NPfIT now known in the US - but for the right reasons?

President Obama has personal reasons for wanting to cut the costs of US healthcare. He speaks of his mother who died of ovarian cancer at the age of 53.  While dying she spent weeks fighting insurance companies.

“If you’ve got a pre-existing condition, insurance companies will still have to insure you,” he said. “This is something very personal for me. My mother, when she contracted cancer, the insurance companies started suggesting that, well, maybe this was a pre-existing condition.”

“Ultimately, they gave in,” Obama continued, “but she had to spend weeks fighting with insurance companies while she’s in the hospital bed, writing letters back and forth just to get coverage for insurance that she had already paid premiums on. And that happens all across the country. We are going to put a stop to that.”

It’s not such a surprise, then, that Obama wants to cut the costs of US healthcare and has put technology at the centre of his plans.


Congress has found nearly $20bn to create a national health-informationnetwork. It wants to put to rights the technically backward UShealthcare systems. There will be incentives for hospitals to adoptelectronic health records.

The independent Rand Corporation estimates that if 90% of US hospitalsand doctors adopted HIT [health information technologies] over 15 yearsthere could be savings of $77bn a year from efficiency gains. Therecould be fewer deaths too if reliable e-records were always available.

But will US taxpayers end up paying for systems that seem to work wellin specific hospitals but which fail when rolled out nationally or on alarge scale?

Supplier lobbyists are at their most credible when marketing successfullocal hospital systems as national software. Will Obama’s plans end uplike the NHS IT scheme?

As the Economist conceded, in a little-noticed article on US EHRs, “health is hard”.

This is where the NPfIT comes into its own, though not perhaps in theway intended by Whitehall officials who went to the US and elsewhere topromote the UK Government’s £12.7bn IT scheme. They’d wanted the NPfITto be used by various governments as an exemplar. It is – as a type ofscheme to be avoided.

Before mentioning the NPfIT, the Economist article on Obama’s healthcare IT plans quoted examples of success around the world:

–    Denmark has an e-health system to which nearly everyone isconnected and which tracks drugs prescribed to whom, by whom and when.
–    India’s Apollo hospital chain uses advanced EHRs built locallywhich provide the “sort of data on patients that doctors need to see”.
–    Bumrungrad Hospital in Thailand is famous for its medical tourism – 400,000 foreign patients ayear. In the absence of suitable products from Western softwaresuppliers, Bumrungrad built its own hospital management system fromscratch. Through the use of its IT Bumrungrad International hospitalhas achieved “amazing outcomes related to improved workflow and patientsafety”, said Peter Neupert, corporate vice president for the HealthSolutions Group at Microsoft.

Then comes the mention of the NPfIT:

“Fancy kit and pots of money alone are notenough, as Britain has discovered to its cost,” said the Economist article. “Under a scheme known as Connecting for Health, theNHS is spending nearly £13bn digitising England’s health system. It maysucceed in the end, but the process has been agonising.”

A big flaw was the top-down approach to the project, said the article.John Halamka, the CIO at Harvard Medical School, said that reformersneed to take a bottom-up approach, listening to doctors and patients.He is convinced that control by the patient works best.

Aureilia Boyer, CIO for the New York Presbyterian Hospital, haslaunched a pilot EHR using Microsoft’s Health Vault. Patients decidewhich parts of their record they wish to share and with whom.

Meanwhile the NPfIT is becoming a useful weapon for Obama’s politicalfoes. Republican Bridgette Wallis says that what works well in theprivate world does not work in Big Government.

“We only have to read current headlines from England to see theunintended consequences of trying to implement a nationalized HITsystem … the programme was started in 2002 and implementation began in2005. It was originally supposed to cost $3.7bn over a three yearperiod of time for full implementation … it  should have been up andrunning successfully since 2008.

“As of this month, only very small parts of the NHS NPfIT are workingcorrectly and two of their four main contractors have either been firedor quit. There is now a revised completion date of 2015 and a revisedprojected cost of $32.9bn – if it is even finished…”

Gordon Brown, Tony Blair, Lord Hunt, John Hutton, Lord Warner and otherLabour notables always wanted the NPfIT to have a reputation across theworld. Perhaps they’re regretting that one of their wishes has cometrue.

Links:

Tom Brooks on US health-care IT plans – IT projects blog

EMIS to the rescue of the Summary Care Records scheme? – IT projects blog

NPfIT – subject to the vagaries of change – The Auricle

UK health record system terminal? – Crhoma.org
 

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It would be a surprise to the 160 hospitals who have been using the open source EHR at the VA system (nation wide) as well as to the 6 million members who belong to Kaiser to discover that EHR's aren't scalable. Both of these systems have some of the highest quality and lowest cost in the country.

An EHR is pretty much useless if you don't have your doctors office and hospital online. It is the equivalent of having Quicken when your bank isn't online and you would have to manually enter all of your data. What EHR does NYP use for example? Does Microsoft even have an EHR (think of the bank records) or just assume that someone else will pay to install that piece and then patients can export that data. It is not what the NHIN is all about.

Remember Microsoft core product "Amalga" is based on the assumption that there you need a piece of software to translate one program to another so they have a vested interest in not having interoperability. Many of the examples cited are Microsoft clients and this article sounds like it might be a PR piece by Microsoft. [edited]

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