A Web Mishmash
A Web Mishmash
A rather depressing article in E-Health Insider reports on what sounds a bit like a panic measure:
NHS Connecting for Health is urgently looking for experienced NHS clinicians, interested in ensuring that NHS IT systems are fit for purpose, to be flown out and work on assignment with clinical software developers in India or the United States.
It has been my impression for some years that the politicians driving this (not very original) vision have been blindly seduced by BigCo IT into believing that simply rolling legacy systems from across the Pond and imposing them on an unwitting NHS would be a piece of cake. Not so. As any observant student of large IT projects will tell you, a system stands or falls on its usability far more than its underlying sophistication, and you cannot assume that usability in one context translates simply into usability in another. Put more simply, the North American healthcare system and the NHS differ in so many social, cultural, and professional respects that a system designed for one will almost certainly fail in the other without significant redesign. It is no surprise then that the successful contractors are discovering that their prized systems are needing to be rebuilt virtually from scratch.
The real sadness is that if those driving this scheme had thought differently, they could have harnessed the knowledge, expertise and enthusiasm behind the large numbers of successful small scale systems that were already in productive use throughout our NHS. As it is, a large cohort of “early adopters” now feels alienated and frustrated.
The more egotistical brand this as the The world’s biggest IT project. It may well be the largest, centrally-driven, top-down IT project on the Planet—but that is hardly a category with a conspicuous history of success. I suspect that the real contender for the “largest IT project” accolade must be the Internet, which is unquestionably hugely successful. Think for a moment about how the Internet came about: its project director, project manager, project plan, champions, whoever. Then read Tony Hoare’s 1980 Turing Lecture: The Emperor’s Old Clothes (especially his take on the classic Hans Andersen tale at the end, and the following quote).
At first I hoped that such a technically unsound project would collapse but I soon realized it was doomed to success. Almost anything in software can be implemented, sold, and even used given enough determination. There is nothing a mere scientist can say that will stand against the flood of a hundred million dollars. But there is one quality that cannot be purchased in this way—-and that is reliability. The price of reliability is the pursuit of the utmost simplicity. It is a price which the very rich find most hard to pay.
Then go place your bets.
Posted by Chris Bunch at August 12, 2005 10:03 PMI should have thought it would be more appropriate for the suppliers to send their staff to the UK to work in our actual NHS environment—the closer they are to it, the better understanding they will gain of issues, clinical and administrative practice, and the interaction between clinical, management and political factors and sensitivities.
There is an assumed but erroneous management theory that the larger the investment in a product or service, the higher the corresponding value generated. This is not necessarily true, and the NHS has a long history of IT initiatives; e.g. patient administration systems, resource management; where major expenditure has not always returned corresponding benefits.
I believe there is a need to fund developments where the costs incurred are under local, departmental control and where there is usually a fast return measured by a corresponding increase in efficiency or care outcomes. One example would be in departmental clinical care systems (e.g. renal monitoring) or the various packages available for clinical audit. I know from personal experience that a simple package to enable general surgeons to review actual morbidity/mortality outcomes against those expected, provided one group with considerable insight into their clinical care and operational practice.
I have considerable respect for all those involved in Connecting for Health, but our reliance on external suppliers to custom build complex systems in an attempt to match every local requirement is a significant risk to long term success.
Posted by: Chris Harvey at August 16, 2005 06:59 PM