The following has just appeared in the UK from e-Health Insider.
SCR may have London roll out
09 Nov 2009
The head of the London Programme for IT has admitted that the ‘one size fits all’ approach to deploying Cerner Millennium was a “mistake”.
Speaking at E-Health Insider Live ’09, Kevin Jarrold said a “significantly different” approach was being taken at Kingston Hospital and St George’s Hospital NHS trusts, which are due to go live “this month” and “in the weeks after that” respectively.
“We have learned that one size fits all, big bang is not the solution,” he said. “We have moved to an incremental approach that lets us tailor the solution to fit particular requirements and a modular approach to deployment.”
Speaking alongside Jarrold, Don Trigg, managing director of Cerner UK, contended that the 60 products that fitted within the Millennium architecture were well fitted to this approach.
He said customers internationally had often taken one product for one department and then rolled it out more widely. He said Cerner had 17 NHS trusts using one or more Millennium product, and that it had 29,000 unique users across those 17 organisations.
More here:
http://www.e-health-insider.com/news/5374/scr_may_have_london_roll_out
The third paragraph is the vital one:
“We have learned that one size fits all, big bang is not the solution,” he said. “We have moved to an incremental approach that lets us tailor the solution to fit particular requirements and a modular approach to deployment.”
“Nota bene” is all that needs to be said. I would note I have been saying virtually forever that this sort of top-down solution delivery is a recipe for failure!
David.
10 comments:
All I can say to that is this:
1. the bureaucrats have been told time and time and time again that a smaller, more regional based approach is the only way to go. They would not listen.
and
2. we've been conned, we've been conned, we've been conned by fast talking, razz-a-matazz salespeople who don't give a stuff about anything to do with hospitals other than milking the honeypot for all its worth.
3. And as for non-performance you can bet the only penalty vendors like Cerner will have to deal with is the pain of asking for another humoungous ordert to fix the problem on the smell of another bucketload of promises.
Time for a vomit.
Interesting you say Victoria and NSW should read this very closely. Sad thing is those two states have already bolted themselves to a central deployment model with excruciatingly slow progress (NSW) or non-existent results (VIC).
The states that really need to look closely are WA (who've just made decisions to roll out a single state-wide PAS), SA (who seem to be in the process of making that decision, at least according to the briefings they're giving) and QLD (who are on the verge of tenders for a statewide EMR and PAS)
Hi.
You are right. Sloppy thinking on my part. The lesson needs to be noted country wide.
David.
All,
See updated title!
David.
"We have learned that one size fits all, big bang is not the solution"
I am not impressed. This "lesson" cost 12.7bn pounds.
They could have learned it for free on the web ... or spent USD $50 for a book such as "Organizational Aspects of Health Informatics: Managing Technological Change" by Lorenzi & Riley, 1st ed. 1994.
Or hired one person in a leadership role who actually knew what they were doing and had no conflicts of interest and no taste for Kool Aid.
It just shows what can happen when a highly complex, publicly funded, under resourced system, like the health system, which operate under enormous funding constraints sees a way of economizing to make the dollar (pound) go further whilst satisfying the political conviction that one large ubiquitous generalized system will be seen as prudent gaining support from the economic rationalists. The IT hardware vendors love it - rationalisation of many sites into fewer bigger sites means new sales, big dollars, and when all that fails a recycling of the market once again into more modest sites and many more machines passing through the sales pipe.
I suspect an element of yet more spin in this story. They talk about a modular approach, selecting from 60 modules that fit within the Cerner Millenium architecture - but the whole point is that this is still a wholly proprietary Cerner architecture, with every module provided by Cerner.
That's not a modular approach - it's just a staged implementation of what is still a single monolithic system. Not to single out Cerner, ISoft and others have exactly the same approach - paying lipservice to interoperability and open architecture, while perpetuating their closed lock-in approach : "You can integrate any module, as long as we sell it to you"
As long as these big vendors get away with their proprietary modules not being interoperable with other modules from other vendors, it makes very little difference.
Does anyone remember the project done by the Divisions of GP some years back in Australia, specifying a modular functional architecture for a primary care solution. It was very high quality work, but sadly never proceeded to implementation as the bureaucrats couldn't understand the advantage of truly modular primary care technology. Instead, we ended up with a perpetuation of the proprietary lockin that companies like HCN maintain.
"You can integrate any module, as long as we sell it to you"
Try making iSoft's iPM and iPharmacy talk to each other.
This is an interesting thread. But I wonder how realistic some of these aspirations are? Here we are, 2009, still struggling to get high level standards for interoperability going internationally (not even nationally), with the simple aim that at the least, disparate systems can send messages to each other, or hopefully share records.
To now ask for 'modules' to directly interoperate is to ask for a much more comprehensive agreement on service interoperability and architecture. There was a recent meeting at Harvard to explore how we might get to service 'substitutabilty' in e-health, but I understand it was a very bleeding edge discussion with no great technical clarity yet emerging. All very 'feasible' technically I'm sure.
So, what is the time-scale for such a shift, the business case for vendors to radically re-engineer their architectures etc etc? Yes, its where we want to get to, but what road do we need to travel to get there?
I do think its fair to beat up vendors for not being standards compliant, but to expect deeper system interaction, in advance of clarity on architecture and service interaction standards, as I read here, might just be a little way off?? Or have I missed something?
No, anonymous, you haven't missed anything, except to note that the vendors are in business to make money, and the easiest way to achieve this it to make their systems proprietary as far as possible.
What is needed, as you rightly note, is the development of standards for (amongst other things)interoperability. This could then result in the positive marketing by vendors of software that is compliant to standards and able to be advertised as such.
This does not preclude vendors from including functionality which is additional to the standard as a selling point for their particular product.
Failing this, standards will continue to be set de facto by commercial vendors in advance (in Australia, well in advance) of any Government "initiatives". Secure messaging and ePrescribing are cases in point.
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