The UK has invested heavily in healthcare information systems that have largely failed. A new national program called NPfIT aims to implement electronic medical records, prescribing, and other systems across the UK. However, past initiatives have failed due to issues like poor project management, a lack of fit with clinical work practices and culture, and pressure to deploy systems before full evaluation. For healthcare IT to succeed, the authors argue it needs a new model implemented at a national level that enhances human interaction and collaboration.

1. TIME TO RETHINK HEALTH CARE
AND IT
By David Avison & Terry Young

2. BACKGROUND
The health services in the U.K. have invested a lot of money into
(primarily failed) information systems
An IS package (NPfIT – National Programme For IT) across the
U.K. is envisaged to include:
Secure email
Patient e-bookings
E-prescriptions
Integrated care records
Picture archiving
Communications systems
Public health website

3. BUT WHY IS THIS VISION DIFFERENT
TO OTHER HEALTHCARE INITIATIVES?
The capital commitment is extremely high and the investment is at a national
rather than a regional/ hospital level
Two arguments are:
1) Healthcare requires face to face interaction, and collaboration for
collaborative diagnosis etc.
2) These interactions can and need to be supported by information systems.
Most information systems within healthcare are isolated & do not connect; if a
patient moves GP, files and letters must be transferred. This is not an
adequate solution.

4. SO WHAT FACTORS CAUSE
FAILURE
Lack of fit between IT; work practices; culture; environment
Lack of robust, widely accepted evaluation methods, particularly
with respect to cost
Poor project management
Inappropriate structure of NHS
Pressure to roll our new ICT services before pilots are fully
evaluated.

5. EXAMPLES OF SYSTEM ISSUES
 Poor Project Management – Regional Information Systems Plan
(RISP)
 Aim to link every ward, surgery and nurse.
 Purchasing failures - £3.3 million mainframe which remained unused until its
value had declined by 75%
 Cultural Problems – Resource management initiative (RMI)
 To put IT systems into every IT hospital
 Cultural problems importing a U.S. Designed System – with strong emphasis
on cost recovery and specific clinical practices into the U.K. environment.
 Helped management to save costs rather than operational staff

6. CONCLUSION
 The enterprise model is too small a building block for healthcare
 A new / different model must be implemented to healthcare
systems
 This model must have a national context
 A model that enhances person to person interaction