Lost in Cyberspace

Once again, I have to thank my colleague Richard Cook for calling to my attention several news items, all of them relevant to my recent posts about Information Technology and health care.

Backround: Wait-times in England's NHS are long, very long, and have been a source of growing dissatisfaction with the NHS.  The resultant political pressure has produced programs to 'manage' and decrease wait-times. Recording and reporting wait-times has become a major marker of performance for the NHS.

Claim: With the power of computers, we should be able to very accurately track every patient and their progress.  A computerized information system will enable the NHS to very accurately track wait-times.

Reality: One of the largest NHS trusts in England has 'lost' lists containing at least two thousand patients.
What is the consequence? All of these patients waited well in excess of the 18 weeks (yup, you read that correctly - more than 4 months) for the treatment that their GP prescribed.

http://www.computerweekly.com/blogs/tony_collins/2009/04/barts-responds-to-criticisms-i.html

http://www.computerweekly.com/Articles/ArticlePage.aspx?ArticleID=235815&PrinterFriendly=true

How did this happen? No one knows for sure.  There are at least two plausible explanations; neither of them is a cause for optimism.  The first is that the electronic tracking system is so complex that it is almost impossible to track information as its purchasers and operators intend.  This is very plausible. The second possibility is that the NHS trust, recognizing that it didn't like the report it was going to generate(e.g. their wait times were terrible), decided to torpedo their IT system, which would deflect criticism from their overall inability to deliver quality care in a timely fashion.  There are other possible explanations, but these two suffice.

To their credit, the administrators of the trust elected to forego issuing a mandatory report on wait-times, because they had absolutely no confidence in the data used to generate the report. So much for precision tracking.  Sadly, this precedent will make every consumer of information eminating from the NHS wonder about its reliability.  Bad data, whether favorable or unfavorable, can only generate further problems for the NHS.  Discussions based on conjecture are worse, but seem inevitable.

Champions of CHIT will contend that experts should, given time and resources, be able to implement a system that works.  The experience NHS thus far reveals the lie beneath this. Two of the 4 major contractors have walked away from  $ 1 billion + deals, taking a loss just to get out.  The is a maelstorm of criticism of the product of the remaining vendor. 

http://www.guardian.co.uk/society/2009/apr/28/nhs-it-cerner-computers-hospitals

We are forced to conclude while it is possible for CHIT to permit precision tracking of patients, that there are no vendors on this planet that have been able to generate a product that might work for the NHS, at least not yet.

This problem is not unique to England, Australia has similar failures looming on the horizon:

http://www.theage.com.au/articles/2009/04/16/1239474999842.html

The Australian story also suggests that the system they have implemented has little or no capability to improve medication safety, one of the major motivators of the mandates to procure such systems.

One final point: These failures receive much less play in the English press than they would in the US press, because all of the 'subscribers' to the NHS have become accustomed to the exceedingly long wait-times associated with the system.  They're not subscribers or consumers as much as they are sheep, herded by the leadership of the NHS.  They don't even bleat in protest of this kind of failure.  No US hospital would survive the aftermath of a failure like this - except one run by the government....

Comments

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