英国宣布放弃国家卫生信息网项目

张琨

NHS pulls the plug on its £11bn IT system

After nine years and with billions already spent, doomed computer system is abandoned

By Oliver Wright, Whitehall Editor

The nine-year-old NHS computer project has been in disarray since it missed its first deadlines in 2007

A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government after running up billions of pounds in bills. Ministers are expected to announce next month that they are scrapping a central part of the much-delayed and hugely controversial 10-year National Programme for IT.

Instead, local health trusts and hospitals will be allowed to develop or buy individual computer systems to suit their needs – with a much smaller central server capable of "interrogating" them to provide centralised information on patient care. News of the Government's plans comes as a damning report from a cross-party committee of MPs concludes that the £11.4bn programme had proved "beyond the capacity of the Department of Health to deliver".

The Commons Public Accounts Committee (PAC) said that, while the intention of creating a centralised database of electronic patient records was a "worthwhile aim", a huge amount of money had been wasted.

edwin_uestc

U.K. Scrapping National Health IT Network
After nine years, and $18.7 billion, the British government is about to scrap its National Programme for IT, which was conceived as a massive, nationwide health IT network for the 52 million residents of England.
    As we reported here already in 2007, one of the many reasons for this tragedy was an over-optimism on the part of Tony Blair and others as concerns the quality of available standards. If we use international standards, sanctioned by ISO, what, after all, can go wrong?
   Yet as the head of the program, Richard Granger, expressed it in giving evidence to the UK House of Commons Select Committee on Health:
In terms of the core Spine infrastructure, there was some mythology in the Health Informatics Community that the standards existed, HL7 was mature, and so forth. That was completely untrue.
Posted by Barry Smith  at Thursday, August 04, 2011
http://hl7-watch.blogspot.com/20 ... lth-it-network.html
Barry Smith is Julian Park Distinguished Professor of Philosophy in the University at Buffalo (New York, USA) and Research Scientist in the New York State Center of Excellence in Bioinformatics and Life Sciences. He is Director of the National Center for Ontological Research (NCOR), a principal scientist of the National Center for Biomedical Ontology (NCBO) and a Coordinating Editor of the Open Biomedical Ontologies (OBO) Foundry

张琨

是否有机会评价和反思一下在中国遍地开花的区域卫生信息化项目呢？ 看看当初的想法和实际的效果，不要拍马屁的那种，要真实的分析，比如GAO做的各种报告....这样做肯定很有意义，但符合中国国情么？

edwin_uestc

回复 3# 张琨
回想中华人民共和国成立的辛酸史，现在的种种也仅仅是为了探索出有中国特色的医疗信息化建设路上在所难免的流血牺牲和各种走弯路而已？？

ironstone

估计现在国内只有成功的，不会有失败的。

e.t.

国内还在摸着石头过河时期。

CDSS

I am not sure how the 中国区域卫生信息化项目is designed. But I think the centralized system has the following advantages:
1.        Standardization for information storage (comprehensive and coded data).
2.        Information sharing.
3.        Standardized patient care with decision support: chronic patient receive the same care when walks into big hospital and small hospital
4.        Save resource: advanced system is expensive and cost a lot to maintenance. The small hospital can not afford it. E.g. our company is web based centralized system using by 23 hospitals and 150+ clinics.  An IE 6 to IE 8 transition cost 20+ people working on many months.
I have been working in a city hospital before. In my experience, about 99% patient never goes out of the city range. So a city health bureau centralized system is good enough.
The “National Health IT Network” does not mean a nationalized central database. It could be set up by link all the sub-centralized system, if all the systems are using the same coding standard and data models.   This Network does not help much on direct patient care, but it’s good for management and research purpose.
One example for why we need the nationalized data is to find the best practice method.  "In most instances people are pushed in a gray area," Poulsen said, "and data makes gray areas less gray."
In 1999, for example, the American College of Obstetricians and Gynecologists advised against giving healthy mothers the option of arranging early deliveries. By not electively inducing births before 39 weeks of pregnancy, it said, the likelihood of complications could be reduced. The college warned that pre-term babies were at higher risk for a host of problems, including severe respiratory-distress syndrome.
But doctors and nurses resisted the new guidelines. From their vantage point, it was hard to see a problematic pattern,  according to an Intermountain study published in the journal Obstetrics & Gynecology in April.
This made sense, considering that if an obstetrician performs 200 deliveries a year -- and 10 percent of his or her patients are electively delivered at 38 weeks -- statistics show only one baby would be admitted to the neonatal intensive care unit (NICU) each year.
Better data, improved results » When Intermountain analyzed nearly 180,000 births, however, the data were startlingly clear: For babies born at 37 weeks, the incidence of severe respiratory-distress syndrome was 22.5 times higher than those born at 39 to 41 weeks. At 38 weeks, it was still 7.5 times higher. Other problems, such as pulmonary hypertension, admission to the NICU and hospital stays beyond five days, were also more likely.
"If no one ever gives you the scientific data to drive your decisions, you can be pretty comfortable not doing best practice. You just don't know," said Janie Wilson, operations director of Women and Newborn Clinical Programs, which in 2001 developed a program to curtail early-term deliveries.
From the above example, we can see,  to give patient the best care, we need data. I vote for centralized system and standard data.
Thanks,

goonyeah

英国宣布放弃？放弃到什么程度？如何放弃？为什么放弃？
要分析分析！

张琨

英国宣布放弃？放弃到什么程度？如何放弃？为什么放弃？
要分析分析！
goonyeah 发表于 2011-8-30 16:51

                               
登录/注册后可看大图

敬请指正

edwin_uestc

看这里
U.K. Health System Expected To Abandon E-Health Network
Government officials in the United Kingdom are expected to announce next month that they will cancel plans to create a centralized database of electronic health records, the London Independent reports.

Report Questions Efficacy of Program

The move follows a report from the House of Commons' Public Accounts Committee that said the network is "beyond the capacity of the Department of Health to deliver."

Margaret Hodge -- chair of the committee -- said, "The department has been unable to demonstrate what benefits have been delivered from the £2.7 billion [$4.4 billion] spent on the project so far."

The committee cited leadership issues in the department and a failure to include health professionals in decision making positions (Wright, London Independent, 8/3). The report also criticized contracts the government awarded to vendors (Versel, InformationWeek, 8/4).

The EHR program is a central component of the U.K.'s £11.4 billion, or $18.7 billion, national health IT program, known as NHS Connecting for Health.

Under the program, every patient was supposed to get an electronic file to be used when they were treated in NHS (Triggle, BBC News, 8/2).

Moving Forward

NHS officials will follow recommendations from the report and allow local health officials to have more flexibility in choosing and implementing health IT systems (InformationWeek, 8/4).

Local officials will be able to develop or purchase individual systems based on their needs, and a smaller server will provide centralized patient data.

Meanwhile, the government is working with vendors on contract issues and trying to avoid legal action, according to the Independent (London Independent, 8/3).

Read more: http://www.ihealthbeat.org/artic ... .aspx#ixzz1WnO8TZMG

edwin_uestc

继续
MPs report on the National Programme for IT in the NHS
The Commons Public Accounts Committee publishes a report today which, on the basis of evidence from the Department of Health and its contractors BT and Computer Sciences Corporation (CSC), examines the delivery of care records systems under the National Programme for IT in the NHS.  

    Report: The National Programme for IT in the NHS: An update on the delivery of detailed care records systems
    Public Accounts Committee

The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:

    "The Department of Health is not going to achieve its original aim of a fully integrated care records system across the NHS. Trying to create a one-size-fits-all system in the NHS was a massive risk and has proven to be unworkable.

    The Department has been unable to demonstrate what benefits have been delivered from the £2.7 billion spent on the project so far.

    It should now urgently review whether it is worth continuing with the remaining elements of the care records system. The £4.3 billion which the Department expects to spend might be better used to buy systems that are proven to work, that are good value for money and which deliver demonstrable benefits to the NHS.

    The substantial reduction in the number of NHS bodies in London receiving new systems from BT has not been matched by a commensurate cut in fees. This casts the Department's negotiating abilities in a very poor light.

    We consider it essential that the government's Major Projects Authority now closely scrutinizes the Department’s continuing negotiations with CSC, which has so far delivered very few of the systems it was contracted to supply. We are concerned that CSC should not be rewarded for its failure with an effective monopoly in the provision of care records systems in the North, Eastern and Midlands cluster, since this could leave many Trusts with little choice but to continue with outdated interim systems that could be very expensive to maintain and to upgrade.

    We are surprised that, after our hearing, in a Memorandum to us of 7 June 2011 which specifically mentioned advance payments, the Department made no mention of a £200 million advance payment to CSC in April 2011. This is unacceptable.

    It is unclear to us how the wider health reforms and NHS restructuring will affect the future management and governance of the care records system. The NHS trusts who will take on the risks have no contractual relationship with existing suppliers and no information about potential future costs."

Margaret Hodge was speaking as the Committee published its 45th Report of this Session which, on the basis of evidence from the Department of Health and its contractors BT and Computer Sciences Corporation (CSC), examined the delivery of care records systems under the National Programme for IT in the NHS
Background

The National Programme for IT in the NHS (the Programme) is an ambitious £11.4 billion programme of investment designed to reform how the NHS in England uses information to improve services and patient care. Launched in 2002, the Department of Health (the Department) has spent some £6.4 billion on the Programme so far.

This report is concerned with a central part of the Programme, where the aim was to create a fully integrated electronic care records system, which is expected to cost around £7 billion in total.

The original objective was to ensure every NHS patient had an individual electronic care record which could be rapidly transmitted between different parts of the NHS, in order to make accurate patient records available to NHS staff at all times.

This intention was a worthwhile aim, but one that has proved beyond the capacity of the Department to deliver and the department is no longer delivering a universal system.

Implementation of alternative up-to-date IT systems has fallen significantly behind schedule and costs have escalated. The Department could have avoided some of the pitfalls and waste if they had consulted earlier with health professionals. The Department has failed to demonstrate the benefits achieved for the £2.7 billion spent to date on care records systems.

The Department has accepted it is unable to deliver its original vision of a uniform care records system with an electronic record for every NHS patient.

It is now relying on individual NHS trusts to develop systems compatible with those in the Programme, which means that different parts of the country will have different systems. However, the committee is very concerned that the Department could not tell us how potential inconsistencies would be dealt with or what it will cost local NHS organisations to connect up.
Findings

The Department should review whether to continue the programme and consider whether the remaining £4.3 billion would be better spent elsewhere. The Department has not got the best out of its suppliers, despite having paid them some £1.8 billion so far. One supplier, CSC, has yet to deliver the bulk of the systems it is contracted to supply and has instead implemented a large number of interim systems as a stopgap. The Department has been in negotiations with CSC for over a year, but conceded to us that it may be more expensive to terminate the contract than to complete it.

The other supplier, BT, has also proved unable to deliver against its original contract. The Department agreed a revised contract reducing the number of systems and increasing the price for each system BT had to deliver. The Department is clearly overpaying BT to implement systems: BT is paid £9 million to implement systems at each NHS site, even though the same systems have been purchased for under £2 million by NHS organisations outside the Programme.

One factor which contributed to these failings is the Department's weak programme management. The committee is concerned that, given his significant other responsibilities, David Nicholson has not fully discharged his responsibilities as the Senior Responsible Owner for this project. This has resulted in poor accountability for project performance.

The Department could not explain to the committee how wider health reforms will affect the future management and governance of the care records system, or what the likely financial implications will be for NHS trusts taking over contracts for care records system contracts. The committee believes it needs to make clear how the Programme will be managed in future given the fundamental NHS restructuring that is expected over coming years.

The committee is further concerned about the problems we and the National Audit Office have faced in getting timely and reliable information from the Department. Information provided has frequently been late, has contained inconsistencies and has contradicted other evidence. This has hampered the committee's ability to scrutinise the Programme on behalf of Parliament.
Further Information

    About Parliament: Select Committees
    Topics: Health finance

ermulong

一两个领导，一两个电脑人员（打字员），找一个公司过来，就想区域卫生信息化，狗屁
一家公司，找一家风投，趋着卫生信息热，想上市，骗钱
一卡通、社区卫生、协同医疗、远程会诊、做个样子，弄个概念，没有实用，忽悠
卫生体制改革未定，把个信息推到所谓四梁八柱之中，本末倒置

sfinder

回复 1# 张琨

哎呀，英国人这么这么衰，肯定是被V３给害的，大部分用V３的整合的区域项目都不是很成功。