Saskatoon, in Canada) is just now in the process of converting to electronic records.

  • Wouldn't it make more sense, rather than huge, Cathedral-style* records management, to publish and then enforce standard record formats? That way, the base data (at least, if not all of your medical records) could fit on a card or USB key, and would be no problem handing your records to a new doctor when you move, or change medical coverage (I'm in the uncivilized US) and are forced to change doctors.

                      mark

  • by close_wait (697035) on Thursday September 22, 2011 @12:48PM (#37482346)
    In case anyone was thinking that £12B is a lot for a database, what that money *actually* represents is providing a large chunk of the NHS's IT infrastructure for the next 12 years; or £1B per year for the IT needs of an organisation with 1.4 million employees and an annual turnover of £100B. The central data spine (which is the bit suffering the biggest problems and delays) is only one aspect of the system: it includes everything from making X-rays digitally available, to providing the network connectivity to individual GPs. Much of this is already in place and happily working.
  • by Tasha26 (1613349) on Thursday September 22, 2011 @02:28PM (#37483372) Homepage
    Major f*ck ups, notably a contractor like Accenture which wasted about a billion £ on failed centralised database projects (Oracle?). Anyone else? Lets name and shame those useless IT contractors. This is public money flushed down the toilet!

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