Hospital staff use paper to wipe up NHS IT mess An internal report on the introduction of patient care records at the Royal Free Hampstead reveals serious problems with the project, and no current date for solving them. Hampstead was one of the first hospitals to switch on the new system, which is being rolled out across the country. But the Lessons Learnt from the Royal …
The NHS project is a classic government project gone wrong. No clear requirements and after all this time still no accountability or decent results. TB's master plan was simply 'spend money on NHS IT' with no clear business drivers.
Cancel the whole thing and instead of foisting a crappy unwanted system on hospitals, set up data exchange standards instead, decentralise IT purchasing and let the market provide the systems that hospitals really need, with capabilities to exchange patient records only where necessary.
The real IT needs of the NHS could have been satisfied for a fraction of this ridiculous amount of money and it is time to recognise it for the failure it truly is. See Private Eye's NHS IT reform write-up (came out some time in the last 12 monhs) for all you ever need to know about this crock.
As they should be expected to.
Shit, if they hadn't done that this would probably be a story about yet another fucked up IT contract that the NHS had bought into. Were they expecting to just have the whole trust's network down while they waited for a 48-hour call-out technician?
Surely there's room within an organisation the size of the NHS for them to have their own dedicated IT department, as opposed to relying on outside private companies? They must also have the clout to insist, whenever they buy software, on full Source Code and modification rights. Then they would be able to minimise the disruption associated with computerisation by modifying the software they use to match their existing workflows, as opposed to modifying their workflows to match the demands of the software..
Or would that be too much like joined-up thinking?
Point of fact: outsourcing IT development & maintenance has been repeatedly proven to be a snare and a delusion. It doesn't work. Never has, never will.
With a low-turnover, permanent, in-house IT staff, after a while they start to understand the core business and you start to get some mighty fine results. If, that is, IT management is on the ball too.
Sadly, the mantra of outsourcing is like one of the living dead, impossible to kill now that it's escaped from its coffin.
I blame, in part, the "MBA mindset" which views workers as utterly fungible regardless of intelligence, talent, education, experience, or anything else. Why else is customer disservice outsourced to Bangalore, where English is not a mother tongue and many of the accents quite difficult to understand.
How to be mean: next time you call customer service anywhere, ask "Is English your first language?" If the answer is no, ask to be connected to someone with English as their mother tongue on the grounds "I'm terribly sorry, but I have an extremely difficult time understanding accented English." If you punctuate the dialogue with "what's that you say?" and "please slow down and enunciate more clearly", this sham becomes almost believable.
I managed to shove a network under the whole of UK Government a good 12 years ago. It worked so well that AFAIK it has been working seamlessly since, right up to now. How did that get established?
Well:
1 - get everyone with a brain around the table and let them have their say. The clever thing to do is to skim just under the level where it gets political and idiots start dictating things they hear from their friends. This is where you will get your real needs from rather than the bells & whistles politicians want. Some of that is well meant, but you must explain to them that there is a time and place for that.
2 - LEAD, but from knowledge. Consensus is cute but never 100% achievable, and you're better off building a base that supports a wide but controlled set of standards than a "one size fits all" which will never work. If it's your project, you take the decisions. If you can't, tell whoever overrides you to stick the project where the sun doesn't shine and walk. I'm serious here - if it's not your decision you don't want to take the hit when it does what most IT projects have done over the last few years.
3 - OK, for the 1000th time: KEEP IT SIMPLE, STUPID. Stick with variables you can control and establish a foundation and a framework before you get fancy. Here's a start: do all practices and entities have an internet connection? Can they be part of a more enclosed network? Are your standards truly open so you don't end up sponsoring a supplier because your integration gets otherwise screwed?
4 - Stop trying to build mega databases. No, I'm not kidding. Think about the Net. Some bits we can all get to, some parts we can only visit after invitation or by being a member. Maybe there is a better way to get and store information. That would also avoid the "all eggs in one basket issue" all these projects are plagued with.
5 - organise a weekly chat with your gov sponsors. They need to know what is going on, but should not try to influence what works by itself, just support it from the sidelines. Keep them up to date and you'll help each other.
Now *bloody* get on with it.
Whipps Cross currently has at least one building full of administrators unable to do anything, no network, cant print etc due to a furry rodent chewing a cable. Everyone went home yesterday and expects to today as well, maybe the next few days. This as they work on an urgent project with an imminent deadline. Me, I'd run a cable from the next building and improvise with some switches, but that would probably violate the assigned contractors "rights".
If a *clinical* system - that is, one which carries active patient records, "goes down" overnight - or any other time - people will die.
I don't know where or what the problem was: this *is* an old US system adapted - somewhat - for the NHS - which is very different from the US with different requirements which have been changed at a bewildering speed since NPfIT was established and a previously free market nationalised - and sold off to the lowest bidder without - I agree - adequate specification.
(does anyone think the OBS was anything other than a vague wishlist?).
IDX was evicted.
I saw Cerner at a Usability session before the contracts were awarded: as it did not (at that time: I haven't seen it since and don't think they *have* a GP module) support Coding in their GP module I was not impressed...
99.9% uptime is not acceptable for life support: what happened to the requirement for backup sites taking over seamlessly?
Hm. Will Patient Choice give us information on the IT used by different hospitals and the performance ratings of those systems?
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