healthy4u: CfH

A Bridge in Brooklyn and an Electronic Medical Records Bargain: Only One Hundred Nineteen Million Dollars Per User - Tolls Included

One of the favorite debates people involved in IT seem to like to have is over the meaning of "failure" of IT projects. <blockquote>Merriam-Webster dictionary: <div mwref="http://www.m-w.com/mwref" id="mwEntryData" hw="failure" code="PI-1b(1)#MD-1b(1)#BZ-2b#EC-2b"><div>Main Entry: fail·ure Pronunciation: \ˈfāl-yər\</div><div>Function: noun </div><div>Etymology: alteration of earlier failer, from Anglo-French, from Old French faillir to fail</div><div>Date: 1643</div> 1 a : omission of occurrence or performance; specifically : a failing to perform a duty or expected action <failure></failure> b (1) : a state of inability to perform a normal function <<a itxtdid="14277878" target="_blank" href="http://www.merriam-webster.com/dictionary/failure#" style="border-bottom: 1px dotted darkgreen ! important; font-weight: normal ! important; font-size: 100% ! important; text-decoration: none ! important; padding-bottom: 0px ! important; color: darkgreen ! important; background-color: transparent ! important; background-image: none; padding-top: 0pt; padding-right: 0pt; padding-left: 0pt;" classname="iAs" class="iAs">kidney failure</a>> — compare <a href="http://www.merriam-webster.com/dictionary/heart+failure">heart failure</a> (2) : an abrupt cessation of normal functioning <a></a><a> c : a fracturing or giving way under </a><a itxtdid="13978570" target="_blank" href="http://www.merriam-webster.com/dictionary/failure#" style="border-bottom: 0.075em solid darkgreen ! important; font-weight: normal ! important; font-size: 100% ! important; text-decoration: underline ! important; padding-bottom: 1px ! important; color: darkgreen ! important; background-color: transparent ! important; background-image: none; padding-top: 0pt; padding-right: 0pt; padding-left: 0pt;" classname="iAs" class="iAs">stress</a> <structural></structural> 2 a : lack of success b : a failing in business : <a href="http://www.merriam-webster.com/dictionary/bankruptcy">bankruptcy</a> 3 a : a falling short : <a href="http://www.merriam-webster.com/dictionary/deficiency">deficiency</a> <a></a><a> b : </a><a href="http://www.merriam-webster.com/dictionary/deterioration">deterioration</a>, <a href="http://www.merriam-webster.com/dictionary/decay">decay</a> 4 : one that has failed</div></blockquote><div mwref="http://www.m-w.com/mwref" id="mwEntryData" hw="failure" code="PI-1b(1)#MD-1b(1)#BZ-2b#EC-2b"> The UK House of Commons Public Accounts Committee report on disastrous problems in their £12.7 billion national EMR program is <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">here</a>. Only the most stubborn would argue that this case and the latest data is not representative of a "failure" in the truest sense of that word: </div> <blockquote><a href="http://www.computing.co.uk/computing/news/2252287/175-people-lorenzo-government">Only 175 people using flagship NHS software, says minister</a> Lorenzo care records system is likely to be costing taxpayer hundreds of thousands of pounds per user per year Written by <a class="" target="" href="http://www.computing.co.uk/articles/authorprofile/2252287">Tom Young</a> <a href="http://www.computing.co.uk/">Computing.co.uk</a>, 30 Oct 2009<div id="post"> <div class="content"> There are only 174 clinicians using Lorenzo patient software across the five early adopter trusts, according to Mike O'Brien, minister for the National Programme for IT (NPfIT). Five Boroughs Partnership, Bradford Teaching Hospitals NHS Foundation Trust, University Hospitals of Morecambe Bay, Hereford Hospitals and South Birmingham have only ever had 19 clinicians using the systems at the same time. Lorenzo is one of two software packages being used to set up centralised electronic health records as part of the £12.7bn National Programme for IT. This part of the programme is already running four years late. Lorenzo is being supplied by services company CSC to trusts in the north of England and by its developer <a href="http://www.isoftplc.com/">iSoft</a> directly to trusts in the south after Fujitsu was fired from the programme. The other patient software package is Cerner Millennium, being supplied by BT in London and a handful of trusts in the south.</div></div></blockquote><div id="post"><div class="content"> By Google: £12,700,000,000 = USD $20,770,850,000 By my calculations, that works out to:£72,571,429 or USD $118,690,571 per user of this software.While a somewhat satirical and sardonic calculation, that's about 73 million pounds or 119 million dollars per user, after almost a decade of work. What more can be said than "stunning?" <blockquote>The information came from a parliamentary question tabled by Richard Bacon MP. Last week in the Commons he said: "I tabled a question yesterday about the number of hospital trusts where Lorenzo has been partially deployed, asking how many users — how many concurrent users — of Lorenzo there are. "It is literally just a handful, which means that the cost per user is not what one would expect… the cost is going to be many hundreds of thousands — possibly even more than a million — pounds per user per year." Bacon said there has not been a single deployment of Lorenzo in 2009 because these early adopter trusts were having such problems. "The reason is that the handful of deployments attempted have been an absolute mess, causing chaos in the hospitals where they were tried," he said.</blockquote> Operations of entire hospitals were disrupted by software. This represents unconsented IT experiments on human subjects gone massively awry. Whether the "chaos" caused anyone harm seems never to be stated. <blockquote>Deployments of Cerner Millennium have also caused problems, with St Barts in London now facing fines of £400,000 a month for missing patient care targets as a result of problems with the system. Bacon also points out that the recently signed contracts with BT to deploy Cerner Millennium at hospitals in the south require BT to be paid even if the hospitals refuse the systems – a possibility if they think they will not work. </blockquote> I would suggest someone in the UK provide screen shots and/or a YouTube video of these systems in operation so others can understand how such results can occur. (Oh, wait: the vendor contracts probably prohibit that, the hospital executives having signed such contracts also having <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda">signed away their fiduciary responsibilities to patients and clinicians</a>.) <blockquote>... Junior Treasury minister Sarah McCarthy-Fry defended The NPfIT in the debate. She said: "We all acknowledge that the NHS IT project is hugely ambitious [profoundly overambitious would perhaps be more accurate - ed.] and that it is essential that we get it right. [The Minister appears to be a master of the obvious - ed.] It is obvious to everybody that many challenges remain. "We still believe that Cerner Millennium and Lorenzo will be able to support the NHS in the long term."</blockquote> </div> </div> Right. I have a bridge in Brooklyn, NY for sale. Perhaps the UK teams responsible for this debacle would be interested. After all, the cost per user of the bridge would be remarkably low, far less than USD $118 million - and the users could even be made to pay a toll for each use: <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidccRyHqPvrCi-f8a4FwEwqYJH4DCu6EaOs0pm7QemIo6M-3SZqk1c0zMFj0PuHOSy-yahQ8VoZ-hBdDqH9eHAGM60FJxaNMd1q0o586YVLzZPdCmDWVyZfFfz7B07MHbkJJwjyqAkf2kO/s1600-h/brooklynbridge.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5399538790921155026" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidccRyHqPvrCi-f8a4FwEwqYJH4DCu6EaOs0pm7QemIo6M-3SZqk1c0zMFj0PuHOSy-yahQ8VoZ-hBdDqH9eHAGM60FJxaNMd1q0o586YVLzZPdCmDWVyZfFfz7B07MHbkJJwjyqAkf2kO/s320/brooklynbridge.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 285px; height: 214px;" /></a>For sale: a bridge in Brooklyn. </div> Perhaps in our own U.S. national health IT initiative, we'll come in at a lower cost per user than $118,690,571 - perhaps about $118,690,570.99 ? After all, those Medical Informatics specialists <a href="http://hcrenewal.blogspot.com/2009/10/medical-informatics-pharma-health-it.html">act like know-it-alls about healthcare IT</a>, and since domain-specific education and expertise are irrelevant in healthcare management, why should anyone listen to them? -- SS

A Bridge in Brooklyn and an Electronic Medical Records Bargain: Only One Hundred Nineteen Million Dollars Per User - Tolls Included

One of the favorite debates people involved in IT seem to like to have is over the meaning of "failure" of IT projects. Merriam-We...

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Cerner board member as Healthcare Czar

President Obama has declared that National Electronic Health Records are essential to curing healthcare's ills. From <a style="font-family: arial;" href="http://www.msnbc.msn.com/id/29466833/">MSNBC</a>: <blockquote style="font-family:arial;">WASHINGTON - President Barack Obama will name former Clinton administration health official Nancy-Ann DeParle on Monday to lead the newly created White House Office on Health Reform, a U.S. official said.DeParle, a former administrator of what is now the Centers for Medicare and Medicaid Services, will lead the White House office charged with coordinating Obama's ambitious healthcare reform efforts with Congress. </blockquote>From the <a style="font-family: arial;" href="http://www.nytimes.com/2009/03/03/us/politics/03czar.html?ref=us">NY Times:</a> <blockquote style="font-family:arial;">WASHINGTON — In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, <a href="http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per" title="More articles about Barack Obama.">President Obama</a> selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/h/harvard_university/index.html?inline=nyt-org" title="More articles about Harvard University.">Harvard</a> Law School and <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/o/oxford_university/index.html?inline=nyt-org" title="More articles about Oxford University">Oxford University</a>. But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate.</blockquote> From <a style="font-family: arial;" href="http://www.cerner.com/public/Cerner_2.asp?id=27436">Cerner Corp</a>, one of the largest vendors of Health IT: <blockquote style="font-family:arial;"> Nancy-Ann DeParle was appointed to Cerner Corporation's Board of Directors in May 2001.</blockquote> From the <a style="font-family: arial;" href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=granger_speaks_out">former head of the UK's Connecting For Health</a> National HIT program: "Sometimes we put in stuff that I'm just ashamed of ... Some of the stuff that Cerner has put in recently is appalling ... Cerner and prime contractor Fujitsu had not listened to end users ... Failed marriages and co-dependency with subcontractors ... A string of problems ranging from missing appointment records, to inability to report on wait times ... Almost a dozen cancelled go-live dates ... Stupid or evil people ... Stockholm syndrome -identifying with suppliers' interests rather than your own ... A little coterie of people out there who are "alleged experts" who were dismissed for reasons of non-performance."<o:p></o:p> From <a style="font-family: arial;" href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm"> The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee, Jan 2009:</a> <blockquote style="font-family:arial;">... 5 The termination of Fujitsu's contract has caused uncertainty among Trusts in the South and new deployments have stopped. One option being considered for new deployments is for Trusts to have a choice of either Lorenzo provided through CSC or the [Cerner] Millennium system provided through BT. There are, however, considerable problems with existing deployments of [Cerner] Millennium and serious concerns about the prospects for future deployments of Lorenzo. Before the new arrangements for the South are finalised, the Department should assess whether it would be wise for Trusts in the South to adopt these systems. Should either of the Local Service Providers take on additional commitments relating to the South, the Department should take particular care to assess the implications of the extra workload for the quality of services to Trusts in the Local Service Providers' existing areas of responsibility. 6 The Programme is not providing value for money at present because there have been few successful deployments of the [Cerner] Millennium system and none of Lorenzo in any Acute Trust. Trusts cannot be expected to take on the burden of deploying care records systems that do not work effectively. Unless the position on care records system deployments improves appreciably in the very near future (i.e. within the next six months), the Department should assess the financial case for allowing Trusts to put forward applications for central funding for alternative systems compatible with the objectives of the Programme.</blockquote> This appointment appears to my untrained eye, on the surface, to be a problem, even with typical promises that these conflicts of interest will not affect decisions. From the NY Times article: <blockquote style="font-family: arial;">White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was “directly or substantially” related to former clients or employers.</blockquote> That is a relief - somewhat. This HIT company is likely to make huge profits in coming years. Will Ms. DePerle give up all financial stakes in this company and industry she and/or her family may hold such as stock, options and other tangibles? In a more general sense, can we as a country really trust such statements from business and government leaders any more? Should we? The <a style="font-family: arial;" href="http://www.dcexaminer.com/opinion/Obamas-HIT-will-likely-be-a-miss-40512247.html">Washington and San Francisco Examiners</a> have it about right in this common sense-filled editorial in which I am cited (I played no part in its appearance): <div id="article_inner" style="font-family:arial;"> <blockquote><h1>America’s foray into HIT will likely be a miss</h1> Examiner editorial 3/2/09 There is a provision of the $878 billion stimulus package rushed through Congress for $20 billion to develop a centralized national health information technology system. Proponents claim HIT will save $77 billion during the next 15 years and greatly reduce medical errors. Who could possibly object to that? Well, for starters, ask health care providers in Britain’s National Health Service, who have been trying to get their HIT system to work properly for the past five years. The cost of NHS’ HIT has escalated to six times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the United States. In January, Public Accounts Chairman Edward Leigh reported to fellow members of Parliament that essential systems are late or, when deployed, do not meet expectations of clinical staff. HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next six months. But even if HIT is eventually junked, British taxpayers will still have to pay for it. The National Academies of Science noted that much of the electronic medical data collected in the U.S. is used mainly to comply with regulations or to defend against lawsuits, rather than to improve patient care. A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one. And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors. After spending billions of dollars during the past three decades, only 4 percent of U.S. physicians have a fully functional HIT system, according to Drexel University biomedical informatics professor Scot Silverstein — and its not because doctors don’t want to use technology. These expensive systems are just not designed for their extremely complex and highly specialized needs. In an open letter to President Barack Obama, Silverstein said HIT is an experiment that’s unproven on a large scale. Computers in hospitals have also been linked to the spread of MRSA, a deadly antibiotic-resistant staph infection. Yet, the same federal government that can’t keep its own military veterans’ medical records secure is bound and determined to spend $20 billion in a top-down, centralized effort that has a very good chance of messing up yours.</blockquote> </div> This raises several questions: <ul><li>Was Ms. DeParle as a board member at Cerner acting definitively when complaints such as those from the UK came in? And perhaps do a google search on terms such as <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&q=healthcare+IT+failure&btnG=Google+Search">healthcare IT failure</a>? </li></ul><ul><li>Will Ms. DeParle support or oppose <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/regulation_and_oversight_hoffman.pdf">needed federal regulation</a> of an industry in which she holds (held) a Board Membership? </li></ul><ul><li>With (former) board members of HIT companies whose products apparently caused the UK's CfH program to cry "uncle" now in positions of ultimate power over U.S. healthcare, and with an administration locked into irrational exuberance over HIT, should physicians in the U.S. also look forward to a forced cybernetic dystopia as at my series <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>?</li></ul> Finally, this is not a piece against our President. He is not, nor expected to be, an expert in information technology and healthcare informatics. I actually feel sorry for him. I feel sorry for him in letting reactionary and opportunistic corporate elements of the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=ecosystem">healthcare IT ecosystem</a> lead him to make calls for full national HIT, along with penalties for nonadoption of this experimental and often defective technology, on the hyperaggressive, absurd and in fact damaging timeframe of five years, by 2014. See "<a style="font-family: arial;" href="http://www.jamia.org/cgi/content/short/13/1/106">Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?</a>" by Ford et al. And parroting the industry line, declaring with full confidence that Health IT will improve quality and decrease healthcare costs. The evidence on both issues is, let's just say, far more contradictory and questionable than the evidence that VIOXX kills people. -- SS

Cerner board member as Healthcare Czar

President Obama has declared that National Electronic Health Records are essential to curing healthcare's ills. From MSNBC : WASHINGTON ...

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