Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, June 30, 2012

Weekly Overseas Health IT Links - 30th June, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Social media in health care create risks, benefits

Stephanie M. Lee
Updated 04:01 a.m., Thursday, June 21, 2012
 On Twitter, 10,000 people are listening to Jen Gunter. Sexual health, shoes and "The Hunger Games" are the subjects of just a few of the 36,500 tweets crafted by the obstetrician-gynecologist at Kaiser Permanente in San Francisco.
Gunter's social-media presence also includes a blog, which she uses to write about birth control and weight loss; a professional Facebook page; another Facebook account for friends; Instagram; and Tumblr.
Gunter has plenty to say and plenty of ways to say it, but when patients she's never met ask for medical advice online, she has just one thing to say: "No."

Beacons lead healthcare quality 'revolution'

By Kate Spies, Contributing Writer
Created 06/22/2012
"We are really at a tipping point here; providers and patients alike have come to realize that the modernization of healthcare is long overdue and that we all have a role in its broad adoption."
So said Jason Kunzman, project officer for the Office of the National Coordinator for Health Information Technology, as he moderated the "Beacon Communities: Leveraging Health IT to Fuel the Quality Revolution" education event at the recent HIMSS 2012 Virtual Conference and Expo. 

Pilots to Speed Access to Drug Histories

JUN 21, 2012 4:58pm ET
A new federally sponsored program will test giving providers quick access to prescription histories in ambulatory and emergency departments to combat prescription drug abuse.
The Office of the National Coordinator for Health Information Technology and Office of National Drug Control Policy have launched the initiative with tests in Indiana and Ohio. The goal is to better take advantage of the information in the databases of state prescription drug monitoring programs and other sources. The Substance Abuse and Mental Health Services Administration is funding the pilots.

ONC to pilot use of health IT in prescription drug monitoring

June 22, 2012 | By Ken Terry
The Office of the National Coordinator for Health IT (ONC) is launching a pair of pilots to test the effects of expanding state programs designed to prevent abuse of prescription drugs. The pilots in Indiana and Ohio will find out how health IT can help increase the effectiveness of prescription drug monitoring programs (PDMPs).
PDMPs are statewide electronic databases that providers can use to identify and intervene with prescription drug abusers. The databases collect, monitor and analyze electronically transmitted prescribing and drug dispensing data.

HIT Expert Contends That EHR Vendors are Curbing Innovation (Part 1)

June 15, 2012
One researcher explains his views of a major issue from the EHR vendor market
In a recent piece for the New England Journal of Medicine, two Boston Children’s Hospital informatics researchers, Kenneth Mandl, M.D. and Isaac Kohane, M.D., make the argument that EMR and EHR vendors are holding back innovation in the health IT industry. Many vendors, the duo insists, have failed to adopt basic Internet-era sources for their systems such as private cloud-based storage and secure communication protocols, as well as modern consumer technologies such as word processing and search engines.               
Mandl and Kohane say the lack of interoperability and standards with these systems have put the industry’s innovation in a standstill. Instead of constraining physicians, they suggest that more open systems with diverse functionality would drive improvements in patient engagement, care coordination, and overall create better care quality, which in turn would reduce costs.
In a two-part interview, HCI Associate Editor Gabriel Perna recently spoke with Mandl, who is the director of the Intelligent Health Laboratory at the Boston Children's Hospital Informatics Program as well as an associate professor at Harvard Medical School, about his somewhat controversial opinion, why he says EHR vendors are afraid of interoperability, and why they shouldn’t be. Below are excerpts from the first part of that interview.

E-health records adopted by more than 100K healthcare providers

About one-fifth of providers eligible for federal reimbursements now use some form of EHRs

June 19, 2012 01:54 PM ET
Computerworld - Electronic health records (EHR) are now being used by 110,000 healthcare providers and more than 2,400 hospitals, according to a report released today.
In all, there are about a half-million healthcare providers and just over 5,000 hospitals across the country that are eligible to receive reimbursements for EHR rollouts through the Medicare and Medicaid EHR Incentive Programs, according to the Office of the National Coordinator for Health Information Technology (ONC).

HL7 touts progress on quality reporting standards

June 20, 2012 | By Marla Durben Hirsch
Significant efforts are underway to develop an end-to-end approach to quality reporting from EHRs, according to Health Level 7 International (HL7), which hosted a webinar on the topic earlier this week.
"Standards are a prerequisite to functionality. When it comes to quality reporting, if you can't measure it, you can't improve it. If you can't standardize it, you can't measure it," Bob Dolin,  president and chief medical officer at Lantana Consulting Group, Past chair of vice chair of HL7 and co-chair of the HL7 Structured Documents Work Group, said during the online event.

MedPAC: EHRs alone won't improve patient care

June 20, 2012 | By Marla Durben Hirsch
Electronic health records have the potential to help providers in different settings better communicate about patients, but they won't improve patient care in a vacuum, warns the Medicare Payment Advisory Commission (MedPAC) in its latest report to Congress.
"[A] better information system by itself is unlikely to improve care unless the systems are interoperable, the providers involved establish protocols for how they will communicate key information to each other, and processes are in place to augment the information provided in the electronic medical record so that all pertinent information can be shared across providers," the report says.

EHR Vendors Comment on NwHIN Governance Model

JUN 21, 2012 12:02pm ET
The federal government needs to take a step back as it seeks to establish a governance model for the emerging nationwide health information network, according to the HIMSS Electronic Health Record Association.
The 41-vendor group recently sent a comment letter to the Office of the National Coordinator in response to a request for information published in May. The RFI sought comment in five categories, including a set of conditions for trusted exchange of data, or “rules of the road.”

BIDMC CIO Halamka: Compliance pressures keep me up at night

June 20, 2012 | By Ken Terry
John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, details how his team is analyzing security risks and deciding what to do about them in a recent post on his blog "Life as a Healthcare CIO."
In a previous post, Halamka said that "mounting regulatory and compliance pressures" are keeping him up at night. Unsurprisingly, a full third of the capital requests in his FY2013 budget were for security and compliance-related projects.

5 keys to evolving role of the CMIO

By Michelle McNickle, New Media Producer
Created 06/20/2012
As strategic initiatives across IT continue to grow, many are looking to the CIO as a leader. But according to Pamela Dixon, managing partner at SSi-Search, another prominent position is evolving to aid the CIO in the development of new projects. 
"To assist in meeting these challenges, we see the chief medical information officer (CMIO) taking a seat next to the CIO in meeting Meaningful Use objectives – and possibly beyond," she said. "The CMIO's role is not new to healthcare but is rapidly gaining importance.  How the role will evolve is raising some questions for the C-suite."

EHR Innovation Gap Threatens Healthcare Progress

EHRs remain stuck in the pre-Internet age and dominated by entrenched vendors, according to recent New England Journal of Medicine commentary.
Electronic health records suffer from a lack of innovation that thwarts physicians' attempts to advance healthcare processes and workflow. Unlike word-processing programs, search engines, social networks, and mobile phones and apps, EHRs are stuck in the pre-Internet world where EHR vendors not only control the data, but also resist improvements to functionality while reaping huge financial rewards, concludes a commentary that appears in the June 14 issue of the New England Journal of Medicine.
Penned by Kenneth Mandl and Isaac Kohane, both professors at Harvard Medical School, "Escaping the EHR Trap – The Future of Health IT", says EHR vendors insist that the healthcare industry is so unique that data collection, the sharing of health information, and many other tasks associated with healthcare workflow require a highly specialized set of tools. This myth, the authors say, has led to EHR vendors declaring that only they can develop health IT to meet the current demands of the healthcare system--a notion with which the authors sharply disagree. AdTech Ad

Congress Pushes HHS to Regulate HIT

JUN 19, 2012 3:48pm ET
Legislation soon to be voted on in Congress and expected to pass lays the framework for federal regulation of health information technologies.
The health I.T. language is part of a final version of the Prescription Drug User Fee Amendments Act of 2012, worked out in a House-Senate conference committee. Companies pay user fees, which in turn help pay for FDA regulatory programs.

Docs increasingly connecting through YouTube

June 20, 2012 | By Susan D. Hall - Contributing Writer
Although most medical videos on YouTube are aimed at patients, physicians also use the videos to present research papers or talks from professional meetings, according to an article in American Medical News. Doctors also use the site to help with personal branding, Michael Banks, M.D., president of The Doctors Channel, told the publication.
"I can tell you 29 percent of physicians do not post their own videos on YouTube," said Banks, who was referencing a figure reported in a report published earlier this year by healthcare recruitment firm AMN Healthcare. "But the ones that do make videos are helping to establish themselves as experts in a certain area."

ONC: Nearly 30 statewide HIEs using Direct Project

June 19, 2012 | By Ken Terry
Statewide health information exchange grantees in nearly 30 states are using the Direct Project clinical messaging protocol, and a dozen more are slated to inaugurate Direct this summer, according to a recent Health IT Buzz blog post.
According to ONC project officer Brett Andriesen, Direct is available to all hospitals and physicians in these states, although an accompanying map indicates that the protocol still is being piloted in five of the states.

13 tips for fighting mobile device threats

By Michelle McNickle, New Media Producer
Created 06/19/2012
As threat risks continue to grow for mobile devices in healthcare — think thumb drives, smartphones, tablets and laptops — the pressure to mitigate these risks is being put on the providers. The folks at ID Experts believe now is the time to assess your mobile strategy and take charge of PHI.
Here are 13 tips for fighting mobile device threats, as compiled by ID Experts and others.
1. Consider USB locks. These can be for your computer, laptop or any other device that may contain PHI or sensitive information, said Christina Thielst, vice president at Tower Consulting Group. A USB lock can help prevent unauthorized data transfer — whether uploads or downloads — through USB ports and thumb drives. "The device easily plugs ports for a low-cost solution and offers an additional layer of security when encryption or other software is installed," she said. "The locks can be removed for authorized USB port use."

CMS, ONC Tout Milestone EHR Adoption Rates, Incentive Payouts

June 19, 2012
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have announced that more than 100,000 healthcare providers are using electronic health records that meet federal standards and have benefitted from the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.
The goal of 100,000 healthcare providers to adopt or meaningfully use EHRs by the end of 2012 was given by CMS’ acting administrator Marilyn Tavenner and National Coordinator for Health Information Technology Farzad Mostashari, M.D., Sc.M., three months ago. Tavenner proposed the 100,000 provider goal in a blog in March with Dr. Mostashari that declared 2012 the “Year of Meaningful Use.”

New board will expand SCR

18 June 2012   Rebecca Todd
A new advisory body is being created to look at expanding the Summary Care Record to include non-GP information such as hospital data.
The Department of Health told eHealth Insider that it is recruiting a chair for a new group, the Summary Care Record Content and Advisory Board, which will look at including information from non-GP settings.
The creation of an advisory board was recommended in The Ministerial Review of the Summary Care Record, which reported in October 2010.

What did NPfIT ever do for GPs?

Many of the national projects developed by the National Programme for IT in the NHS relied on the buy-in and support of GPs. Rebecca Todd investigates their fate and their future.
19 June 2012
“Basically they haven’t achieved what they wanted to do and that’s great.” That is how Dr Paul Cundy sums up the impact of the National Programme for IT in the NHS on primary care.
The joint chairman of the BMA and RCGP's joint IT committee believes NPfIT has been a complete failure; but GPs are “absolutely overjoyed” about that.
“The original national programme completely ignored GPs,” he says. “That was initially because they thought they didn’t need to concentrate on GPs. But eventually that turned out to our advantage, in that we were largely left alone.”

In the summary time

The creation of Summary Care Records for 50m was the most high profile and contentious of the national projects set up by the National Programme for IT in the NHS. Patients were supposed to view and add to these records via the website organiser, HealthSpace. Rebecca Todd looks at the bumpy path of these data-sharing initiatives.
20 June 2012
‘Delivering 21st Century IT’ promised to build a “life-long health record service” that would give healthcare staff and patients access to “universally available, secure, accurate and up to date health records.”
The National Programme for IT in the NHS, which took forward the strategy, turned this commitment into the NHS Care Records Service.
On the one hand, it set up a national project to create a Summary Care Record – a central record of a patient’s health status that was intended to provide vital information for staff working in out-of-hours and A&E services, and for temporary residents.
On the other, it set up local service provider-led projects to deliver detailed care records systems to trusts and other healthcare organisations; with well-known results.

Researcher: Non-secure patient-doc emails OK if both sides accept risk

June 18, 2012 | By Ken Terry
A new Medscape Business of Medicine article about whether and how physicians should communicate with patients by e-mail is instructive, although most of the issues it discusses were thoroughly hashed out years ago. Curiously, the article doesn't bring up the one new element of e-mail communications--the widespread use of mobile devices.
Among the topics the article does address is whether e-mail messaging reduces physician productivity; the lack of reimbursement for non-office-visit encounters; potential liability risks; how e-mail access to providers can grow a practice; the impact of e-mailing on the physician-patient relationship; and privacy issues.

Guide: Share medical data across mobile platforms

June 19, 2012 | By Susan D. Hall - Contributing Writer
The interoperability group Integrating the Healthcare Enterprise (IHE) International has released a guide for simplifying mobile access to health documents for patients and providers.
The guide describes a simplified application programming interface, or API, to access health records through a patient portal, an electronic health record, a personal health record or a health information exchange.
It uses a REST, or representational state transfer, Web-based architectural framework and builds on metadata concepts found in earlier specifications from IHE and international standards group HL7, but simplifies them for web-enabled devices and applications.

Geisinger, Merck to collaborate on cloud-based medication adherence app

June 19, 2012 | By Susan D. Hall - Contributing Writer
Geisinger Health System and drug maker Merck will collaborate on a web-based application to improve medication adherance and identify risk factors for chronic disease, the organizations announced this week.
First up: an interactive Web application to help doctors assess and engage patients at risk for cardiovascular disease and Type 2 diabetes.

EHRs enhance epidemic tracking

June 19, 2012 | By Dan Bowman
Electronic health records are helping public health departments respond to health epidemics faster and with more efficiency, according to an article  published this week in the New York Times. From identifying tainted food sources to spotting disease trends, EHRs have brought real-time statistics to fights that, as recently as 10 years ago, were bogged down by having to sort through paper records.
For example, according to the Times, in February EHRs helped Michigan health officials to link a string of E. coli incidents across a few counties back to sprouts being served at a popular sandwich chain. The health officials ultimately were able to warn the public, ending the outbreak by April.
June 18, 2012

Fast Access to Records Helps Fight Epidemics

Public health departments around the country have long scrutinized data from local hospitals for indications that diseases like influenza, tuberculosis, AIDS, syphilis and asthma might be on the rise, and to monitor the health consequences of heat waves, frigid weather or other natural phenomena. In the years since 9/11, this scrutiny has come to include signs of possible bioterrorism.
When medical records were maintained mainly on paper, it could take weeks to find out that an infection was becoming more common or that tainted greens had appeared on grocery shelves. But the growing prevalence of electronic medical records has had an unexpected benefit: By combing through the data now received almost continuously from hospitals and other medical facilities, some health departments are spotting and combating outbreaks with unprecedented speed.

HIT Security Hinges on Mobile Device Management

Scott Mace, for HealthLeaders Media , June 19, 2012

One of the biggest technology trends hitting healthcare this year, mobile computing, poses one of the biggest security threats to healthcare that will last for many years to come.
Just last week, my first magazine feature story for HealthLeaders explored the surge in Bring-Your-Own-Device  behavior in healthcare. As I researched the story, I became aware of efforts to improve mobile security being led by the Healthcare Information and Management Systems Society.
James Brady, PhD, is chair of HIMSS's mobile security workgroup. Brady's day job is chief information security officer and director of technical services at Hawaii Health Systems Corporation in Honolulu. HHSC operates 1,275 licensed beds across five islands in the state of Hawaii, so Brady certainly has a vested interest in getting mobile security right.

Voice recognition software helps with MU, doc says

By Diana Manos, Senior Editor
Created 06/18/2012
SAN DIEGO – Voice recognition software has provided the means to lower transciption costs, speeding efficiency and populating data for achieving meaningful use, according to Richard Gwinn, MD, director of urgent care at Sharp Rees-Stealy Medical Group in San Diego.
Rees-Stealy Medical Group has 19 locations,400 physicians,1,700 staff members and is one of the largest, most comprehensive medical groups in San Diego County. The group offers primary and specialty care, laboratory, physical therapy, radiology, pharmacy and urgent care.

Health IT potential for patient behavior remains untapped

June 18, 2012 | By Dan Bowman
Although information technology certainly has the ability to change patient behaviors, a lot of untapped potential remains, according to researchers published last week in the Journal of Medical Internet Research. Such capabilities and risks, they concluded, "are not being fully explored." What's more, they said, interactions between different technology components have not been analyzed sufficiently.
The researchers combed through 41 relevant studies, examining the extent to which various technologies--such as wearable sensors and mobile phone apps--helped patients to stay fit and track calories. Overall, they determined the effect of technology on actual behavior to be mostly positive but said that more work should explicitly focus on the functions of active technologies, such as interactive education and self-monitoring.

Health IT a quantum leap from other industries

June 18, 2012 | By Ken Terry
Many physicians are dissatisfied with electronic health record systems, according to a recent survey of members of the professional networking site Sermo. Forty-four percent of respondents said EHRs are not designed with physicians in mind; 15 percent said they believe EHRs lower the quality of care; and 73 percent said EHRs are a distraction from the physician-patient relationship. Less than a third of respondents had a favorable opinion of EHRs, down from 39 percent in 2011.
That's a big drop. One possible explanation is that, because of the Meaningful Use incentive program, many physicians who don't like the technology are adopting it to obtain the government funds while they can. But the other findings suggest that EHRs are not well designed for physician workflow and that many doctors feel they're being forced to spend more time on the computer, leaving less time for interaction with patients.

First Aid Goes Mobile, With Red Cross App Launch

The Red Cross launched a first aid app for iOS and Android, which is the first in a series of preparedness apps the organization will roll out this year.
The app is primarily a resource for emergency situations. You can look up what to do if someone around you is bleeding, for example, and follow a list of steps to determine how best to manage the situation.

AHLA to Conduct Study on EHRs & Serious Safety Events

Thanks to a $45,000 contribution from the American Society of Healthcare Risk Management (ASHRM), the Public Interest Committee of the American Health Lawyers Association (AHLA) will conduct a research project that will address the new types of Serious Safety events and related malpractice liability that can result from the implementation of electronic health records (EHRs).
AHLA's year-long research project, reportedly the first of its kind, will produce tools that healthcare providers can use to minimize EHR-related medical errors, including a checklist that will help identify such errors and best practices guidelines to help minimize the occurrence of EHR-related errors in the first place. In addition, the researchers will craft a list of "dashboard indicators" for use by governing bodies in their quality oversight.
Monday, June 18, 2012

Report IDs 11 Promising Technologies To Tackle Chronic Disease

by Kate Ackerman, iHealthBeat Managing Editor
Nearly 50% of American adults have at least one chronic disease, and chronic disease care accounts for more than 75% of the country's total health care spending.
A new report from NEHI identifies 11 underused technologies that have the potential to lower costs associated with chronic disease, while also boosting health care access and quality.
The report, titled "Getting to Value: Eleven Chronic Disease Technologies To Watch," was developed with support from the California HealthCare Foundation. CHCF publishes iHealthBeat.


Friday, June 29, 2012

There Are Some Important Lessons Here About Health Information Sharing. We Ignore Them At Our Peril.

The following excellent article on the UK NHS’s Shared Care Record (SCR) appeared recently.

In the summary time

The creation of Summary Care Records for 50m was the most high profile and contentious of the national projects set up by the National Programme for IT in the NHS. Patients were supposed to view and add to these records via the website organiser, HealthSpace. Rebecca Todd looks at the bumpy path of these data-sharing initiatives.
20 June 2012
‘Delivering 21st Century IT’ promised to build a “life-long health record service” that would give healthcare staff and patients access to “universally available, secure, accurate and up to date health records.”
The National Programme for IT in the NHS, which took forward the strategy, turned this commitment into the NHS Care Records Service.
On the one hand, it set up a national project to create a Summary Care Record – a central record of a patient’s health status that was intended to provide vital information for staff working in out-of-hours and A&E services, and for temporary residents.
On the other, it set up local service provider-led projects to deliver detailed care records systems to trusts and other healthcare organisations; with well-known results.
Targets and rows
As with the other national projects to create e-booking and e-prescription services, NPfIT set a highly ambitious target for the roll out of the SCR. Every patient in England who wanted a record was to have one by the end of 2007.
By the time the first trial - at two GP practices in Bolton – went ahead in March 2007, new guidance was saying that full roll-out should be achieved by the end of 2008. The delay arose, in part, because the programme soon ran into an outcry over confidentiality and consent.
Privacy campaigners argued that the Summary Care Record was an extension of the ‘database state’, and that patients should opt-in to the programme, instead of having to opt-out and having a record created by default if they failed to do so.
Detractors also argued that patients did not fully understand what information was being uploaded, and that they system was wide open to abuse by anybody with an NHS smartcard.
The British Medical Association was concerned that information was not being kept up to date and its General Practitioners Committee called for the roll-out to be suspended until reviews of the content and consent process had taken place.
The review of the record’s content, led by NHS medical director Sir Bruce Keogh, concluded that the core record should only contain a patient’s demographic details, medications, allergies and adverse reactions, and that these should continue to be copied from the GP’s medical record.
A separate review concluded that an opt-out form should be included in patient information packs. Following these reviews, the coalition government gave the green-light for the project to proceed.
Other ways forward
Despite the slow progress of the SCR roll-out, the drive to share relevant patient information among appropriate health professionals is stronger than ever.
This is shown by the development of local shared record schemes in a number of areas including Cumbria and Hampshire.
Dr Paul Cundy, the chairman of the BMA and RCGP's joint IT committee believes that over the next ten years, the GP record will assume the role of the single electronic record.
“Increasingly people are looking to link up to or add to or extract from the GP record and that’s because it’s so far ahead of anything else that you could develop that it’s the natural place at which to start,” he explains.
“The concept of the GP record becoming the default single electronic record for the patient - that’s fine. We have for the last 60 years acted as the collator of the patient history and that will just bolster our position as the patient guardian.”
Dr Cundy also predicts that over the next decade, there will be a social media effect on health records, starting with lots of “app like applications” and integration of personal communication devices such as mobile phones and iPads into health care.
Emailing GPs, booking appointments and checking results on line will be “taking off in a big way,” he argues.
“Ten years ago when they first told us (GPs) what they were going to do to us (as part of the NPfIT). We were initially worried, then we realised it wasn’t going to happen and it was just a matter of time - of waiting - until it fell apart. And it fell apart.”
Lots more here:
It seems to me this article has a huge number of lessons for Australian policy makers and that the saga it covers needs to be much better known than it is.
The last paragraph I find particularly telling. I wonder, a decade from now, will GPs in Australia have had a similar experience - I suspect so.
The whole of the last section seems to me to reflect where we should be going and it is pretty sad we are heading down the present blind alley.
The whole article needs a very careful read.

Thursday, June 28, 2012

A Really Worthwhile Look Back At The UK NHS Program for Health IT. It Started A Decade Plus Story That Needs To Be Told!

The following pair of very useful articles appeared a little while ago.

Horrible history part one: here comes the 21st century

Ten years ago, the document that led to the creation of the National Programme for IT in the NHS was launched. Lyn Whitfield re-visits ‘Delivering 21st century IT’.
11 June 2012
It is June and the government has set out a ten-year “vision” for information in the NHS. As the result of a new strategy, the patients of the future will “see that their health records are always available to staff” and be able to “help to maintain the quality of those records” by getting access to them.
The time that healthcare staff spend with patients will be “spent more effectively” because of the information at their fingertips. Data will also be opened up to healthcare managers and researchers and to new services such as telemedicine, which will become “commonplace.”
Of course, it is not June 2012 and the strategy is not ‘The Power of Information: putting us all in control of the health and care information we need.’ Instead, it is June 2002, and the strategy is ‘Delivering 21st century IT support for the NHS:  national strategic programme.’
Ruthless standardisation
‘Delivering 21st century IT’ is the document that paved the way for the National Programme for IT in the NHS. Its big innovation was not its vision – which it shared with earlier NHS IT strategies, as well as later ones – but the mechanisms it put in place for delivering that vision.
As it said upfront in its opening paragraphs: “The core of our strategy is to take greater control over the specification, procurement, resource management, performance management and delivery of the information and IT agenda.
“We will improve the leadership and direction given to IT and combine it with national and local implementation based on ruthless standardisation.”
Specifically, a ministerial taskforce was to be established under the chairmanship of Lord Hunt, a former head of the NHS Confederation, who had been made a Labour peer after the 1997 general election and was health minister in the Lords.
A new NHS IT programme director was to be appointed to lead on what Lord Hunt himself described as “the IT challenge of the decade.”
Standards for data and data interchange and system specifications for a new, National Health Record Service were to be set at a national level. And there was to be a big shake-up of procurement arrangements, with “consortia of suppliers” bidding for the work.
Finally, strategic health authorities were to appoint chief information officers to make sure that primary care trusts and providers “implement and use the core IT solutions determined at a national level.”
A product of its time
‘Delivering 21st century IT’ did not come out of nowhere. In 1998, the NHS had published ‘Information for Health’, a well-received strategy written by NHS IT pioneer Frank Burns, that proposed a rather different set of delivery mechanisms.
An NHS Information Authority was set up to create a national IT infrastructure, to run electronic patient record ‘beacon’ projects, to set standards for increasingly sophisticated ‘levels’ of EPR functionality, and to measure progress against targets for deploying that functionality to hospitals.
However, it left trusts to procure their own systems to meet these targets. And by the start of 2002 it was obvious that they were going to be missed.
IfH’s failure was blamed on technical issues, on trusts spending money that was supposedly ring-fenced for IT on other pressures, including a fledgling reform programme, and on the sheer difficulty of procuring systems from a “cottage industry” of suppliers.
But while the strategy had faltered, the pressure on the NHS to make better use of IT had grown. IfH was launched against a background of Tory “cuts” in the health service and Labour promises to restrain growth during its first term in office.
The strategy itself was to be funded from a £5 billion modernisation fund that had other calls upon it.
Yet in January 2000, Prime Minister Tony Blair was bounced into promising a massive increase in NHS funding in response to media stories about the NHS failing to cope with winter pressures.
The Department of Health quickly insisted that more money would have to be accompanied by ‘reform’ and launched The NHS Plan.
This included some ideas for getting the NHS to adopt the kind of consumer-facing technology that had been adopted by other industries – such as ‘airline-style booking.’
Meanwhile, a furious Treasury had asked a former banker, Derek Wanless, to investigate the demands that the health service would need to make on it in the future.
At the start of 2002, Wanless (who died recently) reported that if spending was going to be kept under control, the population would need to become healthier and the NHS would need to become more efficient.
He saw a big uptick in IT adoption as part of the second half of the equation, and proposed that NHS spending on IT should rise to £2.7 billion a year over a three-year period to deliver big gains in productivity.
The final part of the jigsaw was that Downing Street was keen on NHS IT, thanks to a seminar at Downing Street at which Microsoft chief executive Bill Gates, in the UK to promote Windows XP, persuaded Blair and his advisors of replacing a local approach to NHS IT with a national one.
The rest of the beginning story is found here:

Horrible history part two: things fall apart

The National Programme for IT in the NHS got off to a flying start; but soon started to go off-track. Lyn Whitfield looks back.
13 June 2012
Lots omitted as the rush to disaster seemed to accelerate.
So good they abolished it twice
As the programme struggled, the Department of Health’s commitment to its approach declined. In 2006, in a neatly Orwellian touch, it announced a ‘national local ownership programme’ to give SHAs much more responsibility for shaping and delivering NHS IT requirements.
Then, after Richard Granger completed an extended “transition” out of his post in 2008, Matthew Swindells, the chief executive of Royal County Hospital NHS Trust and a ministerial advisor, was brought in to carry out a review.
This urged trusts to focus on creating a “tipping point” in demand for strategic IT systems, by focusing on what became known as the Clinical 5 - a patient administration system, order comms, discharge letters, scheduling and e-prescribing.
Christine Connelly, who succeeded Swindells as the NHS chief information officer, went further. She talked about recasting the national elements of the programme and creating an “app store” for the NHS (which became the interoperability toolkit).
She promised a new “connect all” approach, in which there would be more choice for trusts and “multiple systems in different places” as a result of that choice. And at the end of its term in government, Labour lopped £500m off the nominal cost of the programme.
Despite this, it remained an irresistible target for media pundits and politicians. In opposition, Prime Minister David Cameron the project the “NHS supercomputer”; in government, his health ministers abolished it not once but twice.
In September 2010, Simon Burns announced that £700m would be cut from NPfIT, that the oversight of national projects would move from CfH to “new arrangements” by 2012, and that trusts would be allowed to choose from “a more plural system of IT and other suppliers.”
A year later, following a scathing report from the National Audit Office, and an even more scathing investigation by the Commons’ health select committee into what the programme had delivered by way of health records and into what the NHS had paid for them, Burns did the same again.
The zombie NPfIT
Yet, as EHI editor Jon Hoeksma noted at the time, NPfIT continues to have a kind of zombie existence. After more than 18 months of drafting, ‘The Power of Information’ failed to explain what will happen to CfH, or will be responsible for infrastructure, standards and national projects in the future.
CSC has been locked in negotiations over a new LSP deal for the NME for 18 months. A deal that would have delivered what the government called “savings” of £1 billion on its £3 billion contract looked close this spring. But a ‘standstill agreement’ between CSC and the DH was recently extended to 31 August.
Trusts in the South that were not covered by the BT deal were promised a systems procurement using the Additional Supply Capability and Capacity framework. But this collapsed at the end of December 2011, after almost two years of effort.
These trusts have yet to hear whether an alternative way to deliver national support and funding will be found. But then, amazingly, the £700m of legal action triggered by Fujitsu’s departure has yet to be resolved.
And, of course, the vision of ‘Delivering 21st century IT’ has not been delivered. The patient experience of the NHS has not been transformed by technology, health staff continue to lack universal access to sophisticated health records, data for commissioning and research remains hard to gather and analyse.
‘The Power of Information’ did not make the mistake that ‘Delivering 21st century IT’ made of drawing up a national plan to try and impose its vision on local NHS organisations.
On the other hand, it said virtually nothing about how its remarkably similar ten year vision for NHS IT would be achieved. So the question may be: will no plan succeed where the ‘national strategic programme’ didn’t get results?
Full article here:
This really makes just riveting reading as you see 10 years pass over just a few minutes.
The strategic instability, the lack of clinician engagement and so on are all there and most worrying is the length of time the programme has persisted after so many attempts to kill it off and maybe start again.
The parallels to what is presently happening in Australia are all too obvious.
All in all - compulsory reading.