General Warnings and Advice
From Nhs It Info
Revision as of 08:31, 10 October 2006
MPs urge rethink of NHS records project
The Independent, 31 Aug 2006
http://news.independent.co.uk/business/news/article1222861.ece
“The controversial programme to upgrade the National Health Service's IT systems has suffered another blow after two MPs called for an overhaul of the project yesterday. Richard Bacon, the Conservative MP for South Norfolk, and John Pugh, the Liberal Democrat MP for Southport, argued that the programme should be reformed to allow hospital trusts to purchase systems locally that can then be linked into the national network. Both MPs are members of the Commons Public Accounts Committee that reviewed the programme in June. The pair said that the project's "fundamental error" was to centralise the procurement of single systems across the NHS. "The Government is convincing no one that the situation is under control. The national programme for IT in the NHS is currently sleepwalking towards disaster ... This programme is costing taxpayers a king's ransom, but is descending into chaos," they said. A Department of Health spokeswoman rejected their claims. . . ”
IT deals are failing public services
The Guardian, 29 Aug 2006
http://politics.guardian.co.uk/publicservices/story/0,,1860168,00.html
As someone who was involved in NHS computer system design for nearly 20 years, the latest news, although sad, comes as no surprise (Ex-CBI boss caught up in NHS fiasco, August 26). We were told in 2003 that the contracts for the local and national suppliers were "so tight that the suppliers couldn't wriggle out of them". My response at the time was that if that was the case, the directors would walk off with pocketfuls of money while leaving the companies to founder and their staff searching for new jobs as soon as the going got tough. However, even I am slightly surprised at the amounts these directors have creamed off. My colleagues and I attended many meetings in which the cream of consultants from the supplier companies and their advisers dismissed the painstaking and thorough analytical work that had gone on within the NHS for many years as "science fiction" and "over-complex", before going on to adopt simplistic solutions which were under-researched, had no meaningful clinical input, and were based on naïve assumptions which may be adequate in a commercial environment but were totally inappropriate to the multi-layered, multi-disciplinary and culturally disparate environment which is the NHS. We are now seeing the inevitable results of that inept design, which is unable to meet even the most minimal requirements of patient confidentiality and is so fragile that a simple power failure creates days of chaos for many hospitals. I take no pleasure in these failures, but my main concern is that no one is learning from them and we seem doomed to continue with the same flawed model of procurement. Meanwhile, those systems which were built in and by the NHS many years ago continue to reliably provide the basic IT infrastructure which keeps the whole thing running.” [Ian Soady, Former chair, NHS Information Authority]
What price the NHS computer upgrade from hell?
The Observer, 27 Aug 2006
http://observer.guardian.co.uk/business/story/0,,1859032,00.html
What are the lessons to be learned from the unfolding fiasco engulfing the £12bn NHS computer upgrade? It is a large and complex programme designed to hold the records of 30 million patients, one of the biggest projects of its kind, so it needed to be thought through properly. And the users - the consultants and clinicians - should have been widely consulted. Neither seems to have happened, demonstrating the propensity of government to throw taxpayers' money down the tubes. If everything was going smoothly, why would Accenture, one of the key suppliers, have written off $450m because of delays and glitches that have left its executives seething? Within the NHS, there are stirrings of discontent as fears grow that hospitals may be signing up to something they don't want. The Sheffield Teaching Hospitals NHS Foundation Trust, for example, recently announced it was abandoning one leg of the programme. The troubles at financially stretched iSoft, which is providing some of the software, illustrate what can happen when one firm's fortunes are so closely tied to a single client. They also highlight the need for careful project management, sadly lacking in this instance. It is difficult to escape the feeling that this project is being rushed with unrealistic deadlines (no one seriously believes that it can be completed by 2008) and that targets set for suppliers are too tough to meet. Perhaps the writing was on the wall at the start when IBM pulled out of the bidding - wary, no doubt, about the ability of government to execute such an ambitious task. If IBM, or 'big blue' as it is known in the US, was alarmed about the intricacies of the programme, perhaps others should have drawn their own conclusions. If Accenture decides to quit, as is widely expected, we should be concerned: this is a company which generates tens of millions of pounds from government contracts - and would bend over backwards not to upset one of its most important customers. The NHS computer programme, championed by the Prime Minister, is a wonderful idea in theory. It allows electronic access to patient histories around Britain, making it simpler for people to choose where they have treatment and easier to treat those who fall sick miles from where they live. But with forecasters now saying that the true cost of the upgrade could top £30bn, the question has to be asked: at what price?”
NHS computer chaos deepens: MP brands electronic link for hospitals and surgeries 'a hopeless mess' as costs rise to £15bn
The Observer, 20 Aug 2006
http://observer.guardian.co.uk/uk_news/story/0,,1854311,00.html
“A multi-billion pound plan by the government to link the computer systems of every hospital and GPs' surgery is unlikely to be delivered on time and may fall short of the NHS's requirements, according to a confidential review leaked to The Observer. . . The government has consistently claimed the project will be fully operational by the spring of 2008. But the review of the software that powers the system, conducted five months ago, suggests this is now in doubt. It notes that there has been 'slippage' in the rollout of the software, provided by Isoft, of '300 per cent'. The troubled firm is providing the software for three of the five regional 'hubs' of the national Connecting for Health IT system. The review, conducted by consultancy firms Accenture and CSC, who were awarded multi-million-pound contracts to oversee the implementation of the Connecting for Health system, notes: 'Critical elements of the plan seem significantly underestimated,' and warns that dates for the roll-out of the software are likely to be 'highly optimistic'. . . The review breaks the project down into 39 parts, each of which is given a colour grading. 'Red' requires immediate work, 'amber' suggests there is a potential risk and 'green' indicates there is no problem. Of the 39, 13 are classified red, 21 amber and only five green. The review identifies the issue of clinical safety under the current Isoft system as a 'red' problem. It notes the firm has appointed a director of clinical safety in response to the concerns, but that he could not 'articulate the time frames for establishing a clinical safety team given the current financial climate within Isoft' - a reference to the company's financial problems which have caused its share price to collapse. The report is extremely critical of Isoft's ability to build a system to meet the NHS's needs. It notes that 'programme planning... is based on unrealistic assumptions that drive unachievable plans that ultimately fail to deliver on time'.”
The good of IT in healthcare: Let's not forget the benefits in spite of poor execution
silicon.com, 17 Aug 2006
http://www.silicon.com/publicsector/0,3800010403,39161603,00.htm
“The NHS IT modernisation programme has received its fair share of criticism. Much of which, granted, might well be warranted - with costs likely exceeding £12bn, a series of rollout delays and scepticism from some doctors who wonder if it's "the biggest government IT disaster yet". But ironically at a Northern Ireland hospital trust outside the remit of the NHS Connecting for Health (CfH) programme, silicon.com has seen just how beneficial IT can be to doctors and patients. The Royal Hospitals Trust in Belfast has rolled out a new wireless network which will be used to share X-rays easily among doctors and to speed up drug dispensing. The trust is even handing out Star Trek-style wireless communicators to staff to facilitate finding and communicating with doctors and nurses when they're needed. . . Of course execution is the big issue and that's where the CfH scheme appears to be stumbling. This publication would never argue that the scheme's organisers not be held accountable for missteps. But let's not get too jaded and forget the good that can come from this - or perhaps this just underscores how essential it is for the NHS to get its IT overhaul right, and the magnitude of the consequences if it does not.”
Toughest tests still lie ahead for NHS IT: Two core problems threaten the progress of the national programme for health service technology
Computing, 17 Aug 2006
http://www.vnunet.com/computing/analysis/2162411/toughest-tests-lie-ahead-nhs
“Having made it through the Public Accounts Committee hearing relatively unscathed, the £6bn National Programme for NHS IT (NPfIT) faces tests with far greater implications. The data centre failure that knocked out patient admin systems in 80 hospitals this month raises serious questions, not least because backup systems also failed. But they are only ripples on the surface; two far deeper currents are stirring. The first is the doctors. Progress is already being delayed by disputes with the government over reform plans, with the Connecting for Health (CfH) agency running NPfIT over lack of consultation, and between different clinical groups over who owns what data. While discussions are cloaked by concerns such as confidentiality and security, there is more than a hint of politics, and of a turf war over who is the first and final arbiter of the relationship with the patient. The second vital area will be the suppliers. CfH director general Richard Granger was specifically hired from the private sector to broker hard-nosed, commercial deals. He did a good job. The NPfIT contracts pay only on delivery of working systems, and include punitive fines for under-performance and the scope to swap out the weak at any time. . . An optimist might say the suppliers’ financial issues are evidence that the contracts are working. But private sector pockets are not bottomless, and only a fantasist would say that implementation delays – and therefore payment delays – will catch up in the coming year.”
EHRs: Electronic Health Records or Exceptional Hidden Risks?
Comunications of the ACM, vol. 49, no. 6 (Jun 2006) p.120.
". . . Over the past decade, several countries such as Australia, the U.K. and the U.S. have started IT initiatives aimed at stemming rising health care costs. Central to each of these initiatives is the creation of electronic health record (EHR) systems that enable a patient's EHR to be accessed by an attending healthcare professional from anywhere in the country. . . However, the attempts at creating national EHR systems have been encountering difficulties. In Australia, the implementation cost has risen from an estimated AU$5OOM in 2000 to AU$2B today. In the U.K., the implementation costs have risen from an estimated £2.6B in 2002 to at least £15B today. In the U.S., the "working estimate" for a national EHR system runs between $100B and $150B in implementation costs with $50B per year in operating costs. The UK Connecting for Health initiative calls for everyone in the UK to have EHRs by 2008. However, there have been ongoing problems with its implementation that spurred 23 leading UK computer scientists to write an open letter to the Parliament's Health Select Committee in April, recommending an independent assessment of the basic technical viability. In their letter, they ask whether there is a technical architecture, a project plan, a detailed design, assessments of data volumes and traffic loads, adequate resiliency in the design, as well as conformance with data and privacy laws, and so on. The US. approach to creating a national EHR system differs from the U.K. approach. . . Instead of funding the building of a single, integrated networked system with a central EHR database as in the U.K., the U.S. government is facilitating the definition of standards to allow the interoperability of commercially available EHR systems as well as interoperability certification standards. . . As the UK is discovering, focusing on the technology of electronic medical records without considering the myriad socioeconomic consequences is a big mistake. . ."
The NHS and IT: A failure to connect
The Economist, 15 Jun 2006
"A gulf of mistrust between Mr Granger's team and the GPs threatens the success of the project. Part of the blame lies with CfH for making a poor job of selling itself. But blame attaches to the GPs too. Their status as independent contractors to the NHS too often blinds Britain's doctors to the wider picture."
US conference gets a reality check on NPfIT
e-Health Insider, 26 May 2006
http://www.e-health-insider.com/news/item.cfm?ID=1909
"Former National Programme for IT industry liaison manager, Phil Sissons, delivered a transatlantic reality check this week, exposing some of the warts in the £6.2 billion programme to an American audience, US correspondent Neil Versel reports from the 22nd annual Towards an Electronic Patient Record (TEPR) conference in Baltimore. In a keynote address this week, Sissons, now an ICT consultant said that there was a lot of truth in the negative reports about Connecting for Health (CfH), the agency running the National Programme for IT (NPfIT), despite the frequent denials by NHS officials. A prime example of CfH failure, according to Sissons, is Choose and Book. "Of the 80,000 appointments that have been made, I can count probably about six that have actually been made using the system. The rest are been made by phone. And yet, Choose and Book is seen as a major step forward," he said. Similarly, the data Spine that is to make patient records portable throughout England, has 80,000 people registered to use it, but neither hospital nor surgical information systems feed information to it yet."
Re-configuring the health supplier market: Changing relationships in the primary care supplier market in England
Integrated Health Records - Practice and Technology, National eScience Centre, 9 Mar 2006
http://www.nesc.ac.uk/talks/648/Papers/sugden.pdf
"The NPfIT 'top down' approach has been criticised for appearing to ignore the complexity and diversity of local requirements and developing a 'one size fits all' solution. Whilst the NPfIT goals of information sharing and interoperability across the NHS are laudable, its centralised planning approach has resulted in a shift of the locus of control to management consultants, rather than users or suppliers."
BCS Response to NAO Investigation of NPfIT
BCS, 4 Jan 2005
http://www.bcs.org/upload/pdf/auditofficejan05.pdf
"Summary:
1. NPfIT is damaging the UK healthcare IT Industry by excluding many small but innovative players. Steps must be taken to make systems more open.
2. NPfIT operates in an unnecessarily secretive manner. Its contracts and other documentation need to be made public to allay suspicion and encourage trust.
3. NPfIT is too top down in its approach. It now needs to be made bottom up: owned, understood and made affordable locally.
4. Current experience in the UK is not being exploited.
5. There needs to be confidence in the quality of staff developing NPfIT. Qualified informatics staff should be the norm.
6. More staff are required at all levels to implement NPfIT at the pace planned. Education is needed in health informatics to develop a larger pool of skilled workers.
7. Centralised solutions may not perform well enough for clinical use. Consideration should be given to distributed solutions.
8. Patient care is at risk from a loss in functionality. Much current healthcare is built around and depends upon current IT solutions.
9. There are risks to physical security and privacy of content from the NPfIT approach. Rigorous but practical user access controls are essential.
10. Confidentiality constraints must not interfere with patient care by limiting what information is documented and what is available to whom.
11. Without user ownership, NPfIT systems will not be used. Clinicians need to be consulted about integrating IT systems with operational clinical services.
12. NPfIT is primarily about business change, not information technology. There needs to be an extensive education and training initiative."
Doomed from the start: considering development risk
Reg Developer, 1 Feb 2006
http://www.regdeveloper.co.uk/2006/02/01/development_risk/
"[The NPfIT] project does seem to exemplify one with high scores in all the risk categories I'd review before starting a project:
- It's a very large project, and the Government's record with large projects certainly isn't better than anyone else's.
- It involves massive changes to existing systems.
- It cuts across organisational boundaries (hospitals and GP surgeries, and uses outsourced services).
- It has legal/regulatory issues - doctors are responsible for the governance of patient records, and the Data Protection Act applies to much of the information.
- It is a highly visible project, raising considerable press interest.
- Top management (in this case, probably even our Prime Minister) is taking a lively and, possibly, ill-informed interest.
- It has safety-critical aspects.
- Resources are limited and, in theory, tightly controlled.
- It involves new technologies.
- Few of those involved can have much experience with similar projects - US healthcare is very different and the NHS is an unusually large operation, even in a global context."
Transcript of File on Four
BBC (Interview with Jean Roberts, BCS Health division), 19 Oct 2004
http://news.bbc.co.uk/nol/shared/bsp/hi/pdfs/fileon4_20041019_nhs_it.pdf
"To get these new systems introduced, the people competent to use them and for them to be day-to-day support tools will require somewhere, according to the people in the field, between four and eight times the initial investment."
Public Value and e-Health
Institute for Public Policy Research, 1 Jul 2004
http://www.ippr.org.uk/ecomm/files/public_value_ehealth.pdf
". . . although new ICT systems have been procured for the NHS, in order for the anticipated benefits to be delivered there will have to be significant changes to the way the NHS works in order to take full advantage of the greater availability of information. There are two potential barriers to the successful completion of this change management process. First, control over NHS ICT might have moved from being too devolved to too centralised. This could potentially make systems insufficiently flexible to take account of useful variations in local working practices and might also lead to trailblazing NHS organisations being held back. Second there may simply be insufficient capacity within the NHS to cope with the magnitude of change that will be required. Managers, health professionals and specialist health informaticians are all extremely busy and may not have the time to make sure that the change is a success. Inadequate funding, insufficient skilled staff and the competition of other priorities may mean that although ICT systems have been procured, the benefits delivered will not be as great as they might have been."
The National Programme and Primary Care Informatics
BCS Health Informatics Committee, 1 Mar 2004
http://www.phcsg.org/main/documents/Position%20Paper%20Release%201%20-%20Mar%202004%20.pdf
"The National Programme needs to understand GPs' current high levels of dependence and relative satisfaction with their current systems, and must provide a path to allow GP practices to move to systems that can fully realise the vision of the National Programme in a controlled manner without excessive loss of utility in the process. Critically, the National Programme needs to recognise that there is no hurry to replace current systems before proven alternatives are generally recognised as justifying the disruption."
NHS Confederation Briefing
National Programme for Information Technology in the NHS, 1 Aug 2003
http://www.npfit.cambridgeshire.nhs.uk/default.asp?id=24
"The IT changes being proposed are individually technically feasible but they have not been integrated, so as to provide comprehensive solutions, anywhere else in the world."
More Radical Steps (2003) Initiatives
BCS Health Informatics Committee, Jul 2003
http://www.bcs.org/upload/pdf/rsjul03.pdf
"Estimates of four to eight times current planned investment were suggested as necessary to carry out necessary professional training, organisational systems redesign and realignment to support a successful NPfIT. Until any other figure is ratified, the potential for NPfIT to have a substantial impact on care remains at serious risk"
