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British newspapers and technology blogs were abuzz this past month, with news that England's long, problem-plagued and expensive experience with top-down, nationwide health system digitization would soon be drawing to a close.
On Sept. 22, the Department of Health announced "an acceleration of the dismantling" of the National Programme for IT (NPfIT), an initiative of the National Health Service (NHS). Launched back in 2002 by Tony Blair's Labour government, the massive £11 billion project was billed as the biggest civilian technology undertaking in the world - audacious in its plans to outfit hospitals and health trusts across the country with electronic patient records and link them into an interoperable NHS-wide framework.
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Some £6.4 billion has already been spent on NPfIT, but nearly a decade of doctor resistance, delays and cost overruns have finally led policymakers to cut bait, having concluded that the project is untenable - unfit to provide "the modern IT services that the NHS needs," according to a press release from the Department of Health.
One overarching problem, as choruses of observers have made clear over the years, is that the government's prescriptive approach, by which it entered into massive contracts with vendors for one-size-fits-all nationwide IT implementations, paid little heed to feedback from physicians.
"Labour's IT programme let down the NHS and wasted taxpayers' money by imposing a top-down IT system on the local NHS, which didn't fit their needs," said Andrew Lansley, the UK's secretary of state for health.
So what now? A new approach: scrapping the components of NPfIT that didn't work and salvaging the infrastructure that still does. But how exactly that will be accomplished is still up in the air.
An NHS official, speaking on background, said details on how the "dismantling" of NPfIT would proceed - along with some specific direction for providing informatics support for NHS hospitals and clinics - will be forthcoming later this autumn.
In the mean time, NPfIT's governing board has been disbanded, and a move is being made toward a much more decentralized approach, which will see various health trusts nationwide able to make their own choices about what systems to implement - systems that can then linked together after the fact.
"We will be moving to an innovative new system driven by local decision-making," said Lansley. "This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernized NHS."
Key to achieving that goal is "the development of a vibrant marketplace for healthcare IT," added Katie Davis, managing director for informatics at the Department of Health. "We have a great opportunity to build a new way of working which helps patients and clinicians gain the best value for public money."
Toward that end, the Department of Health has enlisted Intellect, a London-based technology trade group, to help it look for ways to bring more small- and medium-sized IT firms into the fold for various NHS projects going forward.
To be sure, NPfIT's track record with vendors over the past 9 years has been less than ideal. Suppliers have signed onto the project and subsequently signed off. Others have been slow to deliver the technology they promised, and missed crucial deadlines.
On Oct. 4, it was reported that Falls Church, Va.-based CSC, a key contractor to the project, had been compelled to repay £170 million to the NHS, having failed to deliver NPfIT's crucial patient records software, called Lorenzo, on time.
Now CSC is also facing a class action suit from its investors, who claim Lorenzo's poor track record in recent years was "fraudulently concealed" from them. The Guardian reports that "as early as May 2008 CSC knew, through reports and testing, that Lorenzo was 'dysfunctional and undeliverable.'"
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CSC had pledge to implement Lorenzo at 166 NHS trusts by 2016, but has yet to install "a fully functional version" of the technology at any of them, the suit alleges.
But vendor woes are only one exacerbating aspect of this mess, which ultimately stems from NPfIT's formative flaw: a willful disregard, from the beginning, of the wants and needs of doctors, nurses and clinicians.
Recently The New York Times spoke to former National Coordinators David Brailer, MD, and David Blumenthal, MD, and asked what lessons they'd learned from watching the "slow-motion train wreck" play out across the Atlantic these past few years.
"The thing that brought them to their knees was the confrontation with doctors," Brailer told the Times.