Cold Comfort: UK’s Healthcare IT Reform Also Ended in Disaster

Would it make you feel any better about Obamacare’s foundering start to know that the U.K. also failed in its attempt to digitize its national healthcare system? I didn’t think so.

To be fair, the U.K. actually had mixed results with the integration of financial systems and healthcare records that form the information backbone of its massive National Healthcare System.

Revamping the financial aspect actually turned out to be somewhat of a success. Tying in medical information, however, was a huge catastrophe. It was ended when the government pulled the plug in 2011, but it continues to be called the nation’s “most expensive contracting fiasco.” It’s estimated to have cost the nation billions of pounds.

In an IT sense, there seem to have been several striking similarities between the U.K. experience and what has happened in the United States. Namely, an expedited and inflexible launch timeline and a lack of sufficient testing.

Breaking Everything for Healthy Accounting

In terms of tying together the financial systems used to settle healthcare accounts, the U.K. faced a much simpler challenge than the United States.

Here, hundreds of insurance companies need to cooperate with the tens of thousands of health providers including hospitals, clinics, and pharmacies. But in the U.K., one organization, the U.K. National Health Services, is responsible for funding most health care services. As a result, the U.K. NHS was in a position to clean the slate and come up with a consistent set of standards for how it wanted the information to be reported and managed.

It was still a challenge bringing everything together because each of the hospitals had standardized on different accounting and IT systems. Trying to massage this information together into a common format that could be understood by auditors was a significant challenge.

Hannah Goodman, director of solutioning for NHS Shared Business Services, says, “This led to a huge reconciliation at the end of every month, and a nightmare at the end of every year. The Department of Health only knew three months after the reports had been submitted how much had been spent.”

So rather than go through the nightmare of trying to translate these different accounting formats and integrate the various IT systems together, the NHS decided to scrap everything and start fresh. Existing organizations responsible for financial management were disbanded, and accountants were transitioned to new organizations. This made it harder for existing groups to try and reinstitute the old accounting processes that were not aligned with the new one being put into place.

“This was about transformation,” Goodman says. “If we had allowed them to tell us what they wanted, we would have ended up replicating the organizations we abolished.”

The one major improvement was that now the NHS could track spending across all organizations within 48-hours of being spent, as opposed to the three months it took before the reorganization. This made it easier to investigate and take action on anomalies as they occurred and before too much money was blown on bad practices.

But Don’t Break Healthcare Too

If the U.K.’s overhaul worked to fix accounting, the integration of medical information was a massive boondoggle. Much like in the U.S., each hospital had its own approach to managing medical information. The government tried to define a common format for describing health records, but never bothered to consult with the doctors who would be relying on this information to make decisions that affected the well being of patients.

Proponents had initially planned to spend about £2.3 billion ($3.7 billion today) on a three-year project to integrate electronic healthcare records. Ten years and £12.4 billion ($20 billion!) later, the project was scrapped. The U.K. National Accounting Office noted “… it was not demonstrated that the financial value of the benefits exceeds the cost of the Programme.”

Even if the back-end system had worked flawlessly, it would not have mattered if the end-users (the doctors) couldn’t use it.

In a press release about the failed project, the UK Department of Health said, “… we need to move on from a top-down approach and instead provide information systems driven by local decision-making.  This is the only way to make sure we get value for money and that the modern NHS meets the needs of patients.”

Identifying Causes for the Failure

The real failure in this exercise was the lack of user-acceptance testing, which in this case meant ensuring that doctors were able to get the value they needed from the system before scaling it up.

Simply asking doctors what they wanted would have been a good first step. But better yet would have been the rollout of small proof-of-concept tests that could have been studied and improved incrementally before a national rollout.

Here we find a striking similarity to the U.S. experience. Throughout the implementation, doctors and developers alike complained that politicians, in this case former Prime Minister Tony Blair’s government, had established a “non-negotiable” timeline. The U.K.’s Department of Health established as it’s first key requirement “Rapidity: This means the commitment of all parties to do things quickly.”

As the U.S. government has now found, rushing such complex change comes with grave dangers if you lack sufficient means of testing in development and otherwise managing continuous development across partners. Tools exist today that make every step in the process smoother and more assured of success.