Health Information Technology: Whistling by the Graveyard

The United Kingdom invested almost $20 billion in an ambitious Health Information Technology (HIT) initiative that has now been scrapped. But in the United States, the people working on our $20 billion program are confident that our investment will not be wasted. If I were getting a big piece of that $20 billion, I too would “express confidence” that the money I am getting will not be wasted. Nope. Not a chance. No waste here. Never happen.

An article in The Independent reports:

The nine-year-old NHS computer project – the biggest civilian IT scheme ever attempted – has been in disarray since it missed its first deadlines in 2007. The project has been beset by changing specifications, technical challenges and clashes with suppliers, which has left it years behind schedule and way over cost.

Accenture, the largest contractor involved, walked out on contracts worth £2bn in 2006, writing off hundreds of millions of pounds in the process. Months earlier, the US supplier IDX, contracted to provide software in and around London, had also withdrawn from the project, making a $450m (£275m) provision against future losses from the two contracts.

It adds that another American vendor, Computer Sciences Corporation, failed to deliver the bulk of the systems it was contracted to provide, but –

The department told MPs it may be more expensive to terminate the contract than see it through, while another provider, BT, “has also proved unable to deliver against its original contract”.

Another publication, ZDNet, reports

The NHS IT programme has already had £6.4 billion ($9.8 billion) spent on the new centralised service. Originally, £12.7 billion ($19.6 billion) was budgeted for the project, but was later revised down by £1.3 billion ($2 billion).

But after a long-running series of delays and over-spending issues, it was branded “unworkable” by a group of members of parliament last month.

Instead of pumping more money into the already struggling IT programme, it was decided by Cabinet members and other ministers to instead scrap the service and start again.

Now it would seem the UK had many advantages over the U.S. in implementing such a system. At 62 million, its population is one-fifth of ours, it is geographically compact, all of its providers are actually employed by the National Health Service, and there was only one payer involved. So it was willing to spend five times per capita as much as we are and the users of the system could be fired for not cooperating with the roll-out, and still it failed.

But the IT people in the U.S. are undeterred, at least according to the trade publication Information Week. It writes –

Perhaps the United Kingdom should have taken the U.S. approach to health IT. Seems like the Brits might be thinking that, too.

The failure of the United Kingdom’s troubled, $20 billion-plus National Health Service National Programme for IT, launched in 2002 and officially declared dead last month, serves several lessons for the United States as it rolls out its own $27 billion health IT program.

It argues that everything is just nifty in the good ol’ USofA because –

…the U.S. approach of making health IT use voluntary–even while healthcare organizations are being encouraged to do so with financial incentives from the government–helps get buy-in from clinicians.

Let’s see here. Yes, the American government is not actually providing the equipment, but it is dictating “standards,” mandating “meaningful use” of the systems, and requiring U.S. providers to pay for a good portion of the hardware and software.

The article goes on to argue that this is all good because by having to pay for some of the systems, American provides will want to use them, and –

The U.S. also has gone out of its way to get input from healthcare stakeholders–including hospitals, doctors, patient groups, payers, technologists, and others. In fact, the entire HITECH Act rulemaking process for Meaningful Use stages 1, 2, and 3 has taken so long in large part because the U.S. government has been bending over backwards in asking stakeholders for input, through standards and policy workgroups, and also by asking the public for feedback, before finalizing the requirements of the incentive programs.  

So, Dr. Jones will be comforted because lobbyists from the AMA helped to dictate the standards he must comply with and pay for out of his own pocket. What could possibly go wrong?

Comments (13)

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  1. Neil H. says:

    What a farce.

  2. Devon Herrick says:

    Any new system must serve a purpose that solves a specific problem or else little effort will be expended to implement it.

  3. Ken says:

    What a huge waste.

  4. Dr. Steve says:

    Portable medical information can be an asset if it was a small memory unit, chip, whatever carried on their person. It could have their basic medical history, allergies, prescription history, etc maybe even important reference imaging studies, and be available when they present to an unfamiliar facility.
    The patient would be responsible for the security of this information, not the doctor or home hospital, etc., and the government and /or insurance company would not be rummaging around where they don’t need to go.
    If the patient does not want to be a partner in this way, it’s their call. But if they had health saving accounts and large deductibles they might want to avoid duplicate services.

  5. Brian says:

    Seems like a huge waste.

  6. Mark Glasgow says:

    For anyone who watches “House,” you can see the show’s producers not-so-subtly attempting to incorporate these new technologies into the show. Unfortunately, they always come off as bulky or limited in application. Echoing the comments above, what a waste.

  7. Philip Thwing, MD says:

    I just started using my new Electronic Medical Record (EMR) which was mandated by Medicare today. I can see that the information in it will be much more cumbersome to retrieve than paper (and it’s certainly a lot more cumbersome to enter in, too!).
    My system doesn’t talk with either of the hospitals in town. It doesn’t talk with any of the other docs in town who aren’t already my partners.
    What is the advantage again?

  8. John R. Graham says:

    It sounds very similar to what appears to be happening in Canada, which has almost the same market structure as the U.K. Here is a quotation from a Canadian Health IT blogger from early in 2011:

    “As the industry exhausts the early adopter and early mainstream physicians, are they encountering increased difficulties selling their solutions to the more skeptical and demanding late mainstream and laggard physicians? Were provincial government forecasts for physician adoption of EMRs overly optimistic?” (See http://tinyurl.com/83daxrf.)

    Back in 2009, the head of the eHealth agency in Ontario resigned in a scandal of no-bid contracts, with bloated costs and missed deadlines. (See http://tinyurl.com/7wd224g.)

  9. Greg Scandlen says:

    Dr. Steve writes –

    “It could have their basic medical history, allergies, prescription history, etc maybe even important reference imaging studies, and be available when they present to an unfamiliar facility.”

    Or here’s an idea. Why not have a wallet-sized paper card that would have that info? The info would be available in situations where a chip reader wasn’t there, like, say, in case of a car wreck. Granted it couldn’t carry the imaging studies, but it could include the phone number of your Doc, and would be a whooooole lot less expensive.

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