Thursday, May 19, 2011

Are We Seeing Our Future In the Way The UK National Program for Health IT Has Fallen Over?

The release of the National Audit Office of the UK report on the National Program for Health IT is the big global news for the day.

Wednesday, May 18, 2011

Audit Slams British EHR Program for Being Largely Unsuccessful

The billions of pounds allocated by the United Kingdom's National Health Service to deploy an electronic health record system has been poorly spent, and the project needs urgent reassessment, according to a report released Wednesday by the country's National Audit Office, the Wall Street Journal reports.

Audit Details

The £2.7 billion -- or roughly $4.4 billion -- spent so far "does not represent value for money," the report concludes, adding, "Based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different."

The project was designed to create an EHR for every patient by 2010, a goal that has not been achieved (Stovall, Wall Street Journal, 5/18).

The nine-year-old project missed its first deadlines in 2007, the London Guardian reports (Curtis, London Guardian, 5/18).

In addition, many of the health IT systems in hospitals were "mainly providing administrative benefits, rather than clinical ones," and were unable to prescribe or administer medication, according to the audit (King, ComputerWorld UK, 5/18);

Comments

Amyas Morse, head of NAO, said the health department "fundamentally [underestimated] the scale and complexity of a major IT-enabled change program" (Adams, London Telegraph, 5/18).

Morse added that contractors are getting paid the same for deploying "far fewer" systems than planned (Timmins, Financial Times, 5/18).

More here:

http://www.ihealthbeat.org/articles/2011/5/18/audit-slams-british-ehr-program-for-being-largely-unsuccessful.aspx

There is lots of coverage in the British Press as is shown above. Some of the specialist reporting is found here:

NAO says NPfIT is not value for money

18 May 2011 Jon Hoeksma

The National Audit Office has issued a coruscating report on the delivery of integrated care records by the National Programme for IT in the NHS.

In its third report on NPfIT, the NAO focuses on detailed care records, the centrepiece of the programme that was due to have been fully rolled out by 2010.

It concludes that the £2.7 billion spent by the Department of Health and trusts on care records systems and implementation “does not represent value for money”.

“Based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different,” it adds.

The report - 'The National Programme for IT in the NHS: an update on the delivery of detailed care records systems' - examines the contracts placed and renegotiated for the five English NPfIT regions and the progress made in delivering contracted systems to trusts.

It tells a consistent story of reduced delivery for barely reduced prices, and says that the original vision of an integrated system cannot now be delivered.

Amyas Morse, head of the NAO, said: “The original vision for the National Programme for IT in the NHS will not be realised.

"The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money.

“The Department of Health needs to admit it is in damage limitation mode. I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help prevent further loss of public value from future expenditure on the Programme.”

The report says delivery of electronic patient records across the health service has been extremely patchy. Particular criticism is directed at CSC for its failure to deliver the iSoft’s Lorenzo care record system.

This is contrasted with BT’s limited delivery of hospital and community systems in London and parts of the South.

However, the NAO says repeated revisions to the BT contracts have resulted in fairly small reductions in cost for drastic reductions in delivery on what was originally planned.

In the case of Cerner Millennium for acute trusts in London, the report says that prices appear to have increased by 18% - although some trusts in the South are paying around 22% more.

Where care records systems have been delivered, they are not yet doing what the Department had expected.

“In acute trusts, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals.”

Much more here:

http://www.ehi.co.uk/news/industry/6885/nao-says-npfit-is-not-value-for-money

and here:

NAO condemns NPfIT contracts

The NAO’s analysis of the deals done and redone for the different regions of the national programme in England tell a tale of diminishing returns for barely diminishing costs. Lyn Whitfield reports.

17 May 2011

Over 50 pages, the latest report from the National Audit Office on the National Programme for IT in the NHS tells a tale of steadily diminishing expectations and system delivery. But it doesn’t tell a story of steadily falling costs.

Instead, as the report’s first key finding summarises: “Delivery of the contracted number of systems continues to fall well below expectations and fewer systems will now be delivered to NHS organisations, although the cost of delivering care records systems remains substantially the same.”

Overall, the NAO concludes that the Department of Health has so far spent £1.8 billion on care records systems and the NHS has spent another £900m on implementing them.

Yet it says the national programme’s contracts will not deliver on the vision of an integrated care records system for the NHS, even if the latest deals with BT and CSC come good, and the £4.6 billion that remains unspent delivers value for money.

Along the way, the watchdog’s consideration of the deals done and redone for the five NPfIT regions suggests that a staggering amount of money has been committed on the basis of relatively little evidence about the best prices that could be achieved and the benefits that could be secured.

London:

The DH’s contract with BT to deliver IT systems to London has been renegotiated twice; in May 2007 and in November 2009.

The first change allowed BT to shift from delivering one system to a ‘best of breed’ strategy, in which mental health and community organisations were offered RiO from CSE Healthcare and only acute trusts were offered Cerner Millennium.

The second change followed concerns that BT was still unable to deliver Millennium at the scale required. An assessment found the system had 84 defects against a contractual testing limit of 30, and that a more modular and localised delivery system was required.

This, plus enhanced functionality for RiO, pushed up the total contract cost. So the Department cut the number of acute systems required – from 31 to 15 – and scrapped the requirement to deliver new IT to the London Ambulance Service and 1,243 GP practices. Overall, it saved £73m on the original contract price.

The NAO report says: “The Department has been unable to provide us with a full breakdown of the revised, £984m contract, but Departmental papers suggest that the changes increased the average cost of Millennium per acute trust by at least 18%.”

In addition, although London trusts can now choose which core modules of Millennium they want, and choose the order in which they are delivered, additional modules will not be funded by the programme.

Those modules that are still part of the programme are being delivered in three releases, of which only the third “delivers the level of functionality anticipated at the programme’s outset.”

By the end of March, three trusts had the first release and five had the second, which includes connection to the NHS Spine. None had the third release, although “BT reports that this release is ready to be delivered”. The London programme is now due to be complete by October 2014.

Heaps more here:

http://www.ehi.co.uk/insight/analysis/741/nao-condemns-npfit-contracts

What can one say. It seems that the basics have all been ignored and we have sadly a rather inevitable outcome.

It seems just astonishing that CSC and BT are now trying to negotiate more money to deliver less than was planned over a longer timeframe!

“Amyas Morse, head of the NAO, said: “The original vision for the National Programme for IT in the NHS will not be realised.

"The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money.

“The Department of Health needs to admit it is in damage limitation mode. I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help prevent further loss of public value from future expenditure on the Programme.”

The report says delivery of electronic patient records across the health service has been extremely patchy. Particular criticism is directed at CSC for its failure to deliver the iSoft’s Lorenzo care record system.”

This is also an amazing finding!

“Amyas Morse, head of NAO, said the health department "fundamentally [underestimated] the scale and complexity of a major IT-enabled change program" (Adams, London Telegraph, 5/18).”

I hope NEHTA and DoHA have downloaded their copies of the full report and started reading very carefully. The risks of these sorts of programs is not trivial and the penalties for failure are very high!

David.

2 comments:

Oliver Frank said...

Daivd says at the end of his piece: "The risks of these sorts of programs is not trivial and the penalties for failure are very high!"

I can't see that penalties have been exacted on anybody other than the Brisith taxpayer. Have the contracted providers of systems that should have been installed and running, but are not, actually been penalised in any way?

Dr David More MB, PhD, FACHI said...

Wait till we see the outcome of the Parliamentary Enquires that are just about to begin. There the rubber will hit the road. Just as we will eventually see regarding NEHTA and the PCEHR I suspect.

David.