Tuesday 5 February 2013

Health IT and the coalition's great systems failure

Th systems thinker John Seddon has a talent for confronting ministers with unpalatable truths.  His latest newsletter describes how he confronted Health Secretary Jeremy Hunt as he announced that all patients records would have to be digitised.  Has anyone met a doctor or ambulance man who actually faced a problem that digital records would have solved, he asks?  He suggests not.

But the confrontation with Hunt ended with Seddon pointing him in the direction of an American report which explained that computerised records were intended to save the US health industry $81 billion, but now turn out not to have done so.  Worse, the hospitals which digitised the fastest have cost more.

I hope Hunt really considers this report because there is here a fundamental truth, which Seddon has been pedalling but successive governments have been deaf to.  Expensive IT solutions that prevent systems from dealing effectively with diversity - the range of human requirements that different people come up with - will end up locking in costs.  Customers who don't fit start bouncing around the system and creating costs with each bounce, what Seddon calls 'failure demand'.

What is infuriating about all this, from a UK point of view, is that the coalition understood that the New Labour regime had introduced inflexibilities into the way public services ran.  They realised they made services more expensive, and they began to remove the targets which were at the heart of the inflexibility.

But there was a big BUT.  They failed to construct a narrative which explained what had gone wrong with services in the Labour years - and why they were so expensive and ineffective.  And worst of all, they swallowed whole the Labour caboodle of massive IT solutions and merged back office services which were the source of so much trouble.

So the inflexibilities continue, and they harden and the costs rise - and, just when services most need to be able to deal effectively with diversity (delivering the Universal Credit, for example), the disastrous old solutions are trundled out again.  Often what deals with diversity most effectively, and cheaply, is a human being with the responsibility to act as they see fit.

IT has a critical role to play, but not everywhere. In the wrong place it builds in organisational stupidity.


John Seddon said...

David, just to say I was at my most polite when I met Mr Hunt, trying to point out that he is solving the wrong problem.The real problem being fragmention of services - you'd be astonished how many people get involved in any health 'episode'; and you'd be astonished to learn that succesive 'episodes' are treated as new events. Mr Hunt thinks the patient record will solve this problem. I don't think so.

Joe from Reading said...

I was talking to a cancer consultant recently and asked him about his experience of the new American IT system that the hospital is installing. The local press are headlining its failures and he said it was probably worse than they reported. A prescription that used to take seconds now takes five minutes if (and this is a big IF) the system is not going slow. Every action has to be categorised from a 90 item list and he chooses the least bad lie. If a patient comes in to see a surgeon for a follow up visit and is sent to see him (he's a physician) the system can't cope as you can't have a follow up and a new appointment on the same day.
The system is called the Millenium system and it was a rewrite of an old system 12 years ago and is primarily a billing system for smallish American private clinics and yet some-one thought it was a good idea to foist it on a major DGH at a cost of goodness knows how many millions of direct pounds and untold indirect costs.

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