U.K. Dept of Health: Prescription for DisasterBy Baselinemag Print
The British government budgeted close to $12 billion to transform its health-care system with information technology. The result: possibly the biggest and most complex technology project in the world and one that critics, including two Members of Parliame
In late September, Accenture, the global management and technology consultancy, announced it was walking away from a $3.73 billion contract as an information-technology services provider on the world's biggest non-military I.T. project, a hugely ambitious and complex attempt to transform England's entire National Health Service through technology. Accenture, which failed to respond to numerous requests for interviews, did not say why it was exiting the National Health Service (NHS) project, but earlier this year it had set aside $450 million to cover potential losses from its work in England. Its exodus represents the latest in a series of setbacks and missteps that have plagued the highly controversial program since its inception.
In scale, the project, called the National Program for Information Technology (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.
To date, the NHS has delivered some of the program's key elements. For example, in late October Health Minister Lord Warner announced that 1 million patient referrals to specialist care have been made through a Choose and Book service that allows patients to book appointments electronically. As of August, 97% of doctors' offices were connected to a new national network, N3, which is a major component of the project.
Yet, many pieces of the project—including deployment of key electronic records software—have been delayed and the program's cost has ballooned.
The NPfIT was initially budgeted at close to $12 billion. That figure is now up to about $24 billion, according to the National Audit Office (NAO), the country's oversight agency. And it is as high as $28.4 billion, according to other estimates. Even the lower of those two amounts is more than the price tag for building the English Channel Tunnel or Boston's massive Big Dig project, considered to be the most expensive civil project ever. Worse, the funding established to pay for the system has, temporarily at least, dried up.
Among the problems the project has encountered:
- One key health-care software subcontractor, IDX, was dropped from the program in April 2005 after one of the project's prime contractors, Fujitsu, "lost confidence" in its abilities, according to the NAO. IDX failed to respond to requests for a comment.
- Another key health-care software maker, iSoft, is some two years behind schedule in delivering a new electronic health-care system called Lorenzo, according to British newspaper The Guardian.
- A 2005 report issued by the NPfIT stated that the migration of data from computers in health-care practices into systems that complied with a new national health-care records system would take far longer than the five years originally projected by the NHS' Connecting for Health (CfH), the unit overseeing the NPfIT project.
- The N3 network, deployed to connect the country's health-care workers, has been hit by more than 100 system and network failures. Most recently, in July a network outage disrupted for three days mission-critical computer services such as patient administration systems.
- While a June 2006 NAO report praised aspects of the CfH's project management, notably the procurement process and its use of project management software, key elements of the project's management have come into question. The NAO report cited a need for strengthening project management skills, pointing out that "the shortage of such skills is an immediate risk to the timely implementation of the program." Speaking at the Towards the Electronic Patient Record (TEPR) conference in Baltimore in May, former NPfIT liaison manager Phil Sissons noted that as a result of the CfH's top-down, authoritative approach to change management, many hospitals are strongly resisting the NPfIT. "There's no ownership of this system because it is being imposed," he said.
- The project has little support among health-care workers. For example, only 38% of the country's doctors feel the project is a priority for the NHS, and just 13% believe that the program represents a good use of NHS resources, says a recent survey by Medix, an independent market research consultancy in England.
A report issued recently by two British Members of Parliament, Richard Bacon and John Pugh, concluded: "The [NPfIT] … is currently sleepwalking toward disaster. It is far behind schedule. Projected costs have spiraled. Key software systems have little chance of ever working properly. Clinical staff is losing confidence in it. Many local trusts are considering opting out of the program altogether." Local trusts are the regional agencies that administer the country's national health-care programs.
"There have been enormous problems," says Martin Brampton, founder of Black Sheep Research, an independent U.K. technology and research consultancy. "We now have a situation where several years of increased levels of expenditure have largely disappeared into top salaries and I.T. projects, with little evidence of much change in the experience of patients. And the future looks bleak, since the spending on NHS I.T. is by no means over."
In an e-mail to Baseline, the CfH responded: "It is unfair to speculate about failure. The NAO stated that the Program was well managed and has made good progress. Central budgets [core budgets for Local Service Providers, or LSPs] have not risen."
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