Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
The Sunday Times

The Sunday Times

April 16, 2006

Anatomy of a £15bn gamble

The new NHS computer system could be the biggest IT disaster in history, warn experts. Jonathan Ungoed-Thomas and Lois Rogers investigate

Inside a leading hospital in Oxford, expensive new computers were humming away just before Christmas when disaster struck. The Nuffield Orthopaedic Centre was at the forefront of a multi-billion-pound revolution to modernise the entire computer system of the National Health Service — and the screens had suddenly frozen.

 

Medical staff looked on in disbelief as they tried to retrieve lost records. “We had only been running the system for a couple of days when it went down,” said one manager. “You would try to get a patient’s records which you knew were there and it just locked you out.”

Although the system was functioning again the next day, some patient files seemed to have disappeared completely. The trust was so alarmed that it sent a report to the National Patient Safety Agency, warning that it had posed a potential risk to patients.

The collapse of the system and further failures led to cancelled operations and a backlog of outpatient appointments. Bob Cullen, 57, a postman who had been referred for treatment by his GP last year, found himself in limbo.

“I was in agony and was on painkillers, as well as taking liquid morphine,” he said. “I was phoning up the Nuffield in so much pain that I hadn’t slept for days and they said ‘We can’t find you on the system’. This was meant to be a hospital with the latest computer systems for patient care and I somehow got lost.”

All new computer systems suffer from “bugs” and the Nuffield’s trust says the problems were merely “glitches”. But to critics of the NHS’s expensive new computer project, Connecting for Health (CfH), the incident was a portent of further trouble.

So concerned are experts that last week 23 senior academics in computer-related science called for a independent review of the project. They fear that the entire scheme is misconceived, overpriced and a waste of billions of pounds.

Last week NHS trusts were facing an estimated deficit of £800m. Staff are being laid off across the country; wards are being closed; patients are being denied potentially life-saving drugs. Yet at the same time the NHS is spending a fortune on a computer system that, critics say, is needlessly expensive.

Even CfH admitted this weekend that the cost of the scheme, now not due to be completed until 2010, could reach £15 billion. Outside experts suggest that £30 billion is more realistic.

It is the largest civilian computer project in the world, designed to transform the NHS into a beacon of electronic wizardry. But could it instead become the mother of all IT disasters while the country’s hospitals remain desperate for cash?

FOR more than 20 years it has been clear that the NHS needed to modernise its information systems to improve patient care and cut delays. The question has always been: how? The initial suggestion under Labour was pragmatic. After a series of reports between 1998 and 2002, advisers recommended an “off-the-shelf” solution which would upgrade and link existing NHS computer systems and buy readily available software.

However, on February 18, 2002 Tony Blair, a self- confessed computer illiterate, chaired a meeting at Downing Street on the NHS and information technology. Alan Milburn, then health secretary, and his officials outlined a bold new plan to link up GPs, hospitals and patients on a much grander scale.

It envisaged a new NHS computer system designed from the top down to hold the records of 50m patients on one huge database. The prime minister was impressed. One of the main advantages, he was told, was the instant access that the scheme offered to patients’ records. A complete medical history could be pulled up on a screen at the touch of a button — from anywhere in the country.

Patients would be able to book appointments with GPs on their home computer and once in the surgery would choose their preferred hospital for an operation.

Hospital staff would have instant access to electronic records of any accident victim and x-rays would be electronically transferred from one end of the country to the other.

The scheme’s ambition and potential cost were staggering. Yet Blair gave it the go-ahead without public consultation. The government initially allocated £2.3 billion for the project and boldly proclaimed that electronic records for every patient in the country would be online by the end of last year. The costs and the delays have been mounting ever since.

It is an example, say critics, of how the management consultants contracted to deliver such systems are only too happy to think big since it makes more lucrative work for themselves.

The man tasked with running the CfH project is Richard Granger, a Bristol University graduate and management consultant. A driven, abrasive character, he bought a Porsche as soon as he started earning “serious money”, lives in a large country house in Cumbria and was appointed on a salary of £250,000, making him one of the country’s highest-paid civil servants.

Few dispute the need to make improvements — but critics say that a centralised system will require vast computing power, raises questions of security and will be a nightmare if it goes wrong.

“In the system they are building, errors can get spread and copied across the network and nobody can do anything about it,” said Ross Anderson, professor of security engineering at Cambridge University and one of the 23 academics calling for an independent review of the project. “What they are proposing is a recipe for chaos and disaster.”

Helen Wilkinson-Makey, a 40-year-old manager from High Wycombe, Buckinghamshire, says that her experiences highlight the pitfalls. She discovered that an inputting error had led to her being wrongly logged as having received treatment at an alcohol dependency unit in 1998. The computerised record had been distributed to her strategic health authority, primary care trust and a local “shared care agency”.

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“I only found out about it by chance and I was incredibly angry,” she said. Numerous attempts to correct the records have proved futile — and she fears that patient confidentiality is compromised.

“The only way you can stop data being given out to third parties is by opting out of NHS care altogether, and that is what I have done, but they still have not destroyed the record,” she said. “I find it very worrying indeed and I think people should know about this.”

Doctors have similar concerns — and if they refuse to put patient records on the database it will undermine the whole purpose of the system. Many doctors are also doubtful about the “choose and book” system for making hospital appointments, complaining that it is unreliable.

Other aspects are more successful: doctors enthuse about transferring x-rays on computer, for example, because it saves sending film by courier.

But the point, say critics, is that such improvements could have been made much more cheaply and simply.

“The system just isn’t necessary and will cost millions to fix each time it goes wrong,” said David Craig, author of Plundering the Public Sector, a new book on the cost of using computer consultants. “They should have stuck with local databases which could be linked together and searched using internet technology in the way Google does.”

A National Audit Office report on the project is due to be published later this year but it will not consider whether what has been proposed will work. Instead, it will evaluate the delivery to date.

Tony Collins, executive editor of the specialist journal Computer Weekly, said: “The government has a sad history of IT projects going badly wrong. It should now conduct an independent audit or face the risk of a complete disaster.”

STUNG by the criticism, the often secretive CfH is mounting a charm offensive. Granger has invited academics who criticised the project to a meeting on Thursday and last week Gordon Hextall, his chief operating officer, robustly defended the project.

“This will not only improve care, it will save lives. It will mean that if you fall ill or you are involved in an accident, the people who are treating you will be able to check your medical history immediately,” Hextall said.

“We will be the first country in the world to have a national system of patient records. Other countries have introduced similar systems, but only for different regions of the country.”

The NHS plan will mean that all patient records in England will be kept at one site with a back-up computer system at another location.

However, even CfH recognises the risk of having so many eggs in one basket: the sites are being kept secret because they are potential terrorist targets.

As regards patient confidentiality, CfH says that only authorised medical staff will be able to access records.

Doctors remain sceptical. “Security is by far the biggest stumbling block,” said Mike Brown, a general practitioner in Cheadle, Staffordshire, who used an example from the unnecessary panic over MMR — and when and whether people had had the jab — to illustrate the point.

“Only when Tony Blair agrees to put his son Leo’s medical record on the system will we know there is total confidence in it,” he said.

Politicians are wary of questioning investment in the NHS. But as hospitals grapple with deficits in staffing and beds, the soaring cost of IT is coming under scrutiny.

“They have taken all the classic mistakes ever made in previous IT failures and rolled them into one huge project,” said Richard Bacon, South Norfolk’s Conservative MP, who sits on the Commons public accounts committee.

“It has been driven from the centre, they haven’t consulted properly and the operations of the NHS will depend on one massive database. It’s a classic definition of how to end up with a failed IT project. “It’s not even clear who’s paying for all of this. It could cost between £15 billion and £30 billion to implement the project, so where is the money going to come from?

“We need to wait for the conclusion of the [Audit Office] and any independent audit. But we shouldn’t rule out any options — and that includes canning the entire project.”

WE HAVE A PROBLEM: YOUR GUIDE TO COMPUTER SPEAK

Politicians never admit to wasting money on useless IT projects. So below we translate the jargon (all from official statements about computer initiatives)

We will seek to accelerate the pace of development as available resources permit

— It’s going to take years and go way over budget

The costs to date are for computer infrastructure and software. There will be other costs for implementatiion

— You don’t get much for £6 billion. We’re going to need a heap more money if this thing’s ever going to fly

Our suppliers have been unable to maintain full availability without interruption during integration of multiple systems

— The software’s useless and we haven’t enough terminals

Technical issues preclude reliable figures on compliance and throughput

— This monster is so out of control we no longer have any idea what’s going on