The UK National Health Service technology disaster

[starroute]

I don't know if this has been posted already -- if it was, I missed it, but it's important enough to repeat. It sounds like a classic case of large, secretive bureaucracies doing all the wrong things -- and it starts with Accenture, the same people who keep messing up electronic voting:

http://www.baselinemag.com/article2/0,1540,2054702,00.asp

In late September, Accenture, the global management and technology consultancy, announced it was walking away from a $3.73 billion contract as an information-technology services provider on the world's biggest non-military I.T. project, a hugely ambitious and complex attempt to transform England's entire National Health Service through technology. Accenture, which failed to respond to numerous requests for interviews, did not say why it was exiting the National Health Service (NHS) project, but earlier this year it had set aside $450 million to cover potential losses from its work in England. Its exodus represents the latest in a series of setbacks and missteps that have plagued the highly controversial program since its inception. . . .

In scale, the project, called the National Program for Information Technology (NPfIT), is overwhelming. Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies. . . .

Yet, many pieces of the project—including deployment of key electronic records software—have been delayed and the program's cost has ballooned.

The NPfIT was initially budgeted at close to $12 billion. That figure is now up to about $24 billion, according to the National Audit Office (NAO), the country's oversight agency. And it is as high as $28.4 billion, according to other estimates. Even the lower of those two amounts is more than the price tag for building the English Channel Tunnel or Boston's massive Big Dig project, considered to be the most expensive civil project ever. Worse, the funding established to pay for the system has, temporarily at least, dried up.

All you'd know from the article, though, is that it's an overpriced mess. This blog entry at The Yorkshire Ranter gives more of the nitty-gritty on just *why* it's such a mess:

http://yorkshire-ranter.blogspot.com/2006/11/hownotto-build-computer-system.html

First of all, letting the producer interest poison the well. Microsoft execs, eh? The big centralised-bureaucratic proprietary system vendor Microsoft was permitted to influence the whole process towards a big centralised-bureaucratic proprietary system from the very beginning. This occurred at a time when Health Secretary Alan Milburn was constantly railing against "producer interests" blocking his "modernising reforms". This was code for the trade unions that represented low-waged nurses and cleaners, and the British Medical Association that represented doctors. . . .

The managerialists inevitably called on a management consultant to run the show - as we all know, we are living in a new world, and the status quo is not an option, so nobody who actually knew anything about the NHS, hospitals, or for that matter computers could be considered. (Granger failed his CS degree.) With equal inevitability, he called on management consultants to tell him what to do. The great global consulting firm McKinsey duly concluded that only great, global consulting firms could do the job.

Choosing which ones was clearly a job only central authority could undertake, and the intervention of the press, the unions, competitors or elected representatives would only get in the way, so the whole thing vanished behind a cloud of secrecy. Secrecy enhances power. It does this by exclusion. The groups excluded included the doctors, nurses, technicians and administrators of the NHS - which means that the canonical mistake, the original sin of systems design was predetermined before the first requirements document was drawn up or the first line of code written. Secrecy specifically excluded the end users from the design process. . . .

The NHS bought 900,000 desktop licences for MS Windows and further commissioned Microsoft to develop a common interface for the NPfIT, thus ensuring that any common interface would be proprietary and unalterable except by Microsoft. But no-one seems to have thought through the implications of common standards. Instead, the contracts specified that the old systems must be torn out and the data transferred to the new, thus adding a huge sysadmin nightmare to the costs.

Trying to keep down the costs, iSoft outsourced the development to India. . . .

[Deja Q]

1. Corporations claim India is lower cost with more intelligent developers.

Forgive me, but I also hear reports of IT stuff coming BACK to the US in tatters. Never mind the cultural and linguistic differences.

In short, who in the media is telling the truth? If there are so many problems with offshoring, et al, why is it only accelerating, complete with educational centers being built up for the locals? (zdnet.com periodically states ___ is moving x,xxx jobs... new educational centers... et cetera...)

Again, offshoring isn't entirely a bad idea - but the hits being taken by people in the home countries is hurting on many levels. Especially with this favoritism going on; American workers told to get educated and these companies are doling out education to everyone but Americans.

Where is the missing link? Looking at all the media sources, nothing is tying together and I don't want to conjecture based on inferring from hyperbole.