Thursday, September 28, 2006

Healthful IT

Potentilla asked:

“Is the NHS's National Project for IT - run by "Connecting for Health" - going to turn out to be a good thing or a bad thing in terms of investment for the country? Is it being run well or not?”

I don’t think it’s possible to live in the UK and not know of the grand Labour plan for a pan NHS IT system. If you’re curious to know more, or one of my foreign readers, this is the government website, and the horrifics of its navigation and design speak volumes about the project itself. A recent report can be found here, which gives a good indication of the current state of play. In essence, the idea is for a central repository of medical records, and then electronic means to book meetings or hospital appointments or even prescriptions.

Potentilla actually asked two questions. I deal with the first one first. Putting aside the delivery of the project itself, are the goals of value to UK society? I have a very stark view, and that is a firm no. Intellectually I can see the benefit of a GP having the ability to book follow up actions for a patient while meeting. There is also a clear reduction of risk for a patents full medical file to be available by appropriate medical professionals dealing with their health.

However, those benefits are gained at a massive intrusion into personal privacy. Despite the vaunted project claims of absolute security, and only “need know” access to files, in essence your medical details will be completely open. A security professional acquaintance of mine says the controls are laughable. Over lunch one day he showed me how even now hacks are circulating through the internet. Your full medical details have already, or are now in the process of being loaded. Every intimate detail will be available to, effectively, anyone.

I strongly feel that this loss of privacy far outweighs any benefit in booking ease or in reducing the risk of misdiagnosis due to lack of information. The first benefit could have been dealt with separately at far less cost, and institutional controls backed up by patient awareness was pretty effective in dealing with the second. That’s not to say it was perfect, but it was a working human system that did not show massive failure requiring it to be “fixed”.

My main complaint with this current government is its ideological need to “fix” society. The constitution has been meddled with, social programmes have been tried, modified, fixed and abandoned at huge cost and human sacrifice. This is just another example of a “good idea” gone madly wrong. I digress though.

On to the project. It has been, and remains, a farce. Mega projects are difficult at the best of times, and I’ve talked to many IT Professionals who’ve been involved in this one by one shape or another. The universal opinion is that there is gross mismanagement at the top of this project. Partially that is due to the shape of the project, you can find an interesting analysis of that here. There are over 20 contractors and subcontractors on the project, and despite an Audit Office report claiming procurement was exemplary, contracts where signed without clear deliverables and project plans, and there were no penalties for late or incorrect delivery.

Partially it was this mishmash of contractors. There are two prime contractors, a separate contractor with “programme control” and a host of subcontractors that have no direct contractual relationship with the government. Its hard to say where to start about how there appears to be no coordinating programme design, and no mechanism for cost or deliverable control other than slapped wrists and hand wringing.

Costs have overrun by an order of magnitude. There have been delays upon delays. My understanding from within the project, and from medical friends that the systems have massive errors still present, despite sections now being “live”. A relation who is a medical consultant, delights in tales of dealing with medical files that have been incorrectly assigned to the wrong name, of a booking system gone mad (she has reverted her department to paper), of frequent failures in being unable to update records. Her horror stories go on and on.

So, to summarise, it is a grand design that is based on a massive intrusion into personal rights and freedoms, and it is a grand project that has been mismanaged on an almost unimaginable scale. I can safely say I am strongly against it on all grounds…


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