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NPfIT: National Programme of Failed IT in the NHS

I have a suggestion for the Queen:

Perhaps the NPfIT (National Programme for IT in the NHS) should be renamed the "National Programme of Failed IT in the NHS."

No new acronym will be needed.

For this pleasure, the UK has spent upwards of £13 billion.

Of course, we as the progeny of the UK are going down the same path, surely soon to have a "National Program for Failed IT in the US." Ours will be a bit more expensive, unfortunately.

Excerpts from the US and UK press (read the entire pieces at the links):
http://online.wsj.com/article/SB10001424052748703421204576330691233267966.html
Wall Street Journal
Auditor Blasts UK HIT
BY STEN STOVALL
LONDON

The billions of pounds spent so far on England's much-delayed electronic patient record system within the National Health Service have been poorly used and the project urgently needs to be reassessed to ensure taxpayers get value for their money, the U.K.'s National Audit Office said Wednesday. A report released by the independent body concludes that the £2.7 billion spent on the records systems so far "does not represent value for money."


http://www.dailymail.co.uk/health/article-1388224/NHS-IT-project-cost-billions-delivering-ANY-benefits.html
Dailymail.co.uk
NHS IT system 'has cost billions without delivering ANY benefits'
By Sophie Borland
18th May 2011

Health Minister damns project as 'expensive farce'

The NHS’ controversial project to computerise all patient records has cost billions of pounds without delivering any benefits, according to a damning report.

It warns the project is running years behind schedule and will probably never happen.

The £11 billion scheme, launched under Labour in 2002, was meant to create a central computer database of all patient records which could be easily be accessed by GPs and hospitals.

But from the outset it has been hit with technical glitches and arguments between the companies installing the systems.

The scheme has also been heavily criticised by leading doctors and privacy campaigners who warned patients’ personal details would be vulnerable if stored on a database that could be easily accessed by thousands of NHS staff.

... The project was meant to be completed last year but the report warned that it was unlikely to be finished even by 2016, when the contract with one of the main firms installing the system expires.

So far only a few hospitals across the country have installed the new system – and there have been widespread problems.

Doctors have said it is too slow to use during busy clinics and other staff have reported the system suddenly crashing.

Ministers last night described the project as an “expensive farce” and demanded it was scrapped immediately.


http://www.computerworlduk.com/news/public-sector/3280340/official-failed-nhs-national-it-programme-has-no-chance-of-delivering-value-for-money/
 Computerworld UK
Official: Failed NHS National IT programme has no chance of delivering value for money
Time to turn off the life support machine?
By Leo King
Published 00:02, 18 May 11

The NHS National Programme for IT, which is now budgeted at £11.4 billion, has no chance of delivering value for money and has failed on all of its crucial elements.

That is the verdict of a sharp report, compiled by the National Audit Office, that the prime minister has publicly insisted on assessing before any more deals are signed with suppliers. The report will be followed by Public Accounts Committee hearings and a Treasury report, which will also precede any signature.

National audit of the £11.4bn, 10-year UK program to automate all NHS patient records concludes "the project has not been value for money for the Dept of Health."


http://www.bbc.co.uk/news/health-13430375
BBC News
£7bn NHS electronic records 'achieving little' for patients
By Nick Triggle Health correspondent

Patients are getting "precious little" from the NHS electronic care records system in England, a watchdog says.

The £7bn system to replace paper files is falling further behind schedule and in places where it has been introduced it is not working as it should.

The National Audit Office also said some patients would not even get one as large chunks of the NHS had pulled out.

In conclusion, the NAO said the system was not providing value for money - something the government rejected.

Electronic care records are the key part of the overall £11.4bn NHS IT project.

The scheme was launched in 2002 with the aim of revolutionising the way the health service uses technology and also includes developments such as digital x-rays and fast internet connections. It is the third time the NAO has looked at electronic records - and each time the findings have been more damning.


http://www.guardian.co.uk/society/2011/may/18/government-urged-to-abandon-nhs-it-programme
The Guardian
Government urged to abandon NHS IT programme
Polly Curtis, Whitehall correspondent
guardian.co.uk, Wednesday 18 May 2011 12.03 BST

The government is coming under increasing pressure to abandon plans for a new NHS patient record system after the official spending watchdog said the scheme was very likely to waste another £4.3bn in the next four years.

The original aim of the £11.4bn NHS IT programme – to install a patient record database accessible from any point in the NHS in England by 2015 – will fail, the National Audit Office (NAO) warned.

The £2.7bn spent so far on the system has not been value for money, the watchdog said, adding it had no confidence that the remaining £4.3bn would be any better spent.

The nine-year-old project – the biggest civilian IT scheme attempted – has been in disarray since it missed its first deadlines in 2007. While its ambitions have been downgraded in recent years, the bill from the suppliers has remained largely unchanged, the report said.

MPs appealed for the remaining contracts to be abandoned to prevent the £4.3bn from going to waste. It amounts to more than one-fifth of the £20bn efficiencies the NHS is attempting to achieve.

I think it fair to say the UK has been massively fleeced and abused by its suppliers, consultants and health IT pundits.

The people of the UK have paid for this boondoggle. They should think of it as a form of taxation without representation, an abuse of their rights.

Perhaps they can learn a valuable lesson from this document:

The Declaration of Independence of the United States

Truth brings freedom.

-- SS

More Medical Societies Supported by Industry

There were several new reports about the extent that medical societies are supported by industry.  Last week we asked whether the extent of the industrial support provided the Heart Rhythm Society made that organization appear to be more of a marketing firm than a professional society. 

Society for Cardiac Angiography and Interventions (SCAI)

ProPublica reported last week:
The Society for Cardiac Angiography and Interventions (SCAI) received 57 percent of its revenues in 2009 from medical device and pharmaceutical makers, according to financial information on the group's website.

Industry contributions to the society's budget covered $4.7 million of the $8.2 million it received that year.

The group's biggest funders are the companies with the biggest share of the stent market: Cordis Corp. (a subsidiary of Johnson & Johnson), Boston Scientific, Abbott Laboratories and Medtronic.
So here is another medical society that gets more money from pharmaceutical, biotechnology and device companies than it does from its members.

The SCAI does not make obvious any relationships among its board members and officers and industry and does make publicly accessible its CEO's compensation or its recent 990 forms (see its web-site here).


National Lipid Association (NLA)

The CardioBrief blog discussed the somewhat more convoluted case of the sources of support of the National Lipid Association.

First blogger Larry Husten examined the role of industry support for the association's "clinical guidance papers" on familial hypercholesterolemia  (FH). These papers recommended extremely aggressive screening for high cholesterol, that is, starting for 9 year old children, and 2 year olds whose families' had histories of elevated cholesterol and coronary disease. The conference that came up with these ideas was supported by drug companies, per the first blog post in a three-part series:
The January 2011 NLA familial hypercholesterolemia recommendations conference was supported by unrestricted grant funding from the following companies: Abbott Laboratories, Aegerion Pharmaceuticals, Daiichi Sankyo, Genzyme, Kaneka Pharma America LLC, and Merck & Co.

Also,
Each of these companies would benefit from increased screening and treatment of FH and some, such as Keneka, Aegerion, and Genzyme have a huge portion of their future invested in FH.

Furthermore,
The executive summary of the papers includes disclosures from all of the authors, and all the authors list industry ties, and all but two of the authors disclose multiple relationships with industry (see below). Nearly all had ties with the companies that sponsored the conference. In an interview, [chair of the expert panel Dr Anne] Goldberg, told me that 'we believe in transparency' but that, unlike organizations like the ACC and the AHA, 'we have not taken people off of committees because of any ties with industry.'

A second blog post noted that a brochure on FH published by the NLA was supported by a drug company (Genzyme) and that:
The NLA offers a multitude of CME programs, nearly all of which are  commercially supported by the pharmaceutical industry. Often the content of the programs are closely tied to the interests of the sponsor. For instance, the program on 'Lipid-Altering Drug Pharmacology and Safety' is supported by Abbott, Merck/Schering-Plough, and Reliant, all of whom manufacture popular lipid drugs.

However, in pursuit of the "transparency" promised above, Mr Husten was not able to get a clear idea of the total amount of industry support supplied to the NLA:
the NLA does not provide a detailed account of its revenue from industry, so it is impossible to say with certainty precisely how reliant it is upon industry support.

Note that the association's 2010 990 form listed revenues totaling $3,657,060, of which $1,106,091 came from meeting registration, and $216,356 from dues.  So this society received about 36% of its revenue from these traditional sources, while it received 37% from contributions and grants ($1,246,242) plus $116,750 in exhibitor fees.  (Other sources of revenue were less easy to classify.)  This suggests that the NLA does receive substantial revenue from industry.

The NLA did not list amongst its disclosures whether its board members and officers had their own financial relationships with industry.

Furthermore, the NLA seems particularly opaque about its hired executives and how much they are paid. Its 2010 990 form did not name its highest-compensated employees, nor list their compensation. Although it noted that its management was "delegated" to Compass Management & Consulting, it did not state the amount paid to Compass,  or the compensation given to any Compass employees who are effectively the NLA's highest-paid employees, nor did it list Compass as one of its most highly-paid independent contractors. Mr Husten discovered an addendum to a 2010 financial report also posted on the web that did state Compass' compensation was $662,640 in "management fees," and $326,378 for "commissions" for "fund-raising, a total of $989,018, equal to 25% of the organization's total expenses of $3,945,688.

Summary

Here are two more examples of medical societies that receive substantial revenues from companies that make products about which the societies' members may decide to prescribe or implant. In both cases, the societies' seemed to receive at least as much revenue from industry as they did  from members for dues, registration fees, and the like. Although both societies claimed to value transparency, neither disclosed the extent that society leaders and paid managers benefited from the societies' or their own relationships with industry.  So there is reason to be concerned about the extent their volunteer leaders and paid executives may benefit from the soceities' and their own personal relationships with industry.

He who pays the piper calls the tune.  So it does not appear unreasonable to ask whether these societies should be regarded as at least as beholden to their industrial funders as to their members and meeting attendees?  So should they be regarded as commercial marketing firms at least as much as professional societies?

As we said before, if medical societies have come to resemble marketing firms, is it any wonder that they have not spoken up against the commercialization of health care, even when the result has not been good for physicians' core values? But in that case, why would physicians who care about their patients and their core values want to belong and pay dues to marketing firms? Inquiring minds want to know....


Maybe physicians should only join medical societies that really act like medical societies.

Another Blow to the Health IT Idealists: Sony CEO Howard Stringer, and HHS OIG, on Information Security

In a series of Healthcare Renewal posts such as those linked below, I pointed out that healthcare IT information security was largely a pipe dream, and that plans to create a national network of health information, while a seductive idea dating to the beginnings of computer networking, is not a good idea now.


Now you can hear it from another source: The CEO of one of the world's largest electronic companies, Sony.

Emphases mine:

Sony CEO Warns of 'Bad New World'
Wall Street Journal
May 8, 2011

TOKYO—After spending weeks to resolve a massive Internet security breach, Sony Corp. Chief Executive Howard Stringer said he can't guarantee the security of the company's videogame network or any other Web system in the "bad new world" of cybercrime.

Mr. Stringer's comments in a phone interview Tuesday, ahead of a New York roundtable discussion with reporters, come on the heels of a trying month for Sony. The company partially restored two of its online game systems and a streaming movie and music service over the weekend after shutting the services for several weeks when a breach compromised the personal information of more than 100 million account holders.

While Sony has restored part of the PlayStation Network—an online game system for its PlayStation 3 videogame console—in the U.S. and Europe and bolstered security measures, Mr. Stringer, 69 years old, said maintaining the service's security is a "never-ending process" and he doesn't know if anyone is "100% secure."

He said the security breach at PSN, Sony Online Entertainment, an online game service for personal-computer users, and its Qriocity streaming video and music network his company could lead the way to bigger problems well beyond Sony, or the gaming industry. He warned hackers may one day target the global financial system, the power grid or air-traffic control systems. [And healthcare, where identity theft, data alteration, and data destruction might occur - ed.]


I really don't think this is the time to be setting up a national health information network.

Beyond that, I offer no additional comments, other than that regarding the impossibility of keeping healthcare information secure on a national or even regional network, you may have heard it first here at Healthcare Renewal.

It would be prudent and consistent with the Hippocratic Oath to tone down our grandiose expectations and grandiose plans for these technologies in healthcare.

If you feel insecure yet, just wait a moment.

Going from very, very bad to very much worse:

An independent audit of ONC's and CMS's security programs by the HHS OIG (Office of the Inspector General) produced concerning if not alarming results to say the least:

Federal Audits Find HIT Security Problems at CMS, ONC
John Commins, for HealthLeaders Media
May 18, 2011

Audits of the federal agencies charged with implementing and monitoring security measures for healthcare information technology identified this week lax oversight and insufficient standards for healthcare providers.

The audits were conducted by the Department of Health and Human Services' Office of Inspector General, and targeted HIT security standards, privacy protection under HIPAA, and other security measures at the Centers for Medicare & Medicaid Services, and the Office of the National Coordinator. "These two reports are being issued simultaneously because OIG found weaknesses in the two HHS agencies entrusted with keeping sensitive patient records private and secure," OIG said in a media release.

The CMS audit, Nationwide Rollup Review of the Centers for Medicare & Medicaid Services Health Insurance Portability and Accountability Act of 1996 Oversight, examined seven hospitals across the country and found 151 "vulnerabilities" in systems and controls that are designed to safeguard electronic protected health information.

Those lapses included 124 "high impact vulnerabilities" such as unencrypted laptops and portable drives containing sensitive personal health information, outdated antivirus software and patches, unsecured networks, and the failure to detect rogue devices intruding on wireless networks, the OIG audit said.

"These vulnerabilities placed the confidentiality, integrity, and availability of ePHI at risk. Outsiders or employees at some hospitals could have accessed, and at one hospital did access, systems and beneficiaries' personal data and performed unauthorized acts without the hospitals' knowledge," the OIG audit said. "As a result, CMS had limited assurance that controls were in place and operating as intended to protect electronic protected health information, thereby leaving ePHI vulnerable to attack and compromise.

OIG's Audit of Information Technology Security Included in Health Information Technology Standards examined ONC's mandate under the HITECH Act to develop HIT security as part of a national HIT interoperability infrastructure. The audit found "no HIT standards that included general information IT security controls … which provide the structure, policies, and procedures that apply to a healthcare provider's overall computer operations, ensure the proper operation of information systems [which obviously also impacts patient safety - ed.], and create a secure environment for application systems and controls.


That's not very reassuring. In fact, it is downright frightening. ONC has to learn such lessons from HHS OIG? Read the whole thing.

I somewhat mordantly note that organizations such as ONC and CMS would probably never hire a person like me, who might actually kick-start true critical thinking on these issues. This is due to my non-bien pensant "bad attitudes", and lack of faith in cybernetic idols.


Click to enlarge. A well-known idol of gold. Computer circuits use gold, no?

-- SS


Global Fund Will Not Suppress Discussion of Health Care Corruption

Some good news to discuss, for a change....

We previously discussed losses from corruption reported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and by the Health Alliance International here.  At the time, we noted that some experts in health care corruption praised the Global Fund for being transparent about the effects of corruption.

However, last week there was concern that some elements within the Global Fund thought that the best response to losses due to corruption would be hiding them.  As reported by the AP (via CBS): 
A global health fund championed by celebrities and world leaders is considering scaling back its groundbreaking philosophy of full transparency about how it spends billions of dollars in health care in poor countries. Its decision could have broad consequences for the ways international aid groups operate.

Revelations this year by The Associated Press about misspent funds and corruption among recipients of the money — and the donor backlash that has followed — have prompted leaders of the Global Fund to Fight AIDS, Tuberculosis and Malaria to propose scaling back on the investigations that uncovered the problems, and revealing less about them to donors and the public.

But hardly everyone within Fund leadership wanted to abandon transparency:
The Global Fund's internal watchdog fiercely opposes the proposed changes. In its latest progress report, obtained by the AP, Inspector General John Parsons warns the board that a move toward less transparency 'could be interpreted negatively and as a purposeful effort to suppress material information.'

Also,
The president of the board, Ethiopian Health Minister Tedros Adhanom Ghebreyesus, opposes any changes.


'Even the mere appearance of suppression of information is unacceptable. Scaling back, or the perception that we are retreating from, this commitment is something we simply cannot allow,' Tedros said. If anything, he added, 'we should increase our level of transparency.'

Now, it looks like the transparency advocates won, at least in part. As again reported by the AP (via CBS):
A multibillion-dollar fund that fights three killer diseases said Friday that it will make public more detailed information about money it has lost to corruption and mismanagement, but won't release other information critics have sought.

The board of the $22 billion Global Fund to Fight AIDS, Tuberculosis and Malaria met this week to address a backlash among major donors over revelations by The Associated Press that the fund's internal watchdog was turning up losses of tens of millions of dollars of grant money.

Board members decided to publish detailed accounting of losses and money recovered, the fund said, in an effort to distinguish between fraud and other problems such as poor accounting.

However,
The fund will not, however, provide other details from internal investigations and audits that might have made it possible to calculate how much of the money investigated is lost to corruption, or what percentage of the fund's overall disbursements are misspent.

Also,
The fund also is not making public an internal chart obtained by AP showing that in 12 nations where internal audits and investigations reviewed almost $576 million in spending, an average of 8 percent was lost to fraud, undocumented or unauthorized spending.

Still, it is very good news that transparency won out in this case. Maybe the Global Fund leaders' decision will encourage more discussion of the severity of global health care corruption and its negative effects.

On the other hand, it is bad news that even discussion of health care corruption remains controversial. In 2006, Transparency International's Global Corruption Report asserted in its executive summary, " the scale of corruption is vast in both rich and poor countries."  As we summarized here, the report discussed the scale and diversity of health care corruption, and the severity of its adverse effects.  Yet the very subject of global health care corruption remains as anechoic as many of the specific topics we discuss on Health Care Renewal.

Also, as we have noted before, recently here, there are very few if any meetings about global health care corruption, very few courses on it in medical or public health schools, no institutions specifically designed to address it, and no programs at the foundations and NGOs which are losing money to global health corruption to combat it.  Similarly, there are few efforts to promote accountability, integrity, transparency, honesty, and ethics in health care (aside from this blog and a few other similarly informal initiatives.) 

What is wrong with that picture?

We hope that the willingness of the Global Fund to discuss and admit it has a problem with health care corruption will make health care corruption a little less anechoic, and lead us closer to concrete steps to address it.

PS - If anyone in our vast audience does know about any additional anti-corruption or conflict of interest, or pro-accountability, integrity, transparency, honesty and ethics initiatives, courses, meetings relevant to health care, please let me know and I will do my best to disseminate the information.

[Posted on Health Care Renewal by Roy M. Poses MD]