Sunday, March 22, 2009

shooting bits off the zombies

There should be a special term for the phase in the adoption of an idea between the point at which everyone accepts its desirability, and the point at which it wins over other ideas politically. This isn't the same as the point of implementation; it's quite possible for your idea to go into practice, but still to be in the queue elsewhere. So here we are; from E-Health Insider, it looks like the NHS NPfIT is looking at throwing away the disastrous Cerner and iSoft systems and issuing new tenders. In fact, some trusts in the South East have been permitted to sort their own problems out.

However, David Nicholson (the very model of a modern managerialist) is in charge and he for some reason won't let all the other trusts do this. Even though it is clearly sensible, and is being done, it's still in the special gap of political unacceptability. I thought this was interesting:
Nicholson said a key problem that the NPfIT programme had faced throughout was the unique requirements of the NHS and what it is trying to achieve. “There is no system off the shelf we could go for.”
Yet the programme was set up so that the NHS IT community, to say nothing of the NHS clinicians, and even less of the patients, had absolutely no input to it. Both Cerner and iSoft are trying to adapt off-the-shelf products from the US. And the attempts to save by outsourcing were disastrous.
“The Lorenzo product is being developed at Morecambe Bay, so we’re really optimistic that something will come out of that, but its not inevitable,” he went on. “And I think we’ll know over the next few months whether these products will actually be able to deliver the things they promised to do.”

That might have been an idea before you bought them, eh. Further, note that he thinks Lorenzo still might get somewhere because of in-house development work...
The other issue he said that was being focused on is how to deliver products more quickly and to give trusts more flexibility. Answering questions on the Summary Care Record, the NHS boss said it was possible to de-couple the Summary Care Record from the wider CRS development and simplify it.
This is damning to the entire project. If the record formats can be standardised without the rest of the system, there is no reason for "the system" as sold to Tony Blair to exist. Every trust could have its own system as long as they used the standard.

Remember, the only way to kill a zombie is to aim for the head. By the way, it's not as if the Americans don't have Bad Medical IT as well.

1 comment:

Julian said...

"Yet the programme was set up so that the NHS IT community, to say nothing of the NHS clinicians, and even less of the patients, had absolutely no input to it."

Whilst there are many problems with the NPfIT, actually what you describe here is not really one of them. A great many clinicians & patients have been consulted for many aspects of NPfIT. However, there are an estimate 3/4 million clinicians in the NHS and around 70 million potential patients! So it is rather easy to find someone that hasn't been consulted & hard to find someone who has.

Furthermore, with so many people and so many organisations involved (several hundred hospitals, 10k GP & 10k dentist surgeries, pharmacies, etc.) - there is no "one size fits all".

The vast number of organisations and people that need to be consulted to design and deliver a monolithic application like Lorenzo Regional Care for example makes it infeasible to deliver it in any kind of a timescale that is useful. Before the consultancy & design periods are over the NHS has moved on - this happens in all modern organisations not just the NHS. It is why large scale IT implementations fail so often, have a look at the track record of SAP implementations for example.

So there are plenty of problems with the NPfIT programme (and plenty of successes too actually) that you could highlight but this particular statement isn't quite on the ball.

Please bear in mind that NPfIT is a large programme of work and isn't just about the more controversial bits of it - some parts like Choose and Book, Patient Demographics and the authorisation and authentication parts have been working very well for some years now.

As I've said though, there is plenty more to pick at!

Julian Knight,

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