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back to article MPs slam 'unworkable' one-size-fits-all NHS care records' system

The Department of Health has failed in its attempt to properly integrate electronic care records across the NHS system, MPs concluded in a scathing Public Accounts Committee report published this morning. Politicos said that Andrew Lansley's department should seriously consider ditching the £7bn implementation of the care …

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FAIL

What have they spent it on?

I'd really like to know what it is that the uk taxpayer has bought with all this money, as from what I can tell it's just gone straight onto the balance sheets of the companies involved, with nothing of any worth having been delivered.

I'd also like to be able to say that the findings of the report are a complete surprise, but it's been inevitable since the outset.

Who should we be asking about a refund?

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WTF?

350% mark up

What a rip off, put them all in the stocks and pelt them with pies until they rip off the contract and give money back!

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Meh

Waste...

..Of a perfectly good pie!

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Crazy.

Will .gov ever learn to link reward (payment) to *successful*, on time and within-budget delivery?!?

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Anonymous Coward

Re: Crazy

It is linked and as such CSC havent been paid for a lot of the work they've done.

The trouble is in the impending court case should the Gov't tell them to take a hike.

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Yeah, I get that.

Part that's missing is where non-delivery (even in part) means a free exit. When these contracts are signed everyone's an optimist. When it fails the contrator is rich and the tax payer is poor.

But |I get your point.

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Anonymous Coward

Re: just Re:

I think there also penalty clauses... (perhaps) though no one has the cajones to use them.

I seem to remember EDS saying they would pay the penalty clauses on some DWP stuff, on the condition that they were given more govt contracts.

Its crazy that at the low level you have to go through a procurement process to buy a pencil, whilst at the top of the tree its all done on the golf course.

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not that hard

It could have been done so much more simply and for a lot less money.

All they needed to do was set a standard protocol for the structure, storage and transmission of patient records and then let the hospitals, GPs and patients choose the system which best suited them. The protocol gets a review every year to make sure it covers everything then. Each surgery, hospital, health centre can buy tech kit from Currys or DABS or wherever and you create a cottage industry of small businesses and developers to write the software.

You can still send an anonymyised copy of every transaction/record to the central database so they can have their stats analysis and Bob's your uncle.

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Anonymous Coward

To be fair...

That's the situation at the moment.

There is a central NHS spine, which operates on set standards and any client can connect to it. The most used is a program called EMIS LV, a DOS program written by a doctor back in the day.

80+ out of ~95 GP practices in my county were using it. The others were on a later version of EMIS, with a couple of Isoft Synergy users and a handful of System One users. System One was only used by anybody because the local trust was being paid by CFH to bribe (or incentive, depending on your POV) practices to use it. Those System One practices caused >50% of support calls, by my recollection.

The main problem is that the NHS is not one organisation like most people assume. It's primarily a billing organisation. Your GP (and pharmacy) is a for profit local business, which gets paid a set amount per patient by your local NHS trust.

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@ToBeFair

> That's the situation at the moment.

Agreed, and we also have problems with SystmOne. The local PCT is only funding upgrades if you change to SystmOne; about 50% now. The thing I really miss is a way to talk to half-a-dozen different surgery systems - that's what needs to be standardised.

I really miss some way to talk to real IT people who know what's going on, rather than BT or, even worse, the PCT. Any forums out there? There must be literally hundreds of people like me who have no idea what's going on and no way to find out.

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Stop

This is not a title

Your local PCT cannot deny you an upgrade to any clinical system under GPSoC. SystmOne will only talk to SystmOne. EMISWeb, InPS Vision, Adastra are all interoperable (and there are others, the names of which escape me now).

Try joing the EMIS National User Group mailing list; although a group focussed on EMIS it is a great source of knowledge, from the end user perspective, of primary care IT.

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Anonymous Coward

Excuse the ACishness.

Heh.

The only real player you missed is Isoft's Synergy imo. The others might as well not exist for the number of users they have.

Remember the Practice is a business. They can't be forced to do *anything* by the PCT with respects to IT, but what the PCT can do is offer to provide/pay for upgrades for the practice. My PCT was doing this, with very limited success. The practice managers in my county were actually quite good at IT, when all of their knowledge was combined. (which happened once a month at some meeting IIRC) and quite sensibly didn't fancy the PCT having control of all of their IT infrastructure.

You should have seen the lengths we went to trying to debug SystmOne at one site who's practice manager diligently reported every single problem. I'd list everything I had techs do, but i'd prefer to remain very firmly anon in case I end up working back with the NHS again. :/

Suffice to say that I was more comprehensive than anybody was used to, and I didn't just close the incidents or problem because it was to hard to deal with. I can't prove it beyond all doubt, but i'm pretty sure I know what all of the SystmOne problems were caused by.

What problem are you having, if you don't mind me asking? I suspect I know the problem, but I don't want to put words into your mouth.

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@ACishness

The problem was just that the PCT was trying to push us to SystmOne - no specific technical problem. Two of my local practices are on it - one of them was down for a *month* when they lost everything during the move. I don't know anything about it, though I have a general uneasiness about everything being off-site.

We've had a lot of FUD about upgrades. There was a stage last year when the PCT said they'd only fund SystmOne, but they eventually went quiet about this. Just got one practice trying to move to Synergy, and the PCT hasn't complained yet...

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Anonymous Coward

A title is required...

Ah. In which case I shall just say that i'm not personally aware of any SystmOne user that's happy with the installation, and leave it like that. Problems appear to get far worse with more users.

I would consider the move very, very carefully before getting stuck with it and talk to other SystmOne practices about their experience first. Those are best identified through the county practice managers club, not through references given by SystmOne or the local PCT, IMO.

Assuming you want real world experiences similar to the ones your likely to receive, rather than the only happy users in the county/country. If there are any. I assume that there must be one somewhere, it's not impossible. Merely highly improbable.

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One size fits all?

I don't see the one size fits all manilla-envelope-stuffed-with-bits-of-paper being criticised as fatally flawed. It's not the idea it the implementation that doesn't work. The rest of the IT world moved out of monolithic projects in the 1960's.

It is the MPs in built desire to retain their own power bases that is at fault. They cannot cede even the slightest control to anyone so sign huge contracts to single suppliers that they think they can control. They all like to get their signature on the contract so each succeeding committee member makes a little suggestion. The same suppliers get all the contacts so keep all the experience (even of abject failure) and then quote relevant experience as the reason to get the next project.

This kind of project would be ideal to put out to University IT departments to do the R and D. Small building blocks spread around different institutions. Even if the project fails we might get some IT graduates with relative experience and these graduates could possibly found new companies that could end the current hegemony.

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Envelopes?

My wife's records at our local hospital already span two bulging folders (from just two pregnancies and fairly serious broken arm between them).

So whilst "an envelope" isn't enough - clearly the basic concept scales fairly easily. The only issue is if she trips over near another hospital...

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Electronic records

The health system is nothing to write home about and I'm not sure how linked up it is but the Australian system seems ok with regards electronic records. Perhaps it wouldn't hurt to see where they went right and what mistakes were made.

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"It is the MPs in built desire to retain their own power bases that is at fault."

"It is the MPs in built desire to retain their own power bases that is at fault."

Hurrah! The first instance of authoritism I've noticed since I coined the word: http://english.stackexchange.com/questions/34437/what-is-a-word-for-experts-self-serving-practice/35362#35362

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FAIL

Boggling

Once again we're seeing Govt projects that have cost an absolute fortune fail horribly.

It would appear that the people given overall control for the management of these projects are ill-equipped to deal with the challenges of the project and are relying on the BS given to them by the vendors. Spec's are poor and there's no clear overview of what the project needs to achieve.

Add to that an apparent lack of negotiating for bulk pricing of equipment (common on large projects) and it all goes pear-shaped very quickly. And we (you and me) are paying for it all.

Why is no common sense applied where a qualified and experienced person is appointed to ensure that these projects meet sensible deadlines at sensible prices? I only work on relatively small projects but I know that I'd be kicked out on my ass if my projects ended up like these Govt ones do.

Ferr chrissake - Govt, get a grip and do things properly. You are spending MY hard-earned money and I want it spent properly.

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Anonymous Coward

Ha ha ha.

These people are highly qualified, with lots of experience. (of messing projects up) In fact, the entire organisation is setup this way. Nothing but the best educated, most qualified people.

My observation however, is that a sizeable amount of the work in most workplaces is actually done by people who didn't go to uni, get any qualifications and just have stackloads of experience getting the job done. You need a few people like that involved, not that it would ever actually happen though.

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Erm

You mean arse, not ass. Unless you use a donkey to hold your P45.

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FAIL

Oh...

and odds area about 1:1 that some mealy-mouthed politician will tell us that "lessons have been learned" from this debacle.

All I can say is that all these politicians are getting the most expensive education on the planet.

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I can hear the oinks of disappointment

....as the feeding trough is taken away.

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feeding trough.

Does the trough ever actually get taken away?

£2.7bn has been spent of which £1.8bn has already gone to BT and Computer Sciences Corporation. If the projects is ditched, I imagine that this, then relinquishes companies from their obligations of which they were going to fail at. Lucky for them!

To salvage the mess a new feeding trough will have to be prepared. Wouldn't surprise me if the same pigs turn up again for their share.

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Stop

opt out while you can

"We are very concerned at the lack of evidence of risk management of security issues which may arise as a result of medical records being held electronically."

I've opted out, have you?

I opted out my children, too, and had to do it twice as their ECS (Emergency Care Summary - Scottish NHS) *still* ended up on the spine when the GP practice changed from GPASS to Vision and they forgot to reapply the opt-outs (WTF?!).

Should .gov be allowed to requisition *any* IT systems? Seriously, though.

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I'm having a failure of imagination

Why should I opt out?

What are the potential dangers?

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WTF?

RIP

Ahhh ... GPASS - now there was a thing...

RIP

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Flame

here's a damn title for ya!

How about no undetaking for them to keep your records private, ie allow their use by anyone who can dream up a vague reason to access them?

Local government, the police, insurance companies...

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it's not a daft question

The ECS has a minimal amount of information in it and it can only be accessed with the patient's consent (unless they are unable to give it, obviously). So where's the fire?

Once your ECS has been accessed it cannot be deleted, only archived, for medico-legal reasons, so you can never go back. If you opted out at the start you would be okay but you wouldn't have that right later on.

If these records leak out, and lets just look at all the data-fails that occur around here, all of your prescriptions are public knowledge. It depends on whether or not The Sun on Sunday rates you as news, of course, maybe it's just your employer who has a quick shufti.

I believe the vast majority of El Reg readers would have been against the last government's ID card proposals. They would have recognised that the cards were not the real problem, it was the database behind it. Here is another database and this time it knows even more than just where you live.

I have a responsibility to keep my family free from this unwarranted intrusion. Am I endangering them by *not* providing an ECS? My wife, who co-signed the opt-out with me, is a GP. Her judgement was the records are not useful anyway.

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Thanks, Bogle.

Still think I wouldn't bother opting out - chance that I'd want a paramedic to know what medicine I had been prescribed seems at least as great as the chance that I'd give a monkey's about world plus dog knowing the same.

Anyone know how secure medical records are currently? If I was NotW, how hard would it be for me to get hold of any given celeb's notes?

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if you were NotW

If you were NotW level you'd just exploit a daft weakness in so many brand devices where the default logins are well known but that doesn't apply here.

Personally I'd siddle up to a sys admin or senior dev with some access and get a copy that way. Shouldn't be hard. Unlikely there'd be any record of them making the database dump. Maybe a backup tape "wore out", eh?

The number of complete databases I've had over the years beggars belief. Complete marketing databases for insurance firms; the 60m prescription forms annually in the Scottish NHS; even the 35m of you who've ever booked a holiday cottage in the UK. Even if there is encryption the dev who wrote it knows where the keys are.

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Joke

accountability?

Shouldn't those responsible be held to account?

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FAIL

At last!

So they've woken up and smelled the coffee then?

Trouble is the coffee's not only cold but also the stuff growing on the surface is probably smarter than they are by now.....

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Meh

Will 'they' learn?

Professionals and amateurs have been telling the PTB with increasing annoyance and despair since the beginning of the project that it was not needed as stated and would not work for the budget proposed. They have been shown to be correct, in spades.

There is having a vision and having a delusion. In this case the it was a delusion and the taxpayer - you and me - is left with the bill for a pile of shite. No, don't try and defend it! In total it is expensive, un-necessary, over complicated, badly delivered shite! Good in parts, I grant you, but a grand and grotesque failure at the taxpayers cost. It represents a completely unjustifiable opportunity cost to industry and UK PLC.

But, will our politicians and civil servants learn anything from it and let it happen again....

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Facepalm

Shocking stuff...

A giant monolithic system became too unwieldy and complicated to work? Amazing. That's never happened before...

It should've been done via defining a standard framework for transfer of information between systems (kinda like the CTF file in education, but obviously better as that sucks too, and a bit life SIF but with better security).

That way the government can have their precious competition, the market would have innovation as the different developers compete with each other, no-one would be tied to a single system as they'd all be compatible with each other, and there wouldn't be one giant database for some hacker to attack.

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WTF?

No opt out clause in contracts these days?

Are all government contracts lacking any kind of cancellation or close down clauses? As a client facing project manager, I have always had these clauses to protect both parties from these situations (i.e. in the event of a total screw up, grab your coat!).

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FAIL

More to the point:

Penalty clauses.

How can there NOT be penalty clauses for failing to deliver a working system on-time?

I bet that, even if the systems were to be delivered, there's not a nitpicky, snagging maintenance-type period where the companies have to fix all the stuff that doesn't actually work because they never were able to test it properly on real systems.

That'll be an extra, you just watch.

Just who writes these contracts?

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Private sector strikes again

This is what happens when you hand over everything to a bunch of outsiders who are only interested in fleecing you of your money.

People on both sides of this should be facing trial.

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WTF?

What?

'Joined-up care records across the NHS in England were "unworkable", said Hodge.'

Query. Translate. Send.

I'm all for trying to get IT uniformity across the NHS and have every hospital with the same IT systems (they're supposed to be doing the same job after all), but given the history that has meant hospitals have procured independently it would have been better just to grab a few forward-thinking hospitals and proving new systems at those rather than trying to force everybody to move at the same time.

As another Regtard (no offence) wrote above, if you define the public (well, NHS) interface it matters little what the internal systems do. Standard for interfaces and data should be sufficient to make individual systems move closer to each other over time.

Unfortunately politicians love their Big Projects.

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FAIL

Sue!!!

Stuff the contracts, signed my complete labour socialist morons.

Drag the IT vendors in front of parliament or the courts, and force them to hand over penalties 50% of money they took, or make them fix it at their own costs. Stuff the contracts, they have failed to supply what we've paid for.

There no reason that such a large project shouldn't be attempted. Local NHS authorities don't need computer systems based on their needs, with a common protocol that links everyone together. NHS is in the business of fixing people whether it be stubbed toe, organ replacement or the occasional boob job. How can they possible all operate differently when it comes to cataloguing patient records??

My guess, is there were too many Chiefs and not enough Indians. Not to mention a bottom line to shareholders to rip off the UK tax payer for a tidy dividend at the end of the year.

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Anonymous Coward

Never Happen

This will never happen because the vendors have too much proof of where the civil servants increased costs, changed scope, did not follow procedure, forced illogical and sometimes down right stupid decisions on the vendors etc etc - It would be an own goal to take that approach..

Anonymous for obvious reasons.

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Why fix an existing system, when you can build a new one

Standard policy of government projects.

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"standard protocol for ... patient records "

"standard protocol for the structure, storage and transmission of patient records "

You mean like what HL7 and associated (ISO) standards appear to do?

I have no idea whether they are in this picture at all but it does sound in principle like they should have been.

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It is a completely unsurprising fail

The politicians decided from the beginning that it had to be a massive project requiring huge amounts of resources that could only be provided by companies like CSC and BT. CSC and BT were of course happy to oblige with project plans of epic proportions. As numerous posters have already pointed out, the best solution would have been one based on standardised protocols for information exchange, however that would have been way too cheap and simple for CSC, BT or the politicians.

We're all very lucky that the Internet was allowed to develop for so long without politicians taking an interest.

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Meh

Common standards

"As numerous posters have already pointed out, the best solution would have been one based on standardised protocols for information exchange"

That is exactly what is happening now, I'm working on a project which will use it. It's called, unimaginatively, the Interoperability Toolkit (ITK). It should have been done from the start, but at least we're more on the right lines now - hopefully

To the poster above who mentioned HL7, yes I believe it was invovled at some earlier stage, but it definitely is now, HL7v3 and CDA are top of the agenda within the ITK framework.

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@CommonStandards

ITK? Never heard of it, just Googled, looks good.

- have you talked to any real potential users?

- Spine mini service looks good

- Access back into surgery systems? It's not immediately obvious that you're covering this

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Went to the same schools. . .

Particularly enjoyed this passage: "The DoH . . . recently admitted to the committee that ending the contract with CSC could be more expensive than allowing the company to complete the project."

I guess your DoH administrators went to the same schools and took the same courses in administration as your Ministry Of Defense officials.

Nice.

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but otherwise correct

`Defence my dear boy defence

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thank you!

Correction noted, thank you!

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Just like to point out

That there is a national system that consolidates millions of complex data and media records from hundreds of different and disparate bodies with multiple IT systems from many vendors and makes them available to all the other bodies in a common format. it was built by an IT company, and it's well liked by its users, around 200,000, eventually. It didn't cost anything like as much as NHS.

Why didn't it fail, well mainly because the NHS showed them how not to do it, and the project wasn't initiated by an ego who vowed to screw the IT companies into the ground.

Oh, and the users got a say in the contract preparation and requirements.

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