February 2009 Archives

Top 3 lessons from project leaders

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The three main personal lessons learned from project leaders: keep a sense of humour, a backup plan for the unexpected and a focus on the future


The Know How Network.

More NPfIT Lorenzo delays?

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A demonstration of CSC/IBA Health's Lorenzo system was held on 6 November last year at Barnsley Hospital NHS Foundation Trust. The local primary care trust reports that:

"... There remains to be a significant amount of development work to be completed in order for Lorenzo to be considered fit for purpose locally...all future dialogue and work with the SHA and CSC regarding Lorenzo deployment plans must be conducted jointly across the Local Health Community.

"The earliest release that can be considered locally is Release 2 which is planned forQ3 2009/10. However, the Board noted that timescales are subject to confirmation and from previous experiences it was anticipated that this would delay into 2010/11."

Tribunal ruling politely ridicules the OGC

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The wording of the ruling by the Information Tribunal that two early gateway reviews on the ID Cards scheme should be published makes the Office of Government Commerce look foolish.

The Tribunal found, for instance, that the OGC had fielded several (very senior) witnesses, and there were passages in the written statements of more than one witness that read almost identically.

"The Tribunal noted in the course of the appeal that various passages in the statements of more than one witness read virtually identically."

Exemplar NPfIT site in US "endangers patients"

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Reports in the US say that software glitches have endangered patients at the Veterans' Association.

The reports illustrate why e-record systems should be categorised, like some medical equipment, as safety-critical systems. When they go wrong the failures can, when humans don't spot the problem, lead to patients being harmed or worse. 

In 2006 the Department of Health announced that Lord Warner, then a minister responsible for the NHS's £12.7bn National Programme for IT [NPfIT], was setting up a taskforce which would:

"draw on the work in this area done by the Veterans' Association in the United States which has had for some time a fully operational electronic patient record that benefits patients, doctors and medical education and is fully supported by the people in the medical profession who are involved in it".

The US report says:

"VA Software Glitches Endanger Patients

"Because of a software problem that began in August 2008 and persisted for about 4 months, a number of veterans received incorrect drug dosages. The Veterans Affairs Department did not disclose the errors to patients, according to internal documents obtained by The Associated Press under the Freedom of Information Act. Medical data sometimes popped up under another patient's name, and stop orders, as for drugs like heparin, were not clearly displayed. Nearly one-third of 153 VA medical centers reported problems after the annual software upgrade was distributed."

ID Cards insider: scheme is "largest , most complex and sensitive undertaking in Government"

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When they were planning for ID Cards, executives at the Identity and Passport Service thought it a good idea to use the DWP's Oracle-based Customer Information System to store the biometrics part of the National Identity Register.

It avoided the costs, complexities, and risks of failure which would have cast a shadow over building a large database built from scratch.

The problem now is that, through practice rather than any specific plan, the DWP's CIS is becoming the government's main citizen database.

This means that thousands of council staff and other public and civil servants are being given access to it.

And some council staff have already been using the CIS to check the data it holds on their friends and relatives.

Officials at the Identity and Passport Service point out that although the National Identity Register is being built on the DWP's CIS, ID card biometrics will be held separately on the CIS database.

Top tips for project managers?

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Below is a compilation of project management truisms. Some have been around years; a few are my own concoctions - the result of researching and reporting on countless IT projects and programmes.


1. Projects with realistic budgets and timetables don't get approved

2. Activity in the early stages should be dedicated to finding the correct questions

3. The more desperate the situation the more optimistic the progress report

4. A user is somebody who rejects the system because it's what he asked for

5. The difference between project success and failure is a good PR company

OGC loses FOI ID Cards battle - does it care?

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The BBC reports that "ministers have been ordered to publish two reviews into the controversial ID Cards scheme after a four-year Freedom of Information Battle".

This is true. But the BBC doesn't mention that the two "gateway reviews" in question, on the ID Cards scheme, may never be published.

E-records may be banana skin for Obama - SCR expert

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Trisha Greenhalgh, professor of primary health care, University College London, has given a less than ringing endorsement of plans in the US and UK for a national database of health records.  

Greenhalgh was one of the authors of a report last on the NPfIT Summary Care Record. The report was commissioned by NHS Connecting for Health.

Writing in the British Medical Journal Greenhalgh says of US President Barack Obama: 

"I predict that his promise to digitise the medical records of every American within five years will prove to be his first major political banana skin.

"His genes may be half African and half American, but his personal data could never be both 100% shareable and 100% secure.

"And if you place your medical record on a networked computer system in a free market economy you can be sure that there will be someone who wants to sell it--and someone else who wants to buy it."

Thank you to GP Paul Thornton for sending me the BMJ article.


UCL evaluation of the Summary Care Record - led by Trisha Greenhalgh



Summary Care Record opt out - some challenges

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Health officials want to dissuade patients from opting out of the Summary Care Record, but are unsure how to go about it.

If too many patients opt out of a national database of summary health records clinicians may not trouble themselves to use it - and some may not trust it anyway. The summary care record is one of the main beams of the National Programme for IT [NPfIT].

BT relief as NPfIT roll-outs in London due to resume

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Roll-outs in the London area of the Cerner LC1 Millennium Care Records Service are due to resume, Computer Weekly has learned.

The resumption makes it less likely that BT and the Department of Health will part company over the supplier's £1bn contract as London's local service provider under the National Programme for IT [NPfIT].  BT will be relieved to go to its financial year end with renewed activity on the London Programme for IT.

But the risks remain.

Swindells: NPfIT needs to change

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Matthew Swindells, the former interim NHS CIO who led a review of NHS Informatics, says that the NHS's National Programme for IT [NPfIT] should cease being presented as "The Solution" for the health service.

He has also called for a plurality of IT suppliers rather than reliance on the two local service providers CSC and BT. He said that two closed local service provider systems were a hindrance to government policy; and added that delays in implementations "necessitate changes to allow local organisations to take medium-term investment decisions now which won't be invalidated by NPfIT".

Cerner revenues up 18% in 4th quarter

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Cerner beat Wall Street expectations, reporting an adjusted fourth-quarter profit of $53.6 million, or 65 cents a share, reports the local paper where the supplier is based.

Meanwhile at least two UK Foundation Trusts are considering buying the Cerner system from the University of Pittsburgh Medical Center - Newcastle Upon Tyne Hospitals NHS Trust has already bought it

But it's unclear whether having an indirect relationship with Cerner will prove any more successful than having BT as an intermediary. BT supplies and installs the Cerner Millennium system in London as part of the NHS's National Programme for IT.

Homerton in London made a relative success of Cerner - but the trust signed a contract directly with Cerner and has been able to make the changes it wants - unlike other Cerner users.


Kansas City Star - Cerner's local paper

Rotherham set to announce EPR contract - E-health Insider

MPs visit e-record sites in Canada and US as part of NPfIT investigation - IT Projects blog

Interview with CEO of Rotherham break-away trust - IT Projects blog   

NAO inquiry into government IT likely

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The Times reports today that the National Audit Office is likely to investigate Whitehall's biggest computer projects and contracts after disclosures that their costs had exceeded the announced figures by more than £18 billion.

Edward Leigh, chairman of the Public Accounts Committee, said: "As a result of The Times's investigation I am going to immediately ask the Comptroller and Auditor-General [the head of the NAO] to investigate the whole matter of government IT spending and in particular the contracts highlighted in the paper."

The NAO, although independent of the government and Parliament, produces reports and briefings for the Public Accounts Committee and will usually agree to the committee's request for an investigation. The NAO has reported to the committee on several of the individual projects listed by The Times in its joint investigation with Computer Weekly but an aggregated report could point out common factors, problems and lessons.


Government IT projects will cost taxpayers £18bn more than expected - Computer Weekly

Watchdog to investigate how government IT projects overran - The Times

Something must be done to break cycle of IT failure - CW Opinion piece in The Times  

£18bn Government IT scandal - 3 pages in The Times today

Secret deals that cost taxpayers billions  

NPfIT and implications for the US?

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Dr Richard Cook, a US doctor and researcher at the University of Chicago, has drawn my attention to his short analysis of the NHS National Programme for IT and the implications for the US government's investment in clinical healthcare IT. 

He says that what is happening in the UK is giving US observers nightmares. So much for the NPfIT setting the standards worldwide, which was the message being conveyed across the globe in the early years of the programme.

Dr Cook's research includes the study of human error, the role of technology in human expert performance, and patient safety.




Dr Cook's Virtualgryphon blog

IBM and open government

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After The Times yesterday published the results of a joint investigation with Computer Weekly over government IT projects - contracts have cost at least £18bn more than first announced - a public sector employee has emailed to ask me why there was no mention of IBM.

IBM was the prime contractor on one of the projects mentioned in The Times - the Scope system for the intelligence services. But IBM's name was not mentioned.

As The Times says, the government is secretive about its IT contracts. Sometimes the government does not want Parliament or anyone else to know the name of the main IT contractor. This is despite the fact that Scope is on the list of the government's highest-priority "mission-critical" projects.

I understand from separate sources that IBM is the Cabinet Office's Scope system contractor, though neither the Cabinet Office nor IBM will comment.

£18bn Government IT scandal - 3 pages in The Times today

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On its front page today - and in a two-page spread inside - The Times has published a joint Times and Computer Weekly investigation on government IT including an opinion piece from us.

The articles refer to IT-based projects, programmes and contracts which have exceeded the original announced costs by more than £18bn.

MPs are fed up with failures of some large government IT-based projects and programmes - as are the government IT professionals, civil and public servants, and contractors who are achieving success on very limited budgets and find their work is overshadowed by the project Chimeras which have unrealistic time-frames and budgets.

The opinion and the analysis in The Times make it clear that we're not attacking government IT people but the way projects are approved without enough Parliamentary or external challenge to assumptions.

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