| Memo to President Obama:
Mr. President, as your administration pursues its objective to achieve full digital health records by 2014 at an estimated cost of $10 billion a year, you might want to look closely at what other countries have experienced in pursuing similar goals.
Beginning in 2002, as an example, the United Kingdom launched what was to be a 10-year project that would connect more than 100,000 doctors, 380,000 nurses and tens of thousands of other health-care professionals; allow for electronic storage and retrieval of patient medical records; and allow patients to book appointments by computer. In other words, this project, called the National Program for Information Technology (NPfIT), was to provide “a single electronic health-care record for every individual in England; a comprehensive, lifelong history of patients’ health and care information, regardless of where and when and by whom they were treated.”
At least that’s how Richard Granger, the former management consultant who was chosen to head up this hugely ambitious effort, characterized NPfIT. Billed as the "the world's biggest civil information technology program," NPfIT was initially budgeted at about $5 billion, significantly less than the White House plans to allot to the U.S. program. Remember, though, that the U.K. has roughly one-fifth the population of the U.S.
To implement NPfIT, the government divided the country into sections and divvied up the implementation work among top-tier integrators including Accenture, CSC, BT and a Fujitsu-led alliance. Now, any mega IT initiative typically will encounter stumbling blocks along the way, but NPfIT seemed to run into far more than its share. And many of these were, in hindsight, avoidable.
For example, at the outset the project sponsors failed to obtain full or even partial buy-in from the health-care workers who would be using NPfIT services. Five years into the implementation effort only 38% of U.K. doctors felt that NPfIT should be a priority for the National Health Service (NHS). Just 13 percent of MDs believed the program represented a good use of NHS resources. (Note, with the Obama plan, doctors who don’t comply by the deadline will see Medicare payments reduced – a threat that probably isn't the best way to win the hearts and minds of the medical community.)
Costs soared, reaching over $20 billion by 2006 and nearly twice that today. Some of the integrators and software providers were sacked, largely because they promised far more than they could deliver. One of the major integrators, Accenture, voluntarily bailed from the effort, apparently because it wasn’t making hoped-for margins. Delays were rampant. Today NPfIT is four years behind schedule. Meanwhile, NPfIT has been under consistent fire for not adequately ensuring data security and patient privacy,
Meanwhile, the project became politicized and its management, including Granger, who functioned as a kind of uber CIO, was pilloried in the press. Granger finally resigned in early 2008.
After seven years, some vital functions of NPfIT such as the National Network are up and running with 98 percent of U.K.'s GPs connected. Other functions, however, remain far behind schedule or have yet to be deployed at all.That said, it’s important for anyone in the U.S. concerned with our EHR records from the White House on down to understand the U.K. program and learn from successes and failures. No country had ever implemented anything on this scale before.
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