Biggest IT Disaster Ever?

lizzyben writes, "Baseline has a major story about a major IT disaster in the UK: 'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion, and two Members of Parliament say the project is "sleepwalking toward disaster"... In scale, the project... (NPfIT) is overwhelming. Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies.'" An Infoworld article from earlier this year sketches some of the all-time greatest IT meltdowns.

maybe next the Air Traffic systems?

[yagu]

The article:

The inspiration to digitize this far-flung bureaucracy first surfaced in late 2001, when Microsoft's Bill Gates paid a visit to British Prime Minister Tony Blair at No. 10 Downing St. The subject of the meeting, as reported by The Guardian, was what could be done to improve the National Health Service. At the time, much of the service was paper-based and severely lagging in its use of technology. A long-term review of NHS funding that was issued just before the Blair-Gates meeting had concluded: "The U.K. health service has a poor record on the use of information and communications technology--the result of many years of serious under-investment."

It's unfortunate but common to look at "under-investment" as root cause. Britain's problem could have been vastly improved even as a paper system by just getting their arms around communication, procedures, standards, etc. (I'm not talking about IT standards here, they're about as worthless as the electrons they spin on.) And then to be tantalized by Gates himself that technology (probably especially Microsoft Windows, sigh) would solve the problem.

I've seen amazing organization and communication among systems with simple low speed modem and dialup connectivity. It's not the technology, it's the grasp of the subject matter and how to organize it. Britain's example looks to be one of classic "good money after bad".

Get a bunch of people in a room who know what they need (sounds like they didn't) and put them together with a bunch of people who know how to do it (sounds like they didn't). It really is that simple, and it's not as hard as they made it.

The evidence?:

The process for selecting vendors began in the late fall of 2002. It was centralized and standardized, and was conducted, Brennan and others say, in great secrecy. To avoid negative publicity, NHS insisted that contractors not reveal any details about contracts, a May 2005 story in ComputerWeekly noted. As a byproduct of these hush-hush negotiations, front-line clinicians, except at the most senior levels, were largely excluded from the selection and early planning process, according to Brennan.

Though in the next paragraph the "CfH" denies that (why is it always organizations "denying" something, come on someone, step up and take accountability), I'm guessing the accusation is accurate.

When projects like this get going and the emphasis should be on subject matter experts (SME), the projects usually get expendable high-level highly paid deadweight -- I've seen it too many times. One project I was on we got assigned two SME's, one was so oblivious to the statement of the problem we even wondered if he (or she) had ever worked in the industry.

Other evidence the project was ill-conceived and guaranteed a disaster?: from the article:

[from the baseline goals] Reduce the time it takes to send medical images, such as X-rays, from about four minutes to less than one minute.

I'm guessing $24B spent to get an X-ray in one minute instead of four begins to be diminished returns.

Also:

Gates is viewed as the godfather of the NPfIT because he reportedly sold Tony Blair on the benefits of bringing the digital revolution into every doctor's office and hospital in Great Britain. In the process, the British government signed an Enterprise Subscription Agreement (ESA) with Microsoft for 900,000 desktops for Office Professional Enterprise Edition 2003 and various client access licenses. Microsoft also is developing a common user interface for CfH. Gates received an honorary knighthood in 2005.

This just reeks of cronyism and idiocy. If for no other reason, I'd vote Blair out of office for this -- it's insane. Bill probably walked away from this pretty happy though. Aside from the questionable broad brush technology choice, "Microsoft is develop

i work on this project

[alucinor]

I actually work on this project, an application called Choose and Book. We've had a lot of success: little downtime, significant uptake, and physicians seem pleased with the user interface. If you want to know, it allows people at their general practitioner to book appointments with a specialist at a hospital. It actually does a lot more, but I don't want to burden you with details. It's a J2EE application.

This project is far from being a "disaster" as the British newspapers (little better than tabloids) like to tout it as. And the project has very little to do with Microsoft or Bill Gates. Most of the software my company is delivering is C/C++/Java running on IBM AIX.

If you want the opinion of a software developer on the inside of this thing, take my word for it: this article is trash. Like any huge project, it's just moving along slower than anyone first anticipated.

In the end, the British healthcare system is going to be faster and cheaper because of Connecting for Health.

NSH IT's a security disaster too

[giafly]

"The front page lead in [November 1st] Guardian [guardian.co.uk]explains how personal medical data (including details of mental illness, abortions, pregnancy, drug taking, alcohol abuse, fitting of colostomy bags etc etc) are to be uploaded to a central NHS database regardless of patients' wishes.

The Government claims that especially sensitive data can be put into a "sealed envelope" which would not ordinarily be available... except that NHS staff will be able to "break the seal" under some circumstances; the police and Government agencies will be able to look at the whole record -- and besides, this part of the database software doesn't even exist yet, and so the system will be running without it for some time."

Security Research, Computer Laboratory, University of Cambridge [lightbluetouchpaper.org]

Dying for Data

[necro81]

For more information about electronic medical records, and the efforts to create national medical databases, I would suggest an article that appeared in IEEE Spectrum's October issue [ieee.org] entitled "Dying for Data." [ieee.org] The article describes some of the monumental challenges in creating such a system, profiles the British effort, and highlights the success that the Mayo Clinic [mayoclinic.org] has had in moving to electronic records [mayoclinic.org] for all its patients.

[I can't link to the full text of the article, because that issue is not longer current. IEEE members can log in and view it, however.]

Re:Keywords: Government. Health Care. Disaster

[HeavenlyBankAcct]

My lady's brother had MS and died in a fire because of it. This same doctor's clinic treated him at home for no additional charge, and when he lost his job, they continued to care for him at no cost at their office (we drove him there). The doctors repeatedly tell me that most health care is cheap. I have insurance for emergencies only (with a $10,000 deductible now) and my insurance is cheap even though I am a smoker and have a pre-existing condition of kidney stones -- in fact, my lady and I pay less as a household for a year than most people do in a 6-9 months with their overriding policies.

Interesting that you should bring up MS, since my frame of reference is with the same disease.

My mother is a single woman who was diagnosed with MS when I was around eight years old. Her disease is a progressive one, and as such, she gradually lost the ability to operate for periods long enough to sustain a full-time income. Since she was unemployed (and married) at the time of her diagnosis, she was not covered by any private insurance fund, and thus, after her divorce, she fell into the questionable hands of Medicare.

Since that time, I've witnessed our family tossed into bankruptcy proceedings to cover hospital bills that Medicare claimed were out-of-scope. I've witnessed months and years where she was unable to pay for her medication and fell into serious regression. Most recently, I've witnessed her taking part in a completely bogus marriage to a man she barely knew simply so she could be added to his military insurance plan. These are the sort of things that the poor in our country deal with when they have chronic or terminal diseases.

Your friend and you are very lucky to find the sort of treatment that he did, but that's certainly not a commonality, or even a rarity. I would say that's a goddamn miracle -- and I certainly would not assume that because you were accepted for insurance with kidney stones that somebody with a terminal disease would have an easy of a time as you. I've been gainfully employed for years and have been frantically searching for a 'family plan' that would also covered my disabled mother and have been greeted routinely with incredulity and flat-out "no, we don't do that"s.

So, yes, I think I can justifiably use the "what about the poor" argument since that's the reality I know. I'm not sure how the system appears to those who don't actually need it -- I just know the dismal reality of attempting to get health care without money in this country. Regardless of what the rhetoric states -- it's not easy, or pleasant, and most of the time, it's impossible. I thank the powers that be daily that I'm now in a situation where I can provide financial support to my loved ones instead of expecting them to rely on a broken system to keep them intact.

$10,000 deductible?

[Anonymous Coward]

And what if you get cancer, then what? Chemo drugs will drain that 10 grand in an instant - trust me I know. You can be as healthy as an ox and still have a health crisis bite you in the ass. I was prepared for it, sounds like you are not.

Per capita...

[pev]

...this is around £200 / 400USD. Ouch - kinda puts it into context...

~Pev

I was employed by one of the companies

[Anonymous Coward]

(though I wasn't involved in the project -- it was a completely different division. However, I did pay attention to news and rumors). I won't mention which company, but they actively sought out another company to acquire them, due to their faiure on this project.

Anyhow, I wasn't surprised when the company failed it, and I'm not surprised that the project is a failure.

Re:Honourable Mention

[Anonymous Coward]

Just to clarify...

the UK consists of 4 countries (England, Scotland, Wales & N. Ireland).
Please don't refer to UK or GB as "England". The Scots & Welsh get very upset. They benefit from the NHS, too. In fact, the Scots make the money (from oil rigs) for the "English" government to squander on IT projects and making the South-East a nice place to live...

Re:Keywords: Government. Health Care. Disaster

[bberens]

According to the AAPS [aapsonline.org] website there are 9 physicians' offices in the country which practice free market medicine. It's great that you have one where ever you are, but it's totally unrealistic to expect any reasonable number of other people to find the same thing in their local area.

Re:When did England split from the UK?

[Anonymous Coward]

Actually, each of the four nations of the UK has, in effect, its own NHS. NHS Scotland [wikipedia.org], NHS Wales [wikipedia.org] and Health and Care NI [wikipedia.org] are separate from the National Health Service [wikipedia.org] in England.

However, the NHS in England is managed by the UK government (there is no separate autonomous English government), so the text is incorrect in that respect.

Broken by design

[Anonymous Coward]

actually work on this project, an application called Choose and Book. We've had a lot of success: little downtime, significant uptake, and physicians seem pleased with the user interface. If you want to know, it allows people at their general practitioner to book appointments with a specialist at a hospital. It actually does a lot more, but I don't want to burden you with details. It's a J2EE application.

Choose and book is a perfect example of why this project is way way over budget and, I'm sorry to say, ill-conceived. I know people who work with it.

The system searches all the records in the UK for patients instead of the ones actually at the GP practice in question (no possibility of privacy problems there is there?), is very slow, and doesn't focus on what the doctors wanted in the first place. The drive for this kind of system should come directly from the clinicians. How many GPs have you spoken to about it, and did they actually come up with the requirements?

The old system was the GP would choose a hospital from the few near the patient (based on their judgement of what was best for the patient) and call the specialists there to arrange an appointment. Many patients only have one or two hospitals which are realistic options anyway.

The new system is they have to use this computer system (many of the hospitals aren't working properly with it yet anyway), cajole the patient to choose something, and then call around anyway to check it's all ok. In addition, the patients have NO IDEA which hospital is best, best being the one which has the best specialists for their condition, the shortest waiting times, and a myriad of other factors. So their choice is in fact the illusion of choice, and many simply say 'well, whatever you think doctor' - quite sensibly I might add. The whole idea of choose and book has been foisted on the GPs by a govt. and management consultants more interested in sound-bites and keywords eg 'Patient Choice' than in patient care.

If you truly think everything is going swimmingly, it might be worth reading some of the articles in the medical journals [google.com] on choose and book. Now maybe you delivered the system as designed, but it is broken by design. Doubtless it's not the biggest IT disaster ever, but there have been serious problems of scope and ambition in this entire IT upgrade project (ie an attempt to be all things to all people) which are architectural problems, and just won't go away at this stage.

Re:Far far bigger - IT sourcing bug killed a count

[salimma]

Microsoft did do something similar in the past. Windows 3.1 (AFAIR) would check if it was running on top of DR-DOS, and if so would randomly fail.

Re:Keywords: Government. Health Care. Disaster

[InsaneGeek]

Are you so sure about that????

http://www.pittsburghlive.com/x/pittsburghtrib/s_3 07614.html [pittsburghlive.com]

Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. "Britain has one of worst survival rates in the advanced world," writes Bartholomew, "and America has the best."

If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent. Again, reports Bartholomew, "Britain is at the bottom of the class and America is at the top."

More specifically, three-quarters of Americans who've had a heart attack are given beta-blocker drugs, compared to fewer than a third in Britain. Similarly, American patients are more likely than British patients to have a heart condition diagnosed with an angiogram, more likely to have an artery widened with angioplasty, and more likely to get back on their feet by way of a bypass.

Re:Keywords: Government. Health Care. Disaster

[Doctor Memory]

One of my lady's best friends runs a huge network for a hospital chain that is in the process of combining with another hospital. She's told me repeatedly that the biggest costs for her MIS department is integrating all the bureacratic changes that the government requires -- paperwork, forms, etc

When I used to do LIM systems, I once did one for a UK-based pharmaceutical R&D company. The work broke down to roughly 40% effort to make the software function correctly, with the remaining 60% going towards writing code to generate the reports required by the Home Office.

My boss was actually a little upset that I used a template-based approach, as he felt it would permit the users to modify the reports on their own (denying us a revenue stream). Then he found that the users would gladly pay to have someone else keep those reports up-to-date.

A medic's view

[Anonymous Coward]

COI: I have worked on IT projects, and was involved in early focus groups for the NPfIT. I am a practising clinician and left these projects due to disillusionment and an inability to make change.

1. Clinical involvement has been very poor. At even early meetings, it was very clear that the specifications for the new systems were already fixed and unchangeable as they formed part of a formal OJEC notice already posted pending bidding under the European procurement rules.

2. Technology has been used to enforce/encourage/force change on the ground. IMHO, technology should facilitate change, but not impose it. Many of the processes involved in the NPfIT have been top-down, often politically driven, rather than clinician led. These new IT developments have been used to drive change and force a different way of working.

3. There have been numerous worries regarding patient confidentiality and the number of people/organisations having access to centralised data. Many of these issues have been ignored, to be dealt with "at a later date".

4. Systems such as choose&book are poorly thought out and are often used to enforce local political will. For example, local Trusts can refuse to take referrals, actually limiting choice compared to more traditional doctordoctor referrals.

5. The rationale for a centralised data record has not, in my opinion, been fully proven. Data quality held centrally is known to be very poor, and even data held by GP surgeries can be of dubious quality. This will mean clinicians will ignore centrally-held data, in favour of getting the truth from the patient. The "spine" (the centralised patient record) will become a white elephant.

6. There are several sub-projects that, in my mind, are much more straightforward - "low-hanging fruit" so to speak. Development of medical IT needs to be iterative and slow, with a focus on specific task-orientated projects rather than a big-bang, top-down approach. For example electronic prescribing can cut transcription errors, aid doctor-doctor/nurse/pharmacy communication and prevent medical incidents.

7. Procurement needs to be task-driven, small, highly focused, rather than the poorly defined, "do-everything", suits no-one project it is becoming.

8. Newspapers and the media fail to report the fragmentation within the United Kingdom. England's IT strategy is different to that of Wales and Scotland.

9. Dividing England into five separate regions for procurement was a huge mistake. These regions are not small enough to ensure that development is led by front-line staff, and yet there are five regions all repeating the same solutions/mistakes, often procured from the same supplier. It should have been a task-driven, focused, iterative procument.

10. There are a number of posters (mainly from the United States) shifting the discussion to that of public vs private healthcare. This article is not about these issues, and the NHS in the UK is very different to the United States.

Rant over. I could go on all day!

Apologies for posting anonymously.

So do I..

[Anonymous Coward]

Choose and book doesn't sit on the main NPfIT backbone as far as I'm aware. In the hospital where I work, we've had a few issues with it's implementation, but on the whole, it works after a fashion.
Now the core NPfIT product (I take it you've had your training; The product is pretty shoddy. I managed to register several patients in the same bed (woo hoo, except you really don't want that happening), registered a male with a diagnosis of prolapsed uterus (all from the point and click menus for god's sake), crashed the front end application several times, and picked holes in their data model on several occasions.
Their system of data aliases is broken. Relying on a hospital to have a working internet link to even access their own patient data is nuts! Now a simple snip of a couple of fibres can stop a hospital in it's tracks. No local data caches.
This project was never truly specified correctly, and it's implementation is broken (did you know a few hospitals have refused to go live yet because of too many outstanding failures in the product, which the consultancy company has had to raise it's hands and say "You got us. Yes, it's broken.".)
So, speaking as a front line implementer (I'm one of the systems admin team for a hospital rolling this stuff out), I'd say there's a lot of meat in this article. NPfIT scares me.

Posting anonymously for the obvious reason that I'd rather like to keep my job.

Re:Keywords: Government. Health Care. Disaster

[InsaneGeek]

And I'm providing a point that I have direct experience with this, I've not gotten any impression that you do. That you don't have anybody in your immediate family who is of working age and is unable to work because of a physical ailment, my wife has those.

If you are talking about intensive treatment, than I suggest you look around and tell me how much "intesive" treatment you get in other countries? You don't get intensive treatment, you get emergency treatment and a line for ailments. There is nothing really intesive about most social medical programs.

Here are the plain-jane facts: http://www.pittsburghlive.com/x/pittsburghtrib/s_3 07614.html [pittsburghlive.com]
46% chance of dieing of breast cancer in UK, 25% in US
57% change of dieing from prostate cancer 19% in US
1/3 of heart attack patients get beta-blockers in UK, 3/4 of patients in US
UK has half the number of MRI & CT scanners per million people as the US does
36% of non-emergency UK surgeries wait for >4 months, only 5% of the US do
40% of UK cancer patients don't get to see a specialist

Having a loved one who has >8 doctor visits per month for the past 6 years, I'm well aware of the luxury we have in the US, and I have intimate knowledge of what "intensive treatment" means, and waiting >4 months for non-emergency surgery is not what "intensive treatment" means. Interestingly enough I know a person who does have MS, doesn't work, get's a government stipend and government healthcare. She gets her medicine free from the pharmacuticals, which basically every single one offers based upon income and her treatments are completely free. If you have no income, you can be very well covered, unfortunately few people seem to understand that, the people who are in the bind in the US are the people who are middle-class who get into trouble and don't have a fall-back plan. The ones who aren't poor and the ones who aren't rich, the ones that fall outside of the low income requirements and can't cover it themselves and don't have a job that covers it and run into a major medical condition.

Having being with someone so young and unable to work for so many years and constantly in doctors office I have a reasonable understanding of the situation as I too want to save all the cash possible on my medical bills and I have investigaged these different options personally. And FYI, the new medicare perscription plan should keep granny from having to goto canada for her drugs anymore (we aren't under medicare so I can't say for complete certainty, but if granny is on medicare d she should get most everything for like $10, once she figures out the plan that works for her).

If you have a family of 4x and you make less than $40,000 pfizer will send you stuff for free (even viagara), you do have to resubmit your income level every year (boo, hoo that's a terrible price to pay to get viagara) https://www.pfizerhelpfulanswers.com/assets/connec tcareApp_English.pdf [pfizerhelpfulanswers.com]

I'm not going to say everything is perfect, but it is working much better than you think it is.

Re:i work on this project

[dyftm]

I've been involved in upgrading some computers just for Choose and Book. What I want to know is why on earth you people made Internet Explorer 6 a requirement?? I must admit I haven't seen it in action, but I find it hard to believe that you couldn't accomplish the same things without IE6-only technology. No-one can upgrade to IE7, or use an alternate browser to run this thing. So, you're forcing hundreds of thousands of computers with highly sensitive medical information on them to run without the maximum security available.

Re:Honorable Mention

[dulridge]

Sheer size. The NHS employs around a million people (882,000 for England alone) and you are talking about the records for nearly 60 million living people (and the digitised records of dead people - some clinical records are required to be kept for 75 years after the death of the patient). The NHS is 58 years old. That's a lot of data. Tax records are far simpler

Number of locations - every GP surgery in the country - even the ones in the islands 10,465 of them in 2004 (figures here [rcgp.org.uk]) plus all the dentists (5-10,000 practices) opthalmic practitioners (8,000), the 10,000 contracted pharmacies (More figures [doh.gov.uk]), and so on.

ALL of these will need to be connected. There probably isn't much like it anywhere on that scale - and expectations of it are wildly unrealistic.

The backbone will be fun to build out to the islands where power is often flaky in winter - and the UK is rather longer than it is wide. I doubt adequate telco infrastructure is in place for quite large parts of the country - think everywhere where you can't get a mobile signal.

In practice for most NHS workers, all this stuff is taking huge amounts of money away from what really matters - care for the patients. The (7 year old) PC eating half my desk is only useful for receiving bureaucratic garbage - anything important gets done on the phone or in the wards. A huge amount of time is wasted, going through all the garbage that gets emailed to all and sundry, some of which actually needs reading but the vast majority doesn't. The problem is figuring out which is which without reading it first. My favourite one was the day that 10,000 people in got the email about the new lines being painted in a rural health centre car park (staff 8) meaning that there would be 2 less parking spaces that day.

Not to mention the fun stuff like wiring up 200 year old hospital buildings, GP practices and the like.

Re:i work on this project

[Anonymous Coward]

Choose and Book is utterly appalling, a productivity destroyer and a laughably childish attempt at an illusion of choice.

My local practitioner is forced to use it. The practice is over-stretched as it is, with weeks of waiting to get a 10 minute appointment with a doctor (Government targets of 'within 48 hours' notwithstanding). You even have to book short phone conversations with the GP days in advance - but I digress.

With the average time allowed for an appointment being 10 minutes, it literally took 20 minutes after the diagnosis for the GP to get the system to work for him - and this was not a one-off occurence as the GP's conversation while waiting for the system to work confirmed. Of the hospitals offered, the one 'chosen' didn't actually use the system at all - you had to telephone separately to make an appointment(!). Meeting GP's socially confirms it is an absolute and unmitigated disaster, driving down the time available for patient interaction, especially in this particular practice, by huge margins.

Note that this practice is in London, which has the worst resourced NHS infrastructure in the UK - the regions are havens of peace, light, and ever-flowing care by comparison.

Despite the massively increased funding, my experience and of those close to me over the past few years have been of great degradation in the service, to the point of unusability. Other people's experience may well differ, and I am well aware that a single anecdote is not a basis to rest an entire case on. On the other hand, the only people saying positive things about the NHS seem to be spin-doctors, not medical ones.