No matter how far you have gone down the wrong road, turn back

With this excellent proverb in mind Robin Guenier has written a comment for this blog on the NHS’s £12.4bn National Programme for IT [NPfIT]. Guenier is chairman of Medix, an online market researcher which has carried out several surveys of doctors on their views of the NPfIT.

He is also head of the health group of the Information Technologists’ Company, formerly the Worshipful Company of Information Technology. He is expressing a personal view, and is not representing Medix or the ITC.

He comments on a paper by the British Computer Society’s Health Informatics Forum on the NPfIT. His response makes the particularly valid point that the rejection of serious criticism of the NPfIT can lead to complacency which is a probable route to disaster.

Says Guenier: “I fear that the getting-fashionable ‘build on what we have achieved’ philosophy is not a route to success – tinkering won’t do. And success should be all that matters.”

The proverb may apply to any IT project or programme that is in serious trouble, though it was written before the advent of satellite navigation systems.

Would that the proverb had been applied to IT-related schemes such as the Libra project to provide a unified case-management system for magistrates courts, which shuffled on for more than 10 years, those involved knowing it was on the wrong road but unable to say so, because it was deemed politically unacceptable for anyone in authority to say: we have made a mistake; we will rethink the whole idea.

Guenier’s comments are published separately on this blog.

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Sir John Pattison disclosed in late 2007 that the meeting in Number 10 on 14th February 2002, omitted consideration of important aspects, which he listed.

However, he omitted the need for involvement of GPs and their IT systems. Apart from the then PM relying on his “advisors” (in effect potential suppliers and hence not independent), there was a failure to clarify the aims before considering the different options available.

Surely, the end objectives fall into two distinct sections: patient (records) based, and resource based, such as utilisation and waiting times (has the work of Simeon Denis Poisson already been discarded?).

Taking these in reverse order, the second can be vague and subject to the whims of Secretaries of State and Ministers.

However, I would suggest that patient record data falls into three types:

1. If a patient has, say, a good bowel movement at 3am, this may be of significance to the supporting clinical and medical teams, but is of little importance to the aspect of patient records.

2. If a patient needs emergency attention by paramedics away from home, they will require basic data (name, contact data, next of kin, carer, medication, allergies/allergic reactions, etc) for their use and for advising the A & E department of the hospital.

3. In between these sets of data, there is the need for more detailed information (scans, test results, previous treatments, etc).

The lack of a formal approach in 2002 to these needs and the concentration on producing a “prestigious” system has resulted in the present mess.