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UK's NHS Will Drop Delayed E-Records Project

timothy posted about 3 years ago | from the sounds-like-the-denver-airport dept.

United Kingdom 86

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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So I guess UK citizens get the money back, right? (3, Funny)

elrous0 (869638) | about 3 years ago | (#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.

Re:So I guess UK citizens get the money back, righ (4, Interesting)

martijnd (148684) | about 3 years ago | (#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."

Re:So I guess UK citizens get the money back, righ (1)

elrous0 (869638) | about 3 years ago | (#37479200)

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.

Re:So I guess UK citizens get the money back, righ (1)

Ash Vince (602485) | about 3 years ago | (#37479378)

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]

Re:So I guess UK citizens get the money back, righ (2)

Kalriath (849904) | about 3 years ago | (#37485420)

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

No corruption there at all!

MOD PARENT UP - History repeats (0)

Anonymous Coward | about 3 years ago | (#37487770)

I wish I had mod points.

Yes, Australia is doing exactly the same thing, in almost the same way. It's on par with the what turned out to be the abysmal failure of accenture last time.

More info
http://forums.theregister.co.uk/forum/1/2011/08/14/accenture_snags_health_deal/ [theregister.co.uk]
http://www.crikey.com.au/2011/08/18/roxons-health-records-system-a-massive-waste-of-467-million/ [crikey.com.au]

and lots of others. Big pie. Lots of slices. History repeating?

This one's even better! (3, Funny)

djkitsch (576853) | about 3 years ago | (#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...

The old ways are the best. (1)

ThatsNotPudding (1045640) | about 3 years ago | (#37482014)

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."

Time to bring back drawing and quartering...

Re:So I guess UK citizens get the money back, righ (4, Interesting)

LWATCDR (28044) | about 3 years ago | (#37479506)

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.

 

Re:So I guess UK citizens get the money back, righ (1)

Anonymous Coward | about 3 years ago | (#37479912)

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.

Re:So I guess UK citizens get the money back, righ (2)

LWATCDR (28044) | about 3 years ago | (#37480670)

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 get to tax them and they buy stuff in the UK with that money which puts others in the UK to work and so on. A large amount of that gets recycled back. When you guy an Aircraft carrier from the US all that money goes to the US and very little gets recycled back to the UK unless they use their pay to buy a lot of Land Rovers, Jags, and Triumph motorcycles.

Then there's the carriers (0)

DesScorp (410532) | about 3 years ago | (#37480676)

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.

Re:Then there's the carriers (0)

LWATCDR (28044) | about 3 years ago | (#37480788)

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 :)

Re:Then there's the carriers (0)

DesScorp (410532) | about 3 years ago | (#37481786)

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.

Re:Then there's the carriers (0)

mister_dave (1613441) | about 3 years ago | (#37483036)

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.

Re:Then there's the carriers (0)

LWATCDR (28044) | about 3 years ago | (#37484656)

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.

Re:Then there's the carriers (1)

mister_dave (1613441) | about 3 years ago | (#37488884)

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.

Re:Then there's the carriers (1)

LWATCDR (28044) | about 3 years ago | (#37492990)

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.

Re:Then there's the carriers (0)

LWATCDR (28044) | about 3 years ago | (#37484628)

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.

Re:Then there's the carriers (1)

tehcyder (746570) | about 3 years ago | (#37488892)

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.

Re:So I guess UK citizens get the money back, righ (1)

Tasha26 (1613349) | about 3 years ago | (#37483410)

What you are describing here are peasants of the IT/Tech world, and you are absolutely right.

Re:So I guess UK citizens get the money back, righ (1)

mpe (36238) | about 3 years ago | (#37488502)

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 :)

Re:So I guess UK citizens get the money back, righ (1)

LWATCDR (28044) | about 3 years ago | (#37507442)

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.

Re:So I guess UK citizens get the money back, righ (1)

mister_dave (1613441) | about 3 years ago | (#37483144)

Contracts are written for a reason.

Idea: "No-goverment" by the people, for the people (0)

samjam (256347) | about 3 years ago | (#37479014)

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.

Re:Idea: "No-goverment" by the people, for the peo (0)

Anonymous Coward | about 3 years ago | (#37479038)

Read up on EDS and Cap Gemini. One gets a contract and cannot deliver then it is given to the other who has not delivered on a contract elsewhere.

Re:Idea: "No-goverment" by the people, for the peo (0)

Anonymous Coward | about 3 years ago | (#37479522)

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.

The nine most terrifying words in the English language are: "We're from the government, and we're here to help."

Re:Idea: "No-goverment" by the people, for the peo (1)

tehcyder (746570) | about 3 years ago | (#37488908)

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?

Re:Idea: "No-goverment" by the people, for the peo (1)

samjam (256347) | about 3 years ago | (#37488940)

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.

Right, right... (1)

said213 (72685) | about 3 years ago | (#37479020)

This reminds of of a story from earlier this week regarding a poker company called "Full Tilt Poker," only difference being that this one sounds like it might involve a "Ponzi Scheme."

More discussion (2)

LordNacho (1909280) | about 3 years ago | (#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]

Re:More discussion (2)

MightyMartian (840721) | about 3 years ago | (#37480222)

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 dancing in our heads and it shifted our focus away from the immediate project into fanciful realms.

2. Requirement/Feature Creep - Our largest error was in not getting a very clear set of specs on paper as part of our contract with the customer. Within a couple of weeks of development beginning, we were getting faxes (this was the mid-1990s) saying things like "Oh yeah, and by the way, we need to be able to this or that as well." Once you let one or two small requests like this through, you're totally hoses, because you've taught the customer that they can throw anything at you, regardless of the original agreement, and it will end up on the pile.

3. Requiring the Entire Product Be Ready All At Once - This sort of leads from #2, because, well, if you're allowing new features or requirements to be inserted during the initial development cycle, then 3 is pretty much impossible. But even where you stick to the original specs, the more logical approach is a modular one. Prioritize the most important elements, and get them up and running so, if other requirements prove more difficult or complex, at least you can start rolling it out. When our project began running into problems, I wanted to do just that, to get the invoicing and customer management system out, and then worry about the higher-level functions, simply so we could show the customer we had something, but my partner felt it was imperative that we stick to a single release date, and when you factor in #2, that date just getting pushed back and back and back.

I learned the lesson the hard way. Months of work sitting there, some of it all but finished, and the client dropped us. Still an episode of shame for me, in part because as much as I'd like to blame the customer for what happened, at the end of the day, we were as much at fault as they were.

Re:More discussion (1)

advocate_one (662832) | about 3 years ago | (#37481630)

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...

Maybe I'm naive.. (1)

Pecisk (688001) | about 3 years ago | (#37479120)

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

Re:Maybe I'm naive.. (2)

Yo Grark (465041) | about 3 years ago | (#37479178)

Re:Maybe I'm naive.. (2)

ITShaman (120297) | about 3 years ago | (#37479722)

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 care is a provincial jurisdiction in Canada) . Overall, it's been a huge moneypit for Canadian taxpayers in most provinces (http://www.cbc.ca/news/health/story/2009/05/27/f-electronic-health-records.html).

All I can say is good luck to the UK in their quest for EHR...

Re:Maybe I'm naive.. (2)

gweihir (88907) | about 3 years ago | (#37479274)

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.

Re:Maybe I'm naive.. (1)

sycodon (149926) | about 3 years ago | (#37479418)

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. Patient takes a copy of their file with them after every visit on a USB key or something like that. It could be just like a medic alert bracelet. Or, a smart card, or...fill in the technology. They key is the Patient would have it and control it. Local copies are at their Dr.s office. Hospital needs a copy?, Just use the same paperwork they do now to request patient records.

Is it as bullet proof and comprehensive as a well designed and well executed centralized project like they were going for? No. But it's a damned sight better than the EMT trying to ask someone who's lying there with head injuries and amputated limbs if they are allergic to any drugs, which is pretty much what we have now.

Re:Maybe I'm naive.. (1)

JustOK (667959) | about 3 years ago | (#37479494)

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.

Re:Maybe I'm naive.. (1)

sycodon (149926) | about 3 years ago | (#37479862)

Yeah..that will really win a lot of people over.

Re:Maybe I'm naive.. (2)

cyclomedia (882859) | about 3 years ago | (#37480258)

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 like, though I expect a good deal of it is VPN too) so it's not like there'd be web services ripe for the hacking hanging on public IPs.

Re:Maybe I'm naive.. (1)

hmallett (531047) | about 3 years ago | (#37485088)

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.

Re:Maybe I'm naive.. (1)

mmontour (2208) | about 3 years ago | (#37481156)

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]

Re:Maybe I'm naive.. (1)

sycodon (149926) | about 3 years ago | (#37482110)

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

Re:Maybe I'm naive.. (1)

Kalriath (849904) | about 3 years ago | (#37485512)

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).

Re:Maybe I'm naive.. (1)

mikael (484) | about 3 years ago | (#37483488)

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 they have large Victorian bedrooms.

Other flats may just have a single number, but share one mailbox between twelve residents.

Rural locations have a simple address like "The Monastery, Upper Solitude, Churchshire.

Then there would be name fields for patients of all nationalities. Another complication is that many patients might share the same name, eg. Smith, Jones, so having your patient records deleted because some other person with your name happened to die, isn't going to help.

Even with modern digital records, new fields and types of data are going to be entered all the type as research continues: MRI scan, ECG recordings, ultrasound scans, X-ray photographs

As the UK has over 100+ health boards, each health board will have their own data formats and forms constantly being changed as their own research is carried out.

There are legal requirements over guaranteeing the confidentiality of digital patient records; archiving, access controls, logging accesses.

The only way anyone could successfully take on this project, would be to take control of the inhouse IT support departments, and merge them together in small groups, until they are all going together in the same direction.

They would have to agree on a common data format for every basic field (name, address, SSN/NI number, nationality) and then modify their systems as they go along.

Re:Maybe I'm naive.. (1)

sycodon (149926) | about 3 years ago | (#37484058)

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.

Re:Maybe I'm naive.. (1)

mikael (484) | about 3 years ago | (#37484382)

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

One of the consultancies already gave up.

Re:Maybe I'm naive.. (1)

hmallett (531047) | about 3 years ago | (#37485280)

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).

Re:Maybe I'm naive.. (2)

sjames (1099) | about 3 years ago | (#37484926)

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 process shifts to maintenance mode. Not maintaining the softwere, mind you, contracters maintaining the flow of cash and managers on the government side maintaining face. Nobody wants to be the one to declare that the project has turned to shit and become the natural scapegoat.

Off the shelf programs already communicate (1)

sandytaru (1158959) | about 3 years ago | (#37479268)

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 purchase an entire new system.

Re:Off the shelf programs already communicate (1)

gpmanrpi (548447) | about 3 years ago | (#37480274)

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 medical records to useful data. Doctors have notoriously terrible handwriting, and as a result that can be time consuming. But, it is relatively simple to do mass scans, and basically fill in going forward. So, it is only an issue of identifying what is important to convert early on, I am sure there are some bureaucrats and medical administrators that can decide this, and what to convert long term as needed.

Re:Off the shelf programs already communicate (1)

BasilBrush (643681) | about 3 years ago | (#37481228)

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 large scale public records systems than any of these outside consultants, at a far lower cost. Where they lack an expert in a particular technology, they could recruit one.

Re:Off the shelf programs already communicate (1)

Savantissimo (893682) | about 3 years ago | (#37487514)

"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 VistA. Not customizing a successful, open system was hugely risky, if not destined to fail.

Re:Off the shelf programs already communicate (1)

BasilBrush (643681) | about 3 years ago | (#37488484)

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.

Re:Off the shelf programs already communicate (1)

Savantissimo (893682) | about 3 years ago | (#37489336)

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.

Of course Nation-wide Implementation Failed... (1)

eepok (545733) | about 3 years ago | (#37479278)

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.: Massachusetts has a type of UH, so let's make sure that system is locked down and make room for expansion or create a parallel system for a neighboring state. After 2 years of preparation, push UH live in that state. Once that state is locked down, use the experience gathered from State 01 (Mass. being State 00) to prepare 2 more neighboring states. Again, after 2 years of preparation, push it live.

Why go with neighboring states? Because neighboring state frequently have similar values, societies, habits, and problems. You learn as you go, correcting for errors as you slowly implement a massively important system appropriate for the areas.

The same should have happened with the NHS system. Start in a single, smaller city (100,000) and build an expensive, perfect system. Then spread it to the neighbors while learning more and more about cities further out. This way, if the system ever just falls out (as it has), you still have SOME product that's genuinely usable and the potential for future implementation with a future contractor.

Re:Of course Nation-wide Implementation Failed... (1)

fl!ptop (902193) | about 3 years ago | (#37479762)

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.

Re:Of course Nation-wide Implementation Failed... (0)

Anonymous Coward | about 3 years ago | (#37479876)

Why go with neighboring states? Because neighboring state frequently have similar values, societies, habits, and problems. You learn as you go, correcting for errors as you slowly implement a massively important system appropriate for the areas.

In your example, the only neighboring state that is similar to Massachusetts is Rhode Island (more corrupt, more broke, but more efficient a government). CT, NY, VT and NH are unlike MA in all important ways.

Re:Of course Nation-wide Implementation Failed... (3, Insightful)

rilister (316428) | about 3 years ago | (#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.

It moves, all the same (1)

GerryHattrick (1037764) | about 3 years ago | (#37479332)

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 the alternative were doing nothing at all, what exactly would YOU recommend instead? Woz sat at the table, and I did try.

VistA (not the operating System) (0)

Anonymous Coward | about 3 years ago | (#37479362)

Do you think that maybe they would just use a program that already exists? http://en.wikipedia.org/wiki/VistA The VA is the largest medical system in the united states (~8 million patients), and seems to have had this running for at least since the late 90s early 00s. I know they started deployment small with only a few regions and then scaled it up as they needed to.

Re:VistA (not the operating System) (2)

CaptainOfSpray (1229754) | about 3 years ago | (#37481176)

Usng USA solutions elsewhere is really risky. I've seen several of my customers go down (ie cease to exist) ultimately because they chose a software solution built for US states (as opposed to a whole country). Example: one of my customers (a savings bank) wanted to completely refresh every software application they had, so bought an American integrated package that appeared to be pretty successful and pretty widely used. They ran almost immediately into severe performance problems - the elapsed time to process a whole day's transactions was 28 hours. On digging into why this was the case, they discovered that none of the other user sites had more than 100,000 accounts. My customer had 2 million accounts. The software package was simply not built to handle that, and the authors didn't care enough about one customer to rewrite the package. That savings bank now exists only as a brand name.

Re:VistA (not the operating System) (1)

Kalriath (849904) | about 3 years ago | (#37485590)

For a healthcare system, the results range from catastrophic to cataclysmic using US-oriented packages, The US packages all seem to be focused around billing, insurance, and stuff like that whereas in countries with socialised systems these sorts of things aren't even a consideration.

Re:VistA (not the operating System) (1)

Savantissimo (893682) | about 3 years ago | (#37487586)

VistA isn't the usual US medical software. It was built for the VA (a government healthcare system with around 1100 facilities and nearly 200,000 employees) which isn't much concerned with billing insurance companies. VistA is open source, free software. It's used in other large deployments around the world, usually customized for local needs. It forms the backbone of the Finnish system's hospital software, and has done well there.

Open Source eHealth Oscar Mcmaster (0)

Anonymous Coward | about 3 years ago | (#37479560)

http://oscarmcmaster.org/

A Great System? (2)

tubs (143128) | about 3 years ago | (#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.

Re:A Great System? (0)

Anonymous Coward | about 3 years ago | (#37485768)

I live in Spain, and we already have that kind of system at regional level. It have been years since the last time I had to carry over any kind of paper for a doctor. They are trying now to get pharmacies into the system. It's really great.

What's the difference? A bunch of applications were developed for all the region, each hospital or whatever choose to install they ones they liked and could ask for modifications. Databases were not centralized. Since they were free for them, they were soon nearly everywhere. Then, the decentralized databases were interconnected, and the main applications' databases were centralized. Now they are unifying the last ones, and integrating private parties.

You can build such a huge system directly. You have to grow it.

billions and billions (2)

cornface (900179) | about 3 years ago | (#37479740)

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.

Re:billions and billions (1)

nitrowing (887519) | about 3 years ago | (#37479974)

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!!!

Re:billions and billions (1)

sgt scrub (869860) | about 3 years ago | (#37480078)

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

Re:billions and billions (0)

Anonymous Coward | about 3 years ago | (#37482960)

Don't forget the cost of maintenance/replacement of the Segways.

For ODBC? (1)

sgt scrub (869860) | about 3 years ago | (#37479922)

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

No...lots more (1)

Chirs (87576) | about 3 years ago | (#37480240)

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.

Might be for the better (0)

Anonymous Coward | about 3 years ago | (#37479990)

From the security point of view, the system was a potential disaster. The centralized system implemented no access control whatsoever - all of that was to be handled by the client applications! That had a clear potential to become a privacy nightmare (not that we care about privacy anymore). I don't know any other details of the system, since my interests mostly lie in the area of security, but if that's any indication, I wouldn't be overly confident in sane design/correct function of the rest of it either.

Re:Might be for the better (1)

hmallett (531047) | about 3 years ago | (#37485388)

From the security point of view, the system was a potential disaster. The centralized system implemented no access control whatsoever - all of that was to be handled by the client applications!

Source? Have a look at this [connecting...lth.nhs.uk] , under the Access Control Framework section.

Re:Might be for the better (0)

Anonymous Coward | about 3 years ago | (#37489794)

Yes, but they don't mention the enforcement of the access control - that's left up to the apps. At least that's what I heard in a talk by a guy from my Uni group; he's doing a case study on NHS, with regards to access control policies and testing, so I take him to be a pretty authoritative source. Here's a link to a paper [infsec.ethz.ch] .

Why centralized records in the first place? (1)

whitroth (9367) | about 3 years ago | (#37481426)

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

Re:Why centralized records in the first place? (0)

Anonymous Coward | about 3 years ago | (#37488970)

What happens when you need emergency medical assistance and either don't have the USB key on you, or are incapable of giving it to those treating you though?

the £12B isn't what you think it is (2)

close_wait (697035) | about 3 years ago | (#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.

And a big round of applause for... (2)

Tasha26 (1613349) | about 3 years ago | (#37483372)

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!

Fail by default (0)

Anonymous Coward | about 3 years ago | (#37500718)

Isn't every single IT project that is initiated by the goverment flawed in the fact they know jack shit about how to do anything. I mean how many experts are there really, involved in politics? I really think we need to have a think about how democracy should really work and get skilled people in charge - party politics should is simply ridiculous.

As far as getting something built, there really is a design that works, but it involves experts and nobody can build somthing that is constantly changing spec.

This whole project could have been offered to graduate as their thesis and awards given to the best solution / design. Offering them a student loan payoff for the winners and a few runners up could get 10K or somthing. In fact they probably would have saved money if they had of offered every IT grad in the county 10K for a solution that would work and picked the best ones to develop further - employing the grad that did it as an extra bonus. BUT NO THAT WOULD BE TOO EASY

I worked for the NHS as a emergency driver, whilst doing a software engineering degree. When I spoke to doctors and managers they all didn't really know what this new IT system was apart from a way of accessing patent records securely, just a mention of client server systems! This really showed me how little information was shared about specification and what the system needs to be able to do.

STEP1 - Build a prototype using dummy data...
Test on a few selected experts (this would be very cheap and allows doc's and nurses some feedback to improve the GUI and functionality). End up with spec that these are happy with and roll out to more people to test.
STEP2 - Get a skilled system architect to design the network topology.
Explain and cost exactly how the systems connect (securerly)
STEP 3 - Develop Software using appropriate language...
find a company that has most experience and offers most support to develop -
STEP4 - Implementation and maintenance...
Train up IT admins / outsource so that the systems can be installed and configured and the people can be trained.

I would have loved the oppertunity to work with the doctors and nurses to build a system that meets their needs, so patients don't get delayed because the doctor can't access their records (so needs to spend longer checking for other conditions before administreing drugs). Fuck our shit goverment with their bullshit underhand ways. Lets save money and cancel all the IT projects.

I wonder what stage they were at before the plug got pulled? UK citizens could save a lot of money if the admin for certain areas was more computerised... (NHS, IR, Courts / Legal) but they continue to work in the past and waste tax payers money.

Re:Fail by default (0)

Anonymous Coward | about 3 years ago | (#37509322)

The govt and NHS are probably the worst delegators of work on the face of this work. Am not the least surprised by the level of failure and the COST!

Perspective. (0)

Anonymous Coward | about 3 years ago | (#37485016)

Just to put that in perspective, thats £216 per person (children included).

Thanks government.

too difficult (0)

Anonymous Coward | about 3 years ago | (#37485422)

so two guys (so the story teals) have now one of the biggest website in the world with millions of daily user's and truck loads of data, (done some googling) and only spend $100 million. But some some crazy reason $1bn is not enough for some people to setup something probably half the size of the operations those guys have... they must be at the end of the toilet drain...

Re:too difficult (1)

hmallett (531047) | about 3 years ago | (#37485448)

Perhaps the complexity and importance of the data has something to do with it.

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