Health Information Technology: Whistling by the Graveyard

February 3, 2012
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The United Kingdom invested almost $20 billion in an ambitious Health Information Technology (HIT) initiative that has now been scrapped. But in the United States, the people working on our $20 billion program are confident that our investment will not be wasted. If I were getting a big piece of that $20 billion, I too would “express confidence” that the money I am getting will not be wasted. Nope. Not a chance. No waste here. Never happen.

The United Kingdom invested almost $20 billion in an ambitious Health Information Technology (HIT) initiative that has now been scrapped. But in the United States, the people working on our $20 billion program are confident that our investment will not be wasted. If I were getting a big piece of that $20 billion, I too would “express confidence” that the money I am getting will not be wasted. Nope. Not a chance. No waste here. Never happen.

An article in The Independent reports:

The nine-year-old NHS computer project – the biggest civilian IT scheme ever attempted – has been in disarray since it missed its first deadlines in 2007. The project has been beset by changing specifications, technical challenges and clashes with suppliers, which has left it years behind schedule and way over cost.

Accenture, the largest contractor involved, walked out on contracts worth £2bn in 2006, writing off hundreds of millions of pounds in the process. Months earlier, the US supplier IDX, contracted to provide software in and around London, had also withdrawn from the project, making a $450m (£275m) provision against future losses from the two contracts.

It adds that another American vendor, Computer Sciences Corporation, failed to deliver the bulk of the systems it was contracted to provide, but –

The department told MPs it may be more expensive to terminate the contract than see it through, while another provider, BT, “has also proved unable to deliver against its original contract”.

Another publication, ZDNet, reports

The NHS IT programme has already had £6.4 billion ($9.8 billion) spent on the new centralised service. Originally, £12.7 billion ($19.6 billion) was budgeted for the project, but was later revised down by £1.3 billion ($2 billion).

But after a long-running series of delays and over-spending issues, it was branded “unworkable” by a group of members of parliament last month.

Instead of pumping more money into the already struggling IT programme, it was decided by Cabinet members and other ministers to instead scrap the service and start again.

Now it would seem the UK had many advantages over the U.S. in implementing such a system. At 62 million, its population is one-fifth of ours, it is geographically compact, all of its providers are actually employed by the National Health Service, and there was only one payer involved. So it was willing to spend five times per capita as much as we are and the users of the system could be fired for not cooperating with the roll-out, and still it failed.

But the IT people in the U.S. are undeterred, at least according to the trade publication Information Week. It writes –

Perhaps the United Kingdom should have taken the U.S. approach to health IT. Seems like the Brits might be thinking that, too.

The failure of the United Kingdom’s troubled, $20 billion-plus National Health Service National Programme for IT, launched in 2002 and officially declared dead last month, serves several lessons for the United States as it rolls out its own $27 billion health IT program.

It argues that everything is just nifty in the good ol’ USofA because –

…the U.S. approach of making health IT use voluntary–even while healthcare organizations are being encouraged to do so with financial incentives from the government–helps get buy-in from clinicians.

Let’s see here. Yes, the American government is not actually providing the equipment, but it is dictating “standards,” mandating “meaningful use” of the systems, and requiring U.S. providers to pay for a good portion of the hardware and software.

The article goes on to argue that this is all good because by having to pay for some of the systems, American provides will want to use them, and –

The U.S. also has gone out of its way to get input from healthcare stakeholders–including hospitals, doctors, patient groups, payers, technologists, and others. In fact, the entire HITECH Act rulemaking process for Meaningful Use stages 1, 2, and 3 has taken so long in large part because the U.S. government has been bending over backwards in asking stakeholders for input, through standards and policy workgroups, and also by asking the public for feedback, before finalizing the requirements of the incentive programs.  

So, Dr. Jones will be comforted because lobbyists from the AMA helped to dictate the standards he must comply with and pay for out of his own pocket. What could possibly go wrong?