Project Management – Why Brit Health Project Does Everything Twice

Britain’s National Health Service in recent months has been awarding contracts for a major IT project: creating a database of electronic patient records that will include every citizen in England. As with any billion-dollar project, there’s intense interest about the expected costs and benefits. But there’s an added wrinkle here in that the contractors are organized so that they are building duplicate IT systems all over the country. If one contractor’s records system fails, the logic goes, the others will be in a position to pick up the pieces.

The contracts total $10.3 billion over 10 years and concern just England (decentralized Wales and Scotland have their own plans). The project is possible because the tax-subsidized British health system puts 30,000 doctors’ surgeries and 270 regional hospital trusts covering 50 million patients under a single management. Advocates of computerization point to lower costs, the fact that patients’ care notes can stay with them for life and improved medical treatments from automated analysis of medical records.

If that sounds straightforward, the attractions of the contract award process are less obvious. Richard Granger, the director general of National Health Service IT and former Deloitte Consulting lead client service partner, is the first to hold this title that makes him, essentially, health service IT supremo. Granger has led this process that divides the computerization task into a series of subcontracts. Prime contractor BT will manage the project and supply the central database and network, while other regional contracts to computerize hospital and surgeries have gone to a range of companies including Accenture, CSC and Fujitsu. (One notable absentee: EDS, which was widely viewed as responsible for a tax system foul-up that was the subject of a Parliamentary inquiry in 2003.)

Each contractor’s job is to install virtually identical electronic patient records systems in Brighton, Bristol, Birmingham and hundreds of other cities across England. While it might seem inefficient, this duplication is rife?by design. “The approach is radically different to anything we’ve seen before,” says Tola Sargeant, an analyst with Ovum. “By splitting the project into five regions, the idea is to promote competition.” Should one vendor fall down, others will be vying for the work?and be well-placed to quickly take it on.

But despite the hoopla, electronic patient care records aren’t new, having first surfaced in a government strategy document in 1998. Many hospitals had already taken the plunge, and others were about to. “We’ve had to demonstrate that our patient care record project was in compliance with the national guidelines,” says Mark Bostock, IT business development manager at the Lancashire Teaching Hospital NHS Trust. While the Lancashire project passed muster, many other soon-to-start projects didn’t, he explains.

Despite Europe’s reputation for strict privacy laws, privacy issues haven’t dominated the project, notes Ray Jackson, managing director of Solcara, a company involved in de-identifying patient records for the health service. When transmitting patient records externally, the strategy is to strip out names and addresses, and rely on the unique health-service number issued to every citizen. But that won’t take care of confidential information held in free-text fields, such as doctors’ notes, warns Jackson. So far, having been long accustomed to regular newspaper reports of patient records turning up in Dumpsters, British citizens seem unfazed.