The House of Commons Health Select Committee has just published a Report on the Electronic Patient Record. This concludes that the NHS National Programme for IT (NPfIT), the 20-billion-pound project to rip out all the computers in the NHS and replace them with systems that store data in central server farms rather than in the surgery or hospital, is failing to meet its stated core objective – of providing clinically rich, interoperable detailed care records. What’s more, privacy’s at serious risk. Here is comment from e-Health Insider.
For the last few years I’ve been using the London Ambulance Service disaster as the standard teaching example of how things go wrong in big software projects. It looks like I will have to refresh my notes for the Software Engineering course next month!
I’ve been warning about the safety and privacy risks of the Department of Health’s repeated attempts to centralise healthcare IT since 1995. Here is an analysis of patient privacy I wrote earlier this year, and here are my older writings on the security of clinical information systems. It doesn’t give me any great pleasure to be proved right, though.
Here is a piece in Computer Weekly about why the three Conservative members of the Committee refused to sign the report.
The No2ID NHS Blog has pointers to a lot of specialist coverage of the report, including Pulse (see also here), the BMA, and epolitix.
Ross,
As you say “It doesn’t give me any great pleasure to be proved right, though.”.
However in the past you talked mainly about system / implimentation issues that (in theory) do have solutions provided the appropriate resources are brought to bear on the issues.
What you have not directly addressed is why these Government Initiatives happen and will continue to happen for a considerable period of time to come (and also will probably all fail as well).
My somewhat jaundiced view is that it is as a direct result of “representaional democracy” and the way it is carried out.
That is we do not have a demcoracy where we vote on “issues” but we select a person to represent us (the so called “Monkey in a suit”). Unfortunatly the “representatives” have set up a system whereby they have little liability and the ability to use other peoples money as they see fit.
The side effect of this is that to get “into power” and to stay there requires a considerable amount of financial resources. As has been pointed out quite a lot in recent times both the main political parties have significant funding issues (Tony Blair when being interviewed by Jeramy Paxman made the imortal comment “we will take money from anybody”).
What is not so commanly known is that the laws governing donations are at best very minimal. That is direct donations above a certain value have to be open to public view. To avoid this some little fiddles where tried that came to light as the “Loans Scandle”.
However there is also another little fiddle that has not yet met the light of the public gaze which is subsidisation / sponsorship. If you go to the party conferences you will see stands / stalls / events / education programs that are paid for by high tech organisations that are bidding on such things as the Nationa ID scheam etc. The money these organisations spend as it does not go directly into party funds is effectivly invisable under the current rules. In effect it is an “off book” payment to the party as it significantly benifits them, and I think it is fairly safe to assume that the organisations are not spending this money for altruistic reasons. It might well be instructive to analyse the level of sponsorship against the level of contracts obtained etc. 😉 There are many many other little fiddles like this.
One thing all these Government Initiatives (currently) appear to have in common is that they are “long term” and involve “technology”. The other thing is that they also appear to have no real founding in reality.
My jundiced view is that it does not matter what the initiative is or if it is ever likley to succede, in fact it is probaly better if it fails. All that realy matters is that it can be used to raise “off book” money that can be used to support the current party in power.
If my view is even partialy correct then we can expect to see more and more of these “domed to fail” initiatives.
The downside of course is that as a process it is very very inefficient but that does not matter as it is not their money they are spending on these initiatives but yours and mine.
There is also the issue of why senior civil servents award contracts in the way they do and then go off to join the winning bidder within just a few months contry to the rules but then that is a discussion for another day.
i think the main problem is when the government tries to secure anything. the government basically takes the word of a software developer that their system is 99.999% safe etc. lets all hope they do this one right.