End of the ‘Golden Weather’ for Big, Top-down Health IT projects

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I would like to discuss a key trend we are now seeing:  large government-sponsored shared medical records projects hitting the same obstacles all over the world.

When Professor Trisha Greenhalgh analysed the UK’s National Programme for IT (NPfIT) failure to deliver a summary care record (SCR), she identified three key problems, each of which has the potential for huge impact on the success or otherwise of a large health IT system:


  1. Clinicians’ distrust in the completeness and accuracy of a medical record constructed from various, often unknown sources.
  2. Mounting concerns over patient privacy/confidentiality and potential for patients to lose trust in the dependability of the health system.
  3. The cost of integrating information from disparate sources in a sufficiently robust manner to be consistently depended upon.

Let’s take stock is happening in some of these projects.

Closest to home is the Australian Personally Controlled Electronic Health Record (PCEHR).  This system aims to eventually provide each Australian citizen with a health record that he or she controls.  A billion dollars in the making it went live last July.  It is too early to form a firm conclusion about it but early reports, such as this one in the Herald Sun, would indicate that progress is very slow.
In the USA the Obama Government has made a considerable investment in beefing up health IT.  Twelve billion dollars has been spent on subsidising the purchase of hospital and general practice electronic medical records systems and $564 million on purchasing systems that connect them.  Few of us would disagree that such a high level of investment in health IT was a worthy initiative, there are now a number of criticisms emerging as to the way it has been done.  While it is always easy to criticise ‘after the fact’ it is worth reading some of the analysis.  HealthLink's considered view is that some of the electronic medical records systems were not sufficiently advanced to justify their continued/extended use and it might have been better to set in place incentives to develop new/improved systems rather than roll out outdated ones.  We also believe that insufficient effort has gone into developing data-communications standards.  This view is widely shared and there are now moves afoot to re-examine what is happening in the US.  Here is a US Senate paper with some views as to what should be happening. 

And here are some views from the academic community.
And finally, looking at the United Kingdom, the health IT sector is starting to show signs of recovery after nearly being killed off during the NPfIT juggernaut which set out to rip and replace all existing IT infrastructure and failed so spectacularly.
One of the organisations that has thrived in the wake of the NPfIT is EMIS, the UK’s leading brand of electronic medical records software.  The EMIS brand was expected to disappear upon the arrival of the NPfIT.  Today it is a very large and highly successful company. 

Sean Riddell EMIS CEO2Sean Riddell, The CEO of EMIS, upon retirement stated the following: “We were the main system supplier that said no to the NPfIT... The approach of trying to deliver a single monolithic system is absolutely flawed. You need to do it with best-of-breed systems that are directed in a very granular way to do the job that the clinician needs.”

 Where To From Here?

Our view at HealthLink is that the most valuable thing we can do is to continue to design and implement systems that help doctors improve their day to day delivery of healthcare.  For those people who do believe that there is a future beyond the electronic medical record, there is no doubt that they are right.  Take a look at this video from iDoctor - Could a Smartphone Be the Future of Medicine?
And lastly, to see what is happening in the New Zealand health IT scene, plan to come to HINZ 2013, Engaged Patients - Rebalancing The Clinical Relationship, 27-29 November 2013, in Rotorua.  As you probably already know, New Zealand has one of the most advanced health IT infrastructures in the world.  The HINZ conference is where you find out all about what is going on.


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Author: Tom Bowden

Date Published: 24.05.2013