Marin County

Case 1: UK Dept of Health IT Failure: Prescription for Disaster

1.1 Scope

The case involves an in-depth analysis of the problems that affected the implementation of the National Program for Information Technology (NPfIT) project, including the role of the client and the vendors. This report also provides our learning from this case.

1.2 Context

National Health Service (NHS) was established in 1948 as the largest Health Care organization in Europe. It is managed by the Health Secretary, Department of Health and UK government under a bureaucratic jurisdiction. It employs 1 million people and offers full range of health care services to over 50 million plus citizens through 10 strategic health authorities.

1. Primary Care Trusts: 300 in number which oversee general practitioners and dentists.

2. NHS Hospital Trusts: 290 in number which administers hospitals, treatment centers and special care units.

3. NHS Ambulance Trusts / Acute Health Trusts/ Mental Health Trusts

The problems with existing IT systems and process:

1. Procurement and development of Information Technology (IT) within the NHS has been haphazard, with individual NHS organizations procuring and maintaining their own IT systems.

2. Thousands of different IT systems and configurations in the NHS that do not share information with each other.

3. Hundreds of different suppliers, with differing levels of functionality in use across the country.

1.3 Core Objectives for new system

1. Connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals.

2. Allow for the electronic storage and retrieval of patient lifetime medical records.

3. Permit patients to set up appointments via their computers.

4. Let doctors electronically view Health records of patients and transmit prescriptions to local pharmacies.

5. Improve services and the quality of patient care.

6. Coordinated, convenient and integrated patient care.

1.4 Implementation Approach

1. N3 national network

* One of the largest virtual private networks on the planet.

* Provides a seamless, efficient and cost-effective service linking NHS sites.

* BT (British Telecom) was given contract to build N3 network.

2. National Spine

* Biggest computer database in the world

* Core service to provide access to integrated patient data, prescription ordering, proactive decision support and best-practice reference data.

* BT was given contract to build National Spine.

3. NHS Care Record Service

* Individual electronic lifelong care records for every patient in England.

4. Choose and Book

* Provides patients with convenience in selecting the time of their appointments.

5. Enterprise Subscription Agreement with Microsoft

* 350,000 desktops with Microsoft Solutions for healthcare professionals,

6. Vendor selection for each region.

* UK was divided in five major regions to reduce implementation complexity and each region was assigned to an IT service vendor.

LSP's / Vendors Operating geographies Sub Vendor Software used

Accenture Eastern & North Eastern iSoft Lorenzo, isoft, iPM, iCM

Computer Sciences Corporation North West & West Midlands iSoft Lorenzo

British Telecom London Burlington GE's IDX

Fujitsu Alliance Southern Region Burlington IDX

*LSP - Local Service Provider

1.5 Challenges

1. Enormous Size and Scope of the IT System to be built

325 million consultations in primary care, 13 million outpatient consultations, 4 million emergency admissions and 617 million prescriptions.

2. Huge Data Migration

A network of hospitals which had their own IT system and distinctive technology.

3. Centralized control and maintenance of Project secrecy

I. Directly under the supervision of the Department of Health

II. System was the primary interest of the newly elected Tony Blair government.

4. Vendor Management

No single vendor was available to handle the entire project.

5. Change Management

Large number of system users who need to be trained.

6. Public sector barriers

Heavy scrutiny by the media and people leading to series of debates, red tape and other overhead costs.

1.6 Role of Vendors

Act as prime contractors for their regions and decide how to best deliver the service specified by the NHS CfH (Connecting for health) and assemble and integrate software from a range of products.

1.7 Problems faced

1. IDX was dropped from the program after Fujitsu, "lost confidence" in its abilities. This put Fujitsu 18 months behind schedule.

2. iSoft is two years behind schedule in delivering a Lorenzo (electronic health care system).

3. Delay in the migration of data took more than 5 years as originally projected by NHS.

4. The N3 network, deployed to connect the country's health-care workers, has been hit by more than 100 system