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Trouble Across the Pond

May 23, 2011
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British National Health Service’s EHR implementation far below expectations

The Office of the National Coordinator’s project of providing incentives that will lead to a network of interoperable health records is an amazingly complex one. Its success or failure will in large part be judged by how willing physicians and hospitals are to engage in the time-consuming processes of installation, training, and reporting on quality measures.

As a reminder of that complexity, we need look no further than the scathing audit a similar program has just received in Great Britain. Of course, the projects are different in many aspects, but we should all hope that the meaningful use effort never gets an internal audit report like the one the British National Health Service’s National Programme for IT just received from the National Audit Office on May 18.

That audit found that the rate at which electronic care records systems are being put in place across the NHS is falling far below expectations and the core aim that every patient should have an electronic care record under the program will not now be achieved.

“The original vision for the National Programme for IT in the NHS will not be realized,” said Amyas Morse, head of the National Audit Office, in a prepared statement. “The NHS is now getting far fewer systems than planned despite the department paying contractors almost the same amount of money. This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change program.”

The NAO report concludes that the 2.7 billion pounds spent so far on care records systems has not been money well spent. “And, based on performance so far, “ it says, “the NAO has no grounds for confidence that the remaining planned spending of 4.3 billion pounds on care records systems will be any different.”

The report notes that progress in delivering care records systems varies dramatically between regions. Where care records systems are in place, they are not yet delivering what was expected. In some settings, the systems are mainly providing administrative benefits, rather than the expected clinical ones, such as prescribing and administering drugs in hospitals. The Department of Health has now moved away from its intention to replace systems wholesale. Instead it will build on using trusts’ existing systems.

“The Department of Health needs to admit that it is now in damage-limitation mode,” Morse said. “I hope that my report today, together with the forthcoming review by the Cabinet Office and Treasury, announced by the Prime Minister, will help to prevent further loss of public value from future expenditure on the Programme.”

Could the program be dropped altogether? Are there enough similarities to the U.S approach that we should be worried by this example? Are there some lessons to be learned here?

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