May 28 2011

AHLTA is Not Alone – UK NHS IT fiasco tops it as $17 billion fiasco

Published by at 10:22 pm under AHLTA,Heath IT,VistA

I had thought that DoD’s AHLTA held the record for being the world’s greatest health IT fiasco, spending $4-5 billion of taxpayer’s money on a system that was deemed Intolerable by the GAO and an Assistant Secretary of Defense.  It was so bad that it is cited as one of the leading reasons physicians are leaving military service.  One user told me, “The worst part of AHLTA is when you actually have to read some of the documentation it generates…. there is rarely a coherent statement in a 3 page clinical note.”

I knew that AHLTA would be a failure the instant I saw a diagram of it – a giant, centralized single point of failure that ignored everything that I had found successful in doing the VistA architecture.

This is not just dollars we are talking about, or missed opportunity costs.  Bad software kills people.  I don’t know if we’ll ever know how many patients AHLTA has killed, but it has to be significant.

But enough about AHLTA: I just read this article NHS IT system condemned about the UK National Health Service is in the midst of a far greater fiasco:

In a jaw-dropping condemnation of the NHS National Programme for IT, the National Audit Office has exposed a white elephant in the final stages of collapse.

In what read as a final pronouncement, the NAO reported that after nine years and £2.7bn, (US $4.5 billion)  the NHS has failed to deliver its primary aim of an electronic care record for everyone in the country.

The situation looks so dire the system might continue leeching money from the NHS for another decade if the whole scheme and all its software is not seized by state liquidators.

They go on to say that they don’t think its worth going forward with the remaining US$7.7 billion:

The NAO (National Audit Agency) said CSC would likely fail to deliver the rest before its contract runs out in 2016. DoH had been in dispute over its contract with CSC for 18 months, trying to claw back some of the £5bn (US $8.2b) it had promised the supplier.

What is particularly galling about this situation is that both the US DoD and the UK NHS had access to an award-winning, open source hospital information system that has been running at this scale for 25 years… the VA’s VistA system.  As one of the original software architects of this system, I have seen an endless stream of novice health IT folks appear on the scene, thinking that because they know some other aspect of IT that they can apply this to health IT.  In the past, these folks would slink away after losing $100m or so.  But now, it seems the stakes have been raised to the tens of billions.

We took an innovative approach in designing VistA, and it worked…  So, why are people continuing to pour money down the same failed approaches?

The answer is to follow the money:  A $5 billion fiasco is extremely lucrative to the beltway bandits.  Sure, they have to weather a few editorials and a couple of roastings before the various legislators.  But this can all be fixed with a little lobbying effort.  They’ll apologize, promise never to do it again, change the name of the project, and double the price tag of the next round of funding.  And laugh all the way to the bank with the profits they made on the fiasco.  It’s likely that a successful implementation would have probably earned them less profit.

Tthis isn’t just about an atrocious waste of taxpayer’s money.  People die from bad software.



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