The Tory Party, meeting for its annual conference in Manchester this week, has rejected claims that it is set to cancel most of the National Programme for IT - the massive technology project aimed at improving the NHS. A survey by doctors.net.uk found a third of doctors and IT professionals believe the project should be scrapped …
Old thinking: One IT system for the NHS; New thinking: One IT standard for the NHS
There are so many flaws with the government's NHS IT project it should be canned without delay. Really, it's not as bad as you think, it's MUCH worse. The problem stems largely from the same old reason that sees nearly all government IT projects go tits up - get one massive, largely incompetent vendor in to do some badly-defined work in a structure that doesn't permit correction.
Instead, individual PCTs and secondary healthcare units should have total freedom to purchase or implement the systems that suit them - centralisation should focus on standards and APIs not on a massive single point of failure.
Oi scamps, get on msn, I need to talk to you about Stu [-]
'Patient records are expected to be widely available by 2015'
For sale on eBay.
It'll probably be a few years before they're available to health practitioners with less than 100% feedback.
So a survey carried out by an organisation that styles itself "by doctors, for doctors" takes a self-selecting sample amounting to around 0.1% of the NHS workforce size, with (it seems) no other health professional input apart from ... you guessed it ... doctors, and then extrapolates the results to cover the whole NHS.
Oh dear. Once again we perpetuate the myth that doctors are the NHS, and that nurses, physiotherapists, occutational therapists, midwives, dentists, optometrists, pharmacists, ambulance staff and the rest of the 90% or more of the NHS that are not doctors really don't matter. Oddly enough, these latter groups are the disadvantaged ones, who have been trying for years to get enough IT to work joined-up, while GPs have had money for their practice IT systems thrown at them by drug companies and PCTs. I would hesitate to suggest that GPs are not interested in NHS IT because they already have what they need and don't care about the rest of us, but ...
I have a bad feeling about this
"...Patient records are now expected to be widely available by 2015,..."
Yes, on every train seat, rubbish skip, dumped PC hard drive and lost memory stick in the country.
This still going on?
This Specialized Healthcare I.T. (ShIT for short) still going on?
The REAL Reason They Won't Scrap It?
It is making FAR too much money for certain people, who are friends with certain other people. (How much of that 12 billion is going on hardware? Or on the salaries of the people actually doing the work?)
So how much has througput increased after all this tech is in?
That's meant to be what this is all about?
Treating more patients with the same staff levels with fewer complications.
Only if there has not been a *significant* change in this level it would have appeared to be a waste of time and money.
Just a thought.
Listening to others
If the Tories are listening to the opinions and ideas of patients, doctors and others to come up with a plan, then they might be onto something. It would be nice to have a government who had established their policies by listening to what people wanted and then formulating policies based on popular opinion - I think the ancient Greeks had a word for this: "Democracy"
113.333 ... % ?
"A survey by doctors.net.uk found a third of doctors and IT professionals believe the project should be scrapped because of massive costs and limited impact on patient care.
But eight out of ten believe it should be reformed"
So 33 % of those surveyed thought it should be scrapped, and 80% thought it should be reformed ?
Those can't both be true, link to the source ?
Something wrong here
Just how hard is it to create a database to hold 60 million records?
@AC on Standards
This is spot on. We don't need to care how data is stored or processed, we just need to have a standard for what data is stored and for how that data is made available for other systems/providers. A set of standards and interchange formats would facilitate diverse solutions and a more balanced market while avoiding the creation of monolithic centralised systems.
@John Smith 19
"So how much has througput increased after all this tech is in?"
I had an MRI head scan at the Royal Free in Hampstead then a follow up appointment with the consultant at the Throat Nose & Ear in Kings Cross. The system was working so well that the consultant was locked out of the system and couldn't access my scan results and records.
To the best of my knowledge the Royal Free group are one of the early adopters of the system.
Draw your own conclusions. ;)
Yes, that would work! If only there some kind of markup language that we could use to describe the data ? It would need to extensible ...
Truly amazing that they've spent so much time and money and missed that out, innit ? I can only assume that Syd's comment is broadly correct, and that the whole project exists solely to drain taxpayers wonga into private contractors pockets, or that the entire management structure of the project is utterly fucking incompetent. Or both. Not neither though.
@The Other Steve
You might want to take a look at this http://www.hl7.org.uk/
@ AC on Standards
Are you suggesting some kind of open standard that any supplier could sell a product for on the open market? And how would that allow a single vendor with mates in the government to keep the NHS over a barrel with an expensive, locked-down, proprietary system?
Can we have a brown envelope icon?
Payment on completion..
The contract with the vendors is supposed to be payment on completion. However, due to the fact that this is so drawn out, interim payments have been made (huge money).
Fujitsu pulled out, and are now suing the NHS after the failed contract renegotiation (FJ were talking some truly staggering costs, which the NHS just weren't willing to pay; I think these were actually accurate figures as to what doing things properly would be).
A lot of this boils down to a few people seeing the Cerner product in place, highly configured to support one site, and making the decision that this would be bought for everywhere. Things kinda went downhill from there.. Much of the blame for which I think sits at the feet of Richard Granger (he who headed up the NHS IT wing, Connecting for Health after failing his computer studies degree, and having his mother petition Princess Anne to lean on Bristol Uni to allow him to retake his finals; he graduated with a 2:2 in Geology!).
So, the design was flawed from the start (mix of terrible specification, almost non-existent user requirements gathering, lack of planning and a host of other initial screwups). Now the NHS is left with a huge liability and a system that doesn't work properly, and with the vendors now getting a proper feel for how much it'll cost to implement correctly, they want to charge the proper fees. Which the NHS can't afford and won't pay.
Maybe someone has the brains to turn this around, but it's looking shaky.
I'm inclined to agree with this particular AC. Do the doctors surveyed have Ph. Ds in computer science? Is there some reason why their opinion is more important than anyone else who works for the NHS, or the patients for that matter?
I second the call for a brown (funny name that) paper envelope icon. There's way too much casual corruption in our system these days. I don't think there is a lot of overt corruption, but the 'we have always done it this way' gradual creep of institutionalized corruption.
Like MP's expenses as a classic example.
The Payroll Vote (look it up).
Our political system is corrupt top to bottom but it just doesn't realise it. Intellectually and morally corrupt, not so much direct bribery.
"Just how hard is it to create a database to hold 60 million records?"
Yes, thats the easy part. Getting the access controls right is rather more tricky.....and subject to competing and mutually exclusive requirements...
Managed by morons
It's no wonder there's problems with delivery, the government department overseeing the project is run by overpaid morons.
They questioned if we had the right people on a conference call once, "surely there must be someone who knows more" they said. This was with the people who wrote all of the software, who else is going to know more?
Much of the technology choice has been made due to partners on the project, nothing to do with what is the right tool for the job. We've had architecture dictated to us only for another rival to come on-board and be allowed to run on whatever they like. This after a year or so of porting to another database vendor (who's software doesn't work too well).
"Doctors.net's survey found 86 per cent of IT pros and 76 per cent of doctors could see the problem with this plan."
Presumably the rest are fucking morons. Let Google and Microsoft hold our medical records? And they'll do it for free? Damn right they'd do it for free, when you consider you'll be handing over a database system worth millions of pounds. You couldn't wish for more personal information as a direct marketer.
Not many people object to telling their doctor's admin assistant where they live and how to contact not only them, but their relatives too, as much as they would.. say.. a cold caller working for a direct marketing company.
Oh those records will be private? Which PARTS? I absolutely fucking guarantee not the income, credit rating, name, address, telephone number and whatever other information that businesses normally pay huge amounts of money gathering.
I used to work for direct marketing and all I can say is if you give this information to either of the largest and morally bankrupt corporations in the world, you've handed one of them a monopoly of immense value. They will have better and more reliable information than ANY business that sells marketing databases to those lovely people that fill up your letter box with all that glossy paper.
Oh 86% of IT professionals see a problem arising from this do they? I must be the only one that finds it interesting they've accidentally discovered that 14% of IT professionals are FUCKING MORONS.
I don't expect your average doctor to understand the value of this information and it's inevitable misuses, but anyone that claims to be an IT professional should see this immediately, or they can't claim to be both within IT and a professional. A professional moron that answers helpdesk calls all day perhaps, but not a professional that understands anything about databases and their potential for abuse.
The whole medical records thing neatly side steps any Data Protection Act tom foolery, and in a country run by Tories, with wet dreams private health insurance, you can be sure such a database system will be nicely packed with all kinds of interesting financial information.
You might like to think medical database and therefore illegal to sell, but I guarantee that any information that isn't legally shareable will be stored in conveniently separate databases, suitably linked but easily filtered from the salable package.
Think what you mean by NHS IT ..
I'm a GP with an interest in medical records and health informatics - see EHI!
As with most large IT projects involving an organisation as diverse as the NHS, some parts of NPfIT have been a success - including N3, PACS, PDS, the Registration Authority & smartcards/RBAC - and so are completely ignored!
The big problem - as always - lies with hospital systems and medical records.
Just looking at the requirements for an electronic patient record (EPR) in a hospital setting.
Technical - must be incorruptible, either intentionally or accidentally: must be available 24/364 (patients in ITU can't afford downtime for maintenance..): must be structured so that information is presented in comprehensible form to different specialities: must have access controls so that only people who have authority to see them have access - but also must not conceal information that would make a difference to safe treatment of the patient.
Presumably a hospital EPR is a SSEPR (Single Shared Electronic Patient Record) with all the problems of information governance outlined in the RCGP Shared Record Professional Guidance (SRPG) report.
Of course, if we ever get Lorenzo Regional Care and hospital, community and GPs have a single record between them, problems will increase - unless information and clinical governance of the SSEPR is sorted - which I, for one, doubt is possible.
*And we'll be doing it all in SNOMED-CT*
Should be interesting - if it ever happens..
"It's no wonder there's problems with delivery, the government department overseeing the project is run by overpaid morons."
Can you name a government department that /isn't/ run by overpaid morons?
most records are written by doctors: GPs
so yes, we may know something about it on that basis.
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