Friday, October 07, 2011

Wrap Up On the Cancellation of the UK NPfIT. A Set of Links To A Range of Perspectives.

First we have:

U.K. Ends Health-Service IT Upgrade


The U.K. said it was scrapping a £11 billion ($17 billion) information-technology program for its state-run health service, saying that some of the £6.4 billion already spent has been wasted and that the program today "is not fit to provide the modern IT services" the health-care system needs.
Launched in 2002 under the previous Labour government, the program was hailed as one of the biggest IT projects ever attempted. It aimed to digitize patient records and link all parts of the sprawling National Health Service, or NHS, and was closely watched by other countries attempting to adopt new healthcare IT. BT Group PLC and Computer Sciences Corp. are among the suppliers involved.
The scrapping of the ambitious U.K. program could have implications for the digital health-care push under way in other countries, including the U.S., which has suffered its own setbacks as it attempts to digitize medical records. Supporters of modern health-care IT say it can cut costs and improve patient care, but the software is often expensive, complex to design and cumbersome for physicians to use.
In a statement Thursday, Britain's Department of Health said it was "dismantling" the project because it "has not and cannot deliver to its original intent." It said future IT decisions would be made on a regional level, with more suppliers competing for contracts.
The health department said it based its decision in part on a recent report from a parliamentary committee that scrutinizes government spending, which concluded that the government had overpaid for parts of the IT system and faced "extensive delays" from suppliers.
In the U.S., the government has tried to incentivize managed-care organizations to adopt better health-care IT as a means to improve patient care and reduce health-care spending, which the government helps fund through its Medicare and Medicaid programs. But progress has been mixed, said Kenneth Kizer, head of the Institute for Population Health Improvement at the University of California, Davis.
Managed-care groups sometimes design IT systems without enough input from doctors and nurses, who then rebel when the product is forced upon them, he said.
Managed-care giant Kaiser Permanente took a $442 million write-off in 2002 after scrapping a multibillion dollar attempt to create its own electronic medical-record system and has spent billions more on a new one. A Kaiser spokesman said the first system "was out of date and could not provide a common platform organization-wide that could operate at such great scale."
Full article here:
Then we have:

Dismantling NHS computer scheme could cost more money

Dismantling Labour’s disastrous £12billion NHS IT programme may cost taxpayers more than keeping it going.

6:00PM BST 22 Sep 2011
Ministers announced on Thursday that they will speed up the scrapping of the National Programme for IT after a review concluded “there can be no confidence that the programme has delivered or can be delivered as originally conceived”.
It confirmed earlier reports that the central part of the scheme, allowing NHS staff across England to access any patient’s details, was unworkable while costs had increases and deadlines were missed.
The governance board of the programme will now be scrapped, and local trusts will be given the freedom to develop their own versions of the electronic care record rather than having the rules dictated by Whitehall. A new Cabinet Office oversight committee will monitor future IT investment to ensure money is not wasted.
But many trusts across England have large contracts with private suppliers to supply their care record systems, and their cancellation could leave taxpayers even more out of pocket.
The Department of Health’s own chief information officer, Christine Connelly, told MPs on the Public Accounts Committee in May that a £3bn deal with CSC to deliver systems in the north, midlands and east of England would cost more to get out of than to keep going.
She said: “Potentially, if you ask me about the absolute maximum, we could be exposed to a higher cost than the cost to complete the contract as it stands today.”
More here:
We also have a good deal of coverage from E-Health Insider (
First here:

Government axes "Labour" NPfIT

22 September 2011   Lyn Whitfield
The government has used the end of the Cabinet Office’s review of the National Programme for IT in the NHS to announce that it is going to “axe” the project.
The timing of the move appears to be linked to the party conference season. The Labour Party is meeting next week, and this morning a number of Conservative-supporting papers put significant emphasis on the programme's Labour roots.
The Daily Mail opens its coverage by saying that “ministers are to axe Labour’s disastrous £12 billion NHS computer scheme” which it goes on to describe as a “monument to Whitehall folly during Labour’s 13 years in power.”
The paper does not say what will happen to NHS Connecting for Health, the agency that runs the programme, or to CSC’s local service provider contract for the North, Midlands and East of England, on which considerable sums of money are still to be spent.
However, eHealth Insider understands that in line with previous announcements, the future of CfH will be clarified in a report on the future of health informatics that is due later this autumn.
EHI also understands that the DH continues to lead on negotiations with CSC, although there will be further involvement from the Cabinet Office.
Cabinet Office minister Francis Maude will chair an 'oversight committee' to get best value from the contracts, with DH and Cabinet Office representation.
The DH and the US company have been locked in negotiations about a new deal since CSC missed another key deadline to install iSoft’s Lorenzo software at Pennine Care NHS Foundation Trust.
The deal has been interrupted by a highly critical National Audit Office report on the detailed care records elements of the national programme.
This also criticised the deals re-signed with BT for London and parts of the South, which delivered less functionality to fewer trusts for only a small amount less money.
The CSC negotiations were also interrupted by a lively meeting of the Commons’ public accounts committee on the report, and a review of the whole national programme by the Cabinet Office’s Major Projects Authority.
The Mail and other papers report that, in line with changes already announced last year by health minister Simon Burns, the programme will be replaced with regional initiatives and trusts being given more control over their own IT.
In a formal press release, issued onto its website at 9.30am this morning, the DH indicates that the Major Projects Authority came to many of the same conclusions as its own review, which led to Burns' statement last summer.
It says: "The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archving and Communications Service.
And here:

DH and Intellect to stimulate market

22 September 2011   Lyn Whitfield
The Department of Health is to work with Intellect to stimulate the market for NHS IT, following this morning’s announcement that the national programme is to be “dismantled.”
A press release issued by the DH this morning says that a new partnership will “explore ways to stimulate a market place that will no longer exclude small and medium sized companies from participating in significant government healthcare IT projects.”
In response, Intellect issued a statement saying that it wanted the DH to focus on helping the market to deliver interoperable systems and to develop a "central focus on clinical information sharing in the NHS Information Strategy."
To support these moves, Intellect has published a paper - 'We should talk - interoperability and the NHS' - setting out a number of recommendations for helping the NHS to share clinical information more effectively.
The paper's principal authors, Paul Cooper and Martin Whittaker, said that  NHS Connecting for Health, suppliers and trusts should work together to improve the Interoperability Toolkit programme; which has just reached its second iteration.
They argued that for the benefits of ITK to be realised, the NHS will need to make it a central plank of its promised information and technology strategies.
They said it would also need to "evangelise" the benefits to business and clinical leaders, and to engage with suppliers so it becomes an "encouragement to succeed, not a barrier to entry." 
Lots more here:
There is also an editorial on the forward direction:

EHI Editorial

That the National Programme for IT in the NHS is to be dismantled makes a strong newspaper headline; but it leaves a host of problems for those who care about NHS IT and its role in the wider healthcare reforms. First off, much of this week's announcement is re-heated and so not as new as it looks.
Time was called on the programme last autumn, and on the surface very little appears to have changed since then. There's still a big mess with CSC in the North Midlands and East and no information strategy anywhere. However, in the corridors of Whitehall a revolution has been underway. The Cabinet Office has taken a firm grip on the CSC negotiations.
The National Programme Board is to be replaced by direct ministerial control. The Department of Health is to work with Intellect to 'revitalise' the market. If it is remotely serious, it should vigorously dismantle the monopolies created by NPfIT and take steps on certification and interoperability that would begin to reduce the barriers to market entry.
More than anything, though, the NHS needs to have some clear guidance on the future direction of its IT and what, if anything, is going to come from the remaining contracts. NPfIT may be over, again, but we will all have to live with its legacy and pay the bills for years to come.
Here is the Official Department of Health Medial Release:

Dismantling the NHS National Programme for IT

September 22, 2011
The government today announced an acceleration of the dismantling of the National Programme for IT, following the conclusions of a new review by the Cabinet Office’s Major Projects Authority (MPA). The programme was created in 2002 under the last government and the MPA has concluded that it is not fit to provide the modern IT services that the NHS needs.
In May 2011 the Prime Minister announced in the House of Commons that the MPA would be reviewing the NHS National Programme for IT. 
 The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archiving and Communications Service.  Their delivery accounts for around two thirds of the £6.4bn money spent so far and they will continue to provide vital support to the NHS. However, the review reported the National Programme for IT has not and cannot deliver to its original intent.
In a modernised NHS, which puts patients and clinicians in the driving seat for achieving health outcomes amongst the best in the world, it is no longer appropriate for a centralised authority to make decisions on behalf of local organisations.  We will continue to work with our existing suppliers to determine the best way to deliver the services upon which the NHS depends in a way which allows the local NHS to exercise choice while delivering best value for money.
A new partnership with Intellect, the Technology Trade Association, will explore ways to stimulate a marketplace that will no longer exclude small and medium sized companies from participating in significant government healthcare projects.
The Department of Health said:
“The exchange of information between patients and clinicians and across the NHS is a fundamental part of how we are centring care on patients and making sure innovation and choice are fully supported.  The NPfIT achieved much in terms of infrastructure and this will be maintained, along with national applications, such as the Summary Care Record and Electronic Prescriptions Service, which are crucial to improving patient safety and efficiency.  But we need to move on from a top down approach and instead provide information systems driven by local decision-making.  This is the only way to make sure we get value for money and that the modern NHS meets the needs of patients.”
Francis Maude, Minister for the Cabinet Office, said:
“This Government will not allow costly failure of major projects to continue. That’s why we have set up the Major Projects Authority – to work in collaboration with central Government Departments to help us get firmer control of our major projects, and ensure there is a more systematic approach by departments as well as regular, planned scrutiny to keep projects on track.”
“The National Programme for IT embodies the type of unpopular top-down programme that has been imposed on front-line NHS staff in the past. Following the Major Projects Authority review, we now need to move faster to push power to the NHS frontline and get the best value for taxpayers’ money.”
Other comments are also included in the release:
It is interesting that there also seems to be some major aspects still going ahead:

Cabinet Office review pleads stay of execution for NHS IT

The Major Projects Authority has urged the Department of Health to persist, at least for a while, with two key features of the National Programme for IT
A team from the Cabinet Office has recommended that the Department of Health (DH) gives more time to two elements of England's NHS National Programme for IT (NPfIT) dealing with the provision of key information systems.
The Major Projects Authority (MPA), set up last year to scrutinise expensive projects throughout central government, has said the Additional Supply Capability and Capacity (ASCC) should be retained for the south of England, and that CSC should be given more time to deliver the Lorenzo system from iSoft in the North, Midlands and East area for which it is local service provider.
The recommendations are within the MPA's assessment review of NPfIT, which has been made available on the Cabinet Office website.
One of three recommendations, that the programme should be dismembered and reconstituted under different management because of so many negative perceptions, was effectively accepted by the DH last week. But the other two recommend that elements of NPfIT's plans to provide electronic patient record systems – the most problematic part of its work – should be continued, although with reservations in regard to CSC and iSoft's work introducing Lorenzo software.
The second recommendation is that ASCC, which was set up to give healthcare trusts a more flexible procurement model, should be approved for use in the southern cluster despite the Cabinet Office recently refusing to do so. The review says the solutions available through the framework are tried and tested, and that preventing its use will slow down progress in the region.
More here:
Lastly from the UK we have:

NHS software provider CSC may get cash lifeline

• Cabinet Office proposes financial aid for IT contractor
• CSC's Lorenzo system 'not proved fit for purpose', says report
Ministers are considering offering one of the NHS's worst-performing IT contractors financial help to keep the company from ditching a troublesome software package which is "not fit for purpose", according to Cabinet Office documents.
The plan to offer the US group Computer Sciences Corporation (CSC) one last chance to fix the software risks a furious backlash over "payments for failure", in the latest twist to a fiasco that has generated years of delays at considerable cost to the health service.
The move comes despite the Department of Health last week declaring that the £11.4bn National Programme for IT, started in 2002 under Labour, was to be scrapped because it was "not fit to provide the modern IT services that the NHS needs".
However, the department has not severed existing contracts. Most controversially, it remains in a long-running feud with CSC over a £3bn agreement to install IT systems in the Midlands, north and east of England.
More here:
From the US here is the last comment I have spotted:
September 27, 2011, 7:40 am

Lessons From Britain’s Health Information Technology Fiasco

Government press releases tend to be bland, earnest blather. But not one posted on the British Department of Health’s Web site last Thursday. Its headline: “Dismantling the NHS National Programme for IT.”
To translate the acronyms a bit, the NHS is Britain’s state-run National Health Service and the program in question was the ambitious drive to computerize England’s health records and let doctors, clinics and hospitals share patient information electronically. The project, begun in 2002, was budgeted at £12 billion (about $19 billion) and the government hailed it as “the world’s biggest civil information technology program.”
The British digital health project has been a slow-motion train wreck for some time with last week’s announcement mainly confirmation — and a pledge to change course. (The announcement was also a political gesture, as the Conservative government of David Cameron tries to get as much distance as it can from an unpopular initiative, begun by Tony Blair’s Labor government.)
More here:
At the end of the day I believe this initiative will leave a considerable legacy and a vast array of lessons which will need years to really appreciate.
One feels it might just have been a little too big to pull off - and it will be years down the track before we know if the alternative approaches do ultimately deliver!
Time will tell.

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