Biggest IT Disaster Ever?

lizzyben writes, "Baseline has a major story about a major IT disaster in the UK: 'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion, and two Members of Parliament say the project is "sleepwalking toward disaster"... In scale, the project... (NPfIT) is overwhelming. Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies.'" An Infoworld article from earlier this year sketches some of the all-time greatest IT meltdowns.

Honorable Mention

[eldavojohn]

Well, I recall the FBI's Virtual Case File [wikipedia.org] system that took 2-3 years to develop and costed $170 million to produce [cnn.com] an absolute failure. In the end, they found a "suitable commercial replacement." Probably at a fraction of the price.

So, $170 million/3 years = $55 million/year while the article seems to imply an oversight of one billion per year on the NPfIT [wikipedia.org] which is outrageous. I'm confused how one would even spend that much money on an IT project for a country the size of England--were they laying expensive new shiny fibre wire devoted for medical records only to every facility?

Re:

[Anonymous Coward]

Well, I recall the FBI's Virtual Case File...

For those who RTFA, it's linked in the blurb.

Re:Honorable Mention

[IDontAgreeWithYou]

But... But... R'ing TFA means I won't get teh frist psot.

Re:

[__aaclcg7560]

It's a boondoggle. America has the "Bridge to Nowhere" and they have the "Fiber Optic Health Care".

Far far bigger - IT sourcing bug killed a country.

[Anonymous Coward]

The biggest one was deliberate - and took down an entire country.
The biggest IT disaster every was due to choosing the wrong vendor for
sourcing software, in which
deliberate bugs were planted [fcw.com]

"Why not help the Soviets with their shopping? Now that we know what they want, we can help them get it." There would be just one catch: The CIA would add "extra ingredients" to the software and hardware on the KGB's shopping list.
...
computer chips were designed to pass quality-acceptance tests before entry into Soviet service. Only later would they sporadically fail, frazzling the nerves of harried users. Pseudosoftware disrupted factory output.

Resulting in major collapses of Soviet infrastucture.

Some may argue it's not an IT disaster -- but the root of the problem was that people sourced buggy software from closed source vendors and couldn't get their bugs fixed. -- The same thing happens all the time on a smaller scale when people buy Windows.

Re:Far far bigger - IT sourcing bug killed a count

[Atlantis-Rising]

You're comparing purposefully designed flaws done by the CIA with Microsoft incompetence? THat's kind of a stretch.

More importantly, perhaps, was the fact that the CIA was also screwing with the HARDWARE at a manufacturing level.

Frankly, your entire argument doesn't make sense at any level. If the Soviets had the people to check the software in-house, it would have been far more reasonable and realistic for them to make the software in-house too. Instead, the entire REASON the KGB was stealing this software was because they COULDN'T develop it themselves.

For god's sake, the KGB was stealing American technology and the CIA introduced purposeful bugs to counter them. That's got abso-fucking-lutely nothing do to with IT and everything to do with spycraft.

Only an absurd zealot would be in able to connect that somehow to Microsoft being bad.

Re:

[salimma]

Microsoft did do something similar in the past. Windows 3.1 (AFAIR) would check if it was running on top of DR-DOS, and if so would randomly fail.

Re:

[dulridge]

Sheer size. The NHS employs around a million people (882,000 for England alone) and you are talking about the records for nearly 60 million living people (and the digitised records of dead people - some clinical records are required to be kept for 75 years after the death of the patient). The NHS is 58 years old. That's a lot of data. Tax records are far simpler

Number of locations - every GP surgery in the country - even the ones in the islands 10,465 of them in 2004 (figures here [rcgp.org.uk]) plus all the dentists (

maybe next the Air Traffic systems?

[yagu]

The article:

The inspiration to digitize this far-flung bureaucracy first surfaced in late 2001, when Microsoft's Bill Gates paid a visit to British Prime Minister Tony Blair at No. 10 Downing St. The subject of the meeting, as reported by The Guardian, was what could be done to improve the National Health Service. At the time, much of the service was paper-based and severely lagging in its use of technology. A long-term review of NHS funding that was issued just before the Blair-Gates meeting had concluded: "The U.K. health service has a poor record on the use of information and communications technology--the result of many years of serious under-investment."

It's unfortunate but common to look at "under-investment" as root cause. Britain's problem could have been vastly improved even as a paper system by just getting their arms around communication, procedures, standards, etc. (I'm not talking about IT standards here, they're about as worthless as the electrons they spin on.) And then to be tantalized by Gates himself that technology (probably especially Microsoft Windows, sigh) would solve the problem.

I've seen amazing organization and communication among systems with simple low speed modem and dialup connectivity. It's not the technology, it's the grasp of the subject matter and how to organize it. Britain's example looks to be one of classic "good money after bad".

Get a bunch of people in a room who know what they need (sounds like they didn't) and put them together with a bunch of people who know how to do it (sounds like they didn't). It really is that simple, and it's not as hard as they made it.

The evidence?:

The process for selecting vendors began in the late fall of 2002. It was centralized and standardized, and was conducted, Brennan and others say, in great secrecy. To avoid negative publicity, NHS insisted that contractors not reveal any details about contracts, a May 2005 story in ComputerWeekly noted. As a byproduct of these hush-hush negotiations, front-line clinicians, except at the most senior levels, were largely excluded from the selection and early planning process, according to Brennan.

Though in the next paragraph the "CfH" denies that (why is it always organizations "denying" something, come on someone, step up and take accountability), I'm guessing the accusation is accurate.

When projects like this get going and the emphasis should be on subject matter experts (SME), the projects usually get expendable high-level highly paid deadweight -- I've seen it too many times. One project I was on we got assigned two SME's, one was so oblivious to the statement of the problem we even wondered if he (or she) had ever worked in the industry.

Other evidence the project was ill-conceived and guaranteed a disaster?: from the article:

[from the baseline goals] Reduce the time it takes to send medical images, such as X-rays, from about four minutes to less than one minute.

I'm guessing $24B spent to get an X-ray in one minute instead of four begins to be diminished returns.

Also:

Gates is viewed as the godfather of the NPfIT because he reportedly sold Tony Blair on the benefits of bringing the digital revolution into every doctor's office and hospital in Great Britain. In the process, the British government signed an Enterprise Subscription Agreement (ESA) with Microsoft for 900,000 desktops for Office Professional Enterprise Edition 2003 and various client access licenses. Microsoft also is developing a common user interface for CfH. Gates received an honorary knighthood in 2005.

This just reeks of cronyism and idiocy. If for no other reason, I'd vote Blair out of office for this -- it's insane. Bill probably walked away from this pretty happy though. Aside from the questionable broad brush technology choice, "Microsoft is develop

Re:

[kraut]

> This just reeks of cronyism and idiocy. If for no other reason, I'd vote Blair out of office for this -- it's insane
We tried. Two thirds of the popular vote were against him at the last election.

Which explains why he's still in office, think he has a mandate, and is exporting "democracy" to the middle east.

Re:maybe next the Air Traffic systems?

[curunir]

When projects like this get going and the emphasis should be on subject matter experts (SME), the projects usually get expendable high-level highly paid deadweight -- I've seen it too many times.

I think you've hit the nail on the head with this statement. The government made a poor decision on who should run the project and he, in turn, made quite possibly the most bone-headed decisions he could possibly make.

From the article:

Granger commissioned the management consulting company McKinsey to do a study ...[that]... concluded ... that no single existing vendor was big enough to act as prime contractor on the countrywide, multibillion-dollar initiative the NHS was proposing....The result: He divided England into five regions--London; Eastern; Northeast; Northwest with West Midlands; and Southern--each with a population of about 10 million.

That last sentence made my jaw drop. How someone in his position could so blatantly avoid consulting anyone with any technical acumen is beyond me. Yes, it's possible, that no single vendor was capable of creating such a system alone. But the vast majority of a project like this is about creating a single process for every use case that the system is designed to handle. As such, the project shouldn't ever be broken down into groupings like number of patients in the system. Computers are great at handling really large numbers when the software is designed up-front to scale to really large numbers. The system should have been broken down into separate processes for which individual vendors would handle that single process (or grouping of processes) for everyone in the country.

The X-Ray example is a perfect one. Why would anyone in their right mind have 5 separate vendors all attempt to implement a solution for the problem that was only applied to the region they managed? At best, one region would end up with a solution that was better than every other region. However a competant management decision would have been to look for a vendor that could handle *only* the process of integrating the country's X-ray facilities with the country's high-speed data network. Another vendor would be responsible for supplying and maintaing that network. Still another vendor would be responsible for maintaining the huge data center (or centers) where information was housed. Just off the top of my head, GE could be responsible for the X-Ray integration (I know they have the necessary expertise), BT could handle high-speed network (among others, but why use foreign expertise when a UK company could handle it). And there are any number of competant vendors that could handle a high-availability server environment with a massive database.

Basically, had they had anyone with have an ounce of technical acumen, they would have devided the project up along functional boundaries of the application rather than regional boundaries of the country. That way, even if some of the projects went horribly over-budget, at least some of the project would be useful. Now, because of the inept management decisions, the whole thing is a train wreck.

How British...

[byolinux]

Things here in the UK always seem to be thought of as failing or disaster before they're completed. I'm sure we hate success as a nation. We also have a huge obsession with celebrity and magazines that publish how fat celebrities are, or how their lives are in a mess always do very well.

I say wait until the project's finished before kicking it to the ground.

Re:How British...

[kraut]

> Things here in the UK always seem to be thought of as failing or disaster before they're completed.

> I say wait until the project's finished before kicking it to the ground.

No, I think after it's gone 100% over budget and wasted $12 billion (that's 6-8 billon sterling) of taxpayer's money seems a perfectly good time.

Why didn't they just buy

[Marxist Hacker 42]

A country-wide site license for Web MD? That's what all of my local hospitals and clinics use- and it already provides a number of ways for communicating perscriptions to the chemists (from printouts to faxes to e-mail).

Re:

[mendaliv]

Because that would be way too easy.

Either way, I'm not sure how things work in the UK but in the US, if WebMD were to suddenly gain the US Government as a customer, the government would require that WebMD suddenly adapt to a bunch of contractor regulations that they probably aren't following at the moment.

Plus, politicians could put one of two things on their campaign fliers: "...and strongly worked to get our great nation a site license for WebMD" or "...and strongly worked to build the national physicia

Re:

[supersnail]

The problem is it won't scale to the worlds largest health
organisation. The NHS is the primary care organisation for
80% of the UK population (and quite a few visting South Americans and
Easten Europeans!) and the primary care organisation for 99%
of the population who are liable to get ill (Private medical
insurance in the UK being geared up to middle class , less than
middle aged people with no medical history).

IT in the NHS was always underfunded (probably rightly so-
upgrade a couple of thousand PCs or get a

depends on how you look at it

[User 956]

'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion

I imagine if you're the company getting paid the $24 billion, the project is a tremendous success.

a simple equation

[Bananatree3]

(massive govn't project + taxpayer money)^(at least cubed for govn't bloat) + corporate contract = One VERY happy corp.

Equation is defined in the domain {All big govn't}

catchy name

[Speare]

NPfIT

Clearly all that NPfIT needs to increase political buy-in and remain on schedule and under budget is a catchier name for the act. A good catchy feel-good name can bury a lot of dead bodies. Take USAPATRIOT for example. When in the private sector, adding punctuation or coining a new non-cultural word has its benefits too. Consider Cue:Cat: and Flooz.

never heard of it.

[eighty4]

Four years, a couple of trips to hospital, and more than a handful of GP appointments and this is the first I've heard of it. Way to go, NHS(!). Perhaps a better way to spend $24m (or whatever that is in £real money) would have been to keep my local emergency department open, rather than sending me on a half-hour trip to the next nearest hospital...

Fifth Largest IT Disaster

[ReidMaynard]

In 2003 my "D" drive crashed, restore of backups failed, and I lost all my, um.... graphics.

You Try It Sometime

[mpapet]

and see if getting a metric ton of vendors to make their various bits all work together in some new way to deploy mega-healthcare infrastructure gets close to working. One vendor typically does not want to know or care to know what the others are doing which makes for lots of daily progress.

Oh wait, then there's the legacy system vendors.

Easy, in fact, too easy to take shots at programs like this.

They stand such a high rate of failure that incremental change should have been adopted in the first place. The politicians behind this one have all disowned the project by now I'm sure.

Re:

[slashflood]

see if getting a metric ton of vendors

There's the rub.

Overarching

[AKAImBatman]

The word "overarching" comes to mind whenever I hear about projects like this. If there's anything my years in software and systems has taught me, it's that starting with a monolithic design will mean monolithic failure. You invariably end up with too many cooks, all working on Lord knows what, accomplishing a very expensive nothing. There's just too much coordination to maintain any semblence of progress.

In fact, the most successful large scale projects always seem to be grown out of combinations of smaller architectures rather than a single massive architecture. Look at the Internet for an example. The protocol was architected. The routing design was architected. The information delivery systems were architected. The network itself? Grown with tender loving care, and Lots'o'peering agreements.

If you want to solve an issue like modernizing Hospital IT, start small and work your way up. Design each technology independently, but not monolithically. Keep an eye toward standards rather than specific implementations. (Standards will allow you to plug in a few competing implementations, giving you "best of breed" options.) Then use those technologies to build out a few test sites. Work out the kinks, then start deploying at a few more sites. Keep doing that, and the economics of scale will begin to take hold. (i.e. The more you do of something, the less expensive it gets to do it.) With any luck, the project will get done within a reasonable budget and timeline.

In late September, Accenture, the global management and technology consultancy

Never mind what I just said. There's your answer right there. :P

I could do it for a million.

[caluml]

C'mon. A few Dell servers in a datacentre, running Gentoo and Postgres, and all the docs hooked up over ADSL - I mean, it must be that easy, right?

i work on this project

[alucinor]

I actually work on this project, an application called Choose and Book. We've had a lot of success: little downtime, significant uptake, and physicians seem pleased with the user interface. If you want to know, it allows people at their general practitioner to book appointments with a specialist at a hospital. It actually does a lot more, but I don't want to burden you with details. It's a J2EE application.

This project is far from being a "disaster" as the British newspapers (little better than tabloids) like to tout it as. And the project has very little to do with Microsoft or Bill Gates. Most of the software my company is delivering is C/C++/Java running on IBM AIX.

If you want the opinion of a software developer on the inside of this thing, take my word for it: this article is trash. Like any huge project, it's just moving along slower than anyone first anticipated.

In the end, the British healthcare system is going to be faster and cheaper because of Connecting for Health.

Re:

[kraut]

> In the end, the British healthcare system is going to be faster and cheaper because of Connecting for Health.
$24 billion better?

Oh look, the pigs are flying in such a pretty formation today.

Given that the NHS is now laying off Doctors and Nurses for lack of cash, I think there are better ways to spend that amount of money. And I'm not talking about PFI.

Re:

[alucinor]

$24 billion better? Umm ... yes? No? I think that in the long run, having an electronic medical record system will save trillions of dollars for your government.

Re:

[BertieBaggio]

I think that in the long run, having an electronic medical record system will save trillions of dollars for your government.

If it works. And if it couldn't have been done for less than $24B...

Re:

[Anthony]

There are few times when I can say "I wish I had mod points". Thanks for providing your "Informative" comments. To be fair to the article, it does point out .Net -based Lorenzo and it's problems. Does Choose and Book tie in with this?

So do I..

[Anonymous Coward]

Choose and book doesn't sit on the main NPfIT backbone as far as I'm aware. In the hospital where I work, we've had a few issues with it's implementation, but on the whole, it works after a fashion.
Now the core NPfIT product (I take it you've had your training; The product is pretty shoddy. I managed to register several patients in the same bed (woo hoo, except you really don't want that happening), registered a male with a diagnosis of prolapsed uterus (all from the point and click menus for god's sake), crashed the front end application several times, and picked holes in their data model on several occasions.
Their system of data aliases is broken. Relying on a hospital to have a working internet link to even access their own patient data is nuts! Now a simple snip of a couple of fibres can stop a hospital in it's tracks. No local data caches.
This project was never truly specified correctly, and it's implementation is broken (did you know a few hospitals have refused to go live yet because of too many outstanding failures in the product, which the consultancy company has had to raise it's hands and say "You got us. Yes, it's broken.".)
So, speaking as a front line implementer (I'm one of the systems admin team for a hospital rolling this stuff out), I'd say there's a lot of meat in this article. NPfIT scares me.

Posting anonymously for the obvious reason that I'd rather like to keep my job.

Re:i work on this project

[dyftm]

I've been involved in upgrading some computers just for Choose and Book. What I want to know is why on earth you people made Internet Explorer 6 a requirement?? I must admit I haven't seen it in action, but I find it hard to believe that you couldn't accomplish the same things without IE6-only technology. No-one can upgrade to IE7, or use an alternate browser to run this thing. So, you're forcing hundreds of thousands of computers with highly sensitive medical information on them to run without the maximum security available.

Re:

[Dr_Barnowl]

I second this.

The entire rationale behind Choose and Book is fallacious. It's a piece of window dressing for government policy - a service rooted in spin. The premise that "Patients want to choose which healthcare service to consume." is utter nonsense.

Patients in the UK, by and large, do not want to choose. They just want to receive treatment. Because of the prevalence of the NHS, and the relatively low takeup of private healthcare, there is no real perception of choice anyway.

Making the patient choose a s

EDS Strikes again...

[Channard]

.. was what I was thinking, even before I read the article. Disappointingly I was wrong. EDS was the company responsible for a large number of failed or messed-up government computer projects. So the question is, given that another company entirely screwed up, are these projects just to sprawling and optimistic to actually work? My money is on yes.

It's failing because good IT people will avoid it

[cryfreedomlove]

I know the reason that this project, and others like it, will fail. This project cannot attract great IT people to work on it because its boring and run by bureaucrats. I'm a strong IT developer but I'd never work on a project like this. Life is just too short. I'd look for something a lot more fun that will attract great people to work with.

Re:It's failing because good IT people will avoid

[pev]

For a proper slice of the 12 billion pounds I'd be tempted to put up with the boredom for a year or two...

~Pev

Re:It's failing because good IT people will avoid

[Maximum Prophet]

Y'know, I was one of several interviewers interviewing a candidate who answered an impossible question, with something along the lines of "I wouldn't do that", or something else indicating that he would give up rather than flog the dead horse. I thought it was the correct answer, but the other interviewer thought it displayed lack of dedication. Anyway, that person wasn't hired and the project failed. It really would have been better to give up early. C'est L'vie.

Re:It's failing because good IT people will avoid

[supersnail]

No project which employed more than 20 techies ever really worked.

Which may seem a strange comment from someone who has been involved
in 500 plus people projects that came in.

This was entirely due to project managers who picked the 20 best
techies and worked them to death while giving the other 480 busy
work.

Obviusly given that EDS, Accenture etc. are involved the top
0.1% in this project just werent good enough.

This is what happens when there's no profit motive

[ScentCone]

The behind-the-scenes IT operations for UPS (well, and the public-facing stuff) completely eclipses something like this, and it runs more or less like clockwork... substitute merchants for doctors, integrated warehouse operations for pharmacies, and half the civilized world tracking shipments in the second half of December... and then COMPETE with FedEx or DHL, and you get: success. Socialized stuff like this chokes because it involves people who don't quite have the fire lit under their asses the way that

Re:This is what happens when there's no profit mot

[kalidasa]

There's a bit of skew on this, though. You never hear about major IT disasters at private companies because 1. it's competition sensitive information anyway, and 2. if it's a major disaster, the company is snuffed out of existence. Remember, too, that most companies are nowhere near the size of a big government ministry because they don't have the huge customer interface: millions of customers, and millions of different types of contacts.

Re:

[ScentCone]

Remember, too, that most companies are nowhere near the size of a big government ministry because they don't have the huge customer interface: millions of customers, and millions of different types of contacts

Hence my citation of UPS (www.ups.com). They DO have millions of customers and hundreds of integration schemes, and it has to work, around the clock. They're a great example of doing it right (as is FedEx). You're right that the really spectacular failures put private businesses OUT of business... b

Re:This is what happens when there's no profit mot

[Knight2K]

I'd hardly hold up UPS as a model. I've had the counter staff at the UPS customer service center tell me not to bother checking with the on-line tool because it never matched reality during the holiday season. Operations that seemed to work fine during the rest of the year, like having a delivery held for pickup, took two or three tries to take effect, resulting in a couple of wasted visits to the center. Never mind the fact that UPS refused to leave packages at my apartment complex office and then would

NSH IT's a security disaster too

[giafly]

"The front page lead in [November 1st] Guardian [guardian.co.uk]explains how personal medical data (including details of mental illness, abortions, pregnancy, drug taking, alcohol abuse, fitting of colostomy bags etc etc) are to be uploaded to a central NHS database regardless of patients' wishes.

The Government claims that especially sensitive data can be put into a "sealed envelope" which would not ordinarily be available... except that NHS staff will be able to "break the seal" under some circumstances; the police and Government agencies will be able to look at the whole record -- and besides, this part of the database software doesn't even exist yet, and so the system will be running without it for some time."

Security Research, Computer Laboratory, University of Cambridge [lightbluetouchpaper.org]

A different spin

[Spiked_Three]

I have been programming 25 years now and I see a different problem at the root of these massive failures.

The current state of development tools is hideous. We have some very nice powerful languages, Java, C#/.Net, some very powerful databases, but we still have to spend hideous amounts of time making them work together.

These large applications (the FBI and this Health Care system) take soooo long to spec out and build that by the time they are done the requirements have changed, the technology has changed and the developers are always having to restart the process. I will admit, I do not like web applications. They are very limited in robustness. Developers resort to hacks like AJAX to make them somewhat useable. And it makes me mad that in the 21st century I have to resort to using a text based editor to design Graphical UIs. How dumb. Yes there are some WYSIWYG editors but they NEVER get you to where you want to go. Any good web application (of which I guess there 3 or 4) had the HTML written by hand. I had hoped XAML was going to change that. It will not, at least initially. It provides much better user experience potential, but in order to develop a real application you are still going to have to code text by hand.

What went wrong? The dBase III of the 80s was a far better development environment than what we have today. We have taken several steps backwards. Yes the end products that we develop today by hand scale enormously, but they take too long to develop. We spend at least 80% of our time coding plumbing that we shouldn't even had to think about.

If you can cut the development cycle, then maybe you can get a large application developed and delivered before it is out of date. Vendors need to wake up. If someone ever comes out with a real dBase/Notes/Delphi/early VB type product that can deliver large scale applications (hopefully not on web) they would put the others out of business.

Flash: Here is your chance!

Re:

[Chas]

Having worked with dBase in multiple applications I can say that there's a good reason for all the 'plumbing'.

Everything's nice when it all works.

But, when it doesn't work, how do you fix it? How do you recover from it? How do you track these problems?

dBase was great until it simply wouldn't load. Then you had to dig through the system for every known bug, since most of the error messages weren't exactly helpful.

Or if you corrupted a file or set of files when bombing out of a locked app. BOHICA.

All this

SOX compliance

[gelfling]

Huge waste of effort time and money. All in the name of making sure of something or other vaguely related to another Enron. We spend billions every year furiously auditing and managing compliance for essentially zero net improvement in security.

Brazil has excellent national healthcare software

[TheNarrator]

http://www.infoq.com/articles/Brasilian-Healthcar e -System [infoq.com]

The Brazilian National Healthcare System has been called the largest Enterprise Java application ever built, with over 2M lines of code, and a domain model of 350 classes. The application models all of the domain concepts one could imagine in a country-wide health care system and is bringing a level of automation that is creating enormous value for the public healthcare system as well as for the people of Brazil. This case study, the only one of it's

Old Skool failure: CONFIRM/RS

[RobertB-DC]

There aren't many references to it on the newfangled Internet (though three of the five results of this search [google.com] are relevant), but back in the late '80s to early '90s, some of the biggest names in travel got together to create CONFIRM/RS. Hilton Hotels, Budget Rent-A-Car, and Marriott got together with a division of AMR to create it. AMR, with the biggest reservation system in the galaxy in SABRE, was clearly in the best position to develop the next generation reservations system.

Then again, maybe not.

I wa

Big surprise...

[sane?]

I was involved in the early stages of this. Even from the beginning it had screwup written all over it - so bad that many of those who looked and examined it walked away. Rather than define standards it defined a monolythic entity that was then broken into 6 blocks, given to separate contractors, and then they were told they had to fit together. Then they held a competition to force prices down, played even more tricks to force the price even further down, and gave it to the lowest price bidder. The few weeks around that time were nuts with people taking the most shiny, most optimistic assumptions to beat the competition. 20% off best and final tells its own story.

We haven't even got to the part yet where things really go wrong, they are further down the line. However we already have large firms doing anything to get out and taking large losses to do so.

It is a huge disaster in the making and should be canned as soon as possible. What will be delivered will be an embarassing mess in comparison to what anyone here would expect from a 21st century health system. I'm trying to make sure my data goes nowhere near it

involved in the early stages ..

[rs232]

"I was involved in the early stages of this"

What exactly failed. What hardware/software was chosen. Who were the contractors. What kind of network topology. How does a power cut [silicon.com] in the north of England cause a distributed data base fallover in kent [theregister.co.uk]. Has something on this scale ever been done previously. If as you say they force prices down then where did the $12 billion go exactly.

was Re:Big surprise...

Y2K?

[xenocide2]

With 300 billion spent in the US alone fixing it, it seems like a significant "disaster" even if most people managed to avoid it.

Dying for Data

[necro81]

For more information about electronic medical records, and the efforts to create national medical databases, I would suggest an article that appeared in IEEE Spectrum's October issue [ieee.org] entitled "Dying for Data." [ieee.org] The article describes some of the monumental challenges in creating such a system, profiles the British effort, and highlights the success that the Mayo Clinic [mayoclinic.org] has had in moving to electronic records [mayoclinic.org] for all its patients.

[I can't link to the full text of the article, because that issue is not longer current. IEEE members can log in and view it, however.]

Lost Confidence

[digitaldc]

Among the problems the project has encountered:

One key health-care software subcontractor, IDX, was dropped from the program in April 2005 after one of the project's prime contractors, Fujitsu, "lost confidence" in its abilities, according to the NAO. IDX failed to respond to requests for a comment.

Come on, doesn't anyone have some type of enhancement pill they can prescribe for Fujitsu in its time of crisis? Or doesn't anyone want to comment on that either?

Health Care + Government Agency + IT System =

[fortinbras47]

DISASTER. Not like it's hard to see this one coming.

In health care, you don't have to computerize 10 documents or even a hundred, its in the thousands and thousands... Docters are set in their ways and can be slow to change... Health care is governed by a complex interlocking set of rules, regulations, etc...

Add to this complexity all the efficienct and results oriented forward planning of a government bureaucracy and you can be almost guaranteed that you will be building a boondoggle.

IMHO this is totall

Duke Nukem Forever

[Zantetsuken]

so if I understand the summary right, they've basically done what the DNF dev team did - they want it to be the latest and greatest, so when they are just about done, they decide to upgrade the hardware or programming language, causing a need for the other to be upgraded (code a wont run on hardware y, or hardware x wont run code b) - therefor skyrocketing costs...

Per capita...

[pev]

...this is around £200 / 400USD. Ouch - kinda puts it into context...

~Pev

Yay NHS!

[BertieBaggio]

I work in the NHS. I hope to one day practice clinically for the NHS. I usually like to espouse the benefits of a nationalised healthcare system, but fuckups of this magnitude piss me off. Aside from the fact that other organizations can do better with less (see NASA, etc), these kind of things normally come back to the same mistake: failure to plan (design) properly.

Even looking at some of the touted features in the summary, I can see bad decisions:

"...allow for the electronic storage and retrieval o

Wait until the follow up

[mikerich]

In an official statement the British government expressed its delight with the recognition of NPfIT.

'We've been working on this for years,' a spokesman burbled, 'honestly, we'd like to thank EDS, Lockheed, Siemens, Microsoft and BT who've been laying down the groundwork for this cockup for years now.'

To what do they owe their success?

'Pacing, it's all about pacing. We started small with screw-ups in the Magistrates system, Air Traffic Control and the Child Support Agency, then we could take on more am

Impossible to know from the outside

[cascadingstylesheet]

I worked on a state child support system project that was regularly denounced in the media as a "disaster".

I'm not going to go into all the details here, but most of the stories were just bunk. The users, who had despised the old system when it was rolled out, suddenly loved it and hated the new system. So they went to the media with their complaints. Nobody wanted to hear actual *reasons* for anything.

Ever since I take any story like this with a HUGE grain of salt.

There's also a serious privacy issue at stake here

[mikerich]

The NPfIT system relies on a system called the IT Spine which will contain medical records of all people in the UK. These records can be shared around the network and can potentially be viewed by some 250,000 health workers. There is, at present, almost no provision for the protection of personal health records - the most personal information can be viewed without the knowledge of the patient's own doctor or the patient. The system is meant to have protections built in, including a series of 'sealed envelopes' where the most confidential information can be stored - none of them have been implemented.

The government has also passed legislation that will allow anyone on the system to release confidential information about a patient when it is seen to be in 'the public interest' (a deliberately vague term). Previously personal information could only be released under specific circumstances with the consent of a patient's GP or specialist. You can imagine how insecure this will be and what a tempting target for blackmailers and scum-sucking journalists looking for dirt.

Despite these concerns the government is proceeding to upload personal information on to the Spine using a system of 'implied consent' - that is, if you don't opt out, your data will be put on to this privacy nightmare. Once the information is on the Spine you cannot ask for it to be removed, nor amend it where it is found to be incorrect. The Guardian has produced the most readable to this [guardian.co.uk]meltdown [guardian.co.uk] and has also published a guide to ensuring your personal data is not put on to the spine [guardian.co.uk].

One GOOD example of healthcare + government + IT

[Dekortage]

Although many people are not aware of it, the Veterans Health Administration (otherwise known as the Veterans Affairs/VA hospital network) in the United States has progressed from a backwards, poorly-kept system in the 1980s to the best, most advanced medical organization in the nation. Read more here [charlestonbusiness.com], here [washingtonmonthly.com], or this reprint from Time Magazine [va.gov].

It's proof that government + healthcare + technology does not always equal disaster.

Canadian Gun Registry

[hey]

Wiki sez:

The project which was meant to cost approximately $119 million ended up costing over a billion dollars to implement. Documents obtained by the Canadian Broadcasting Corporation now estimate the program cost at $2 billion.

I don't get how it can cost so much when its just a simple database app that most of us could write in a day. However I have heard that noncompliance of gun nuts was a cost. Eg flushing rolls of toilet paper to cause a flood.

 

Re:Keywords: Government. Health Care. Disaster

[HeavenlyBankAcct]

Those "three words" together are four words.

And excellent steak analogy, but you forgot to include the circumstances that prompt the need for a government managed health care system in the first place -- what happens when the restaurants sell so many burgers and so few steaks that they need to manipulate their pricing structure until those burgers become the price of steaks? Or when they decide to just stop serving burgers entirely and choose instead to offer a 'name brand equivalent' like maybe some ground buffalo, which tastes just the same, but costs a whole lot more? And what happens to the individuals who desperately NEED those steaks but can only afford a small side salad? There's a big difference between 'subsidizing irresponsibility' and sharing costs to help treat people with terminal and degenerative diseases who are incapable of generating a full-time income.

It never ceases to amaze me that there are people who will apply the "pull yourself up by your bootstraps" mentality to those suffering from Muscular Dystrophy, ALS, Leukemia and all of those others afflictions that obviously afflict far more than just the 'lazy' and 'irresponsible'. Is this compassionate conservatism in action?

Re:

[dada21]

It never ceases to amaze me that there are people who will apply the "pull yourself up by your bootstraps" mentality to those suffering from Muscular Dystrophy, ALS, Leukemia and all of those others afflictions that obviously afflict far more than just the 'lazy' and 'irresponsible'. Is this compassionate conservatism in action?

I don't use an AMA Doctor in the States, I use an AAPS Doctor. He doesn't accept insurance, Medicare, Medicaid, or any third party payment, and neither does anyone in his clinics.

Re:Keywords: Government. Health Care. Disaster

[HeavenlyBankAcct]

My lady's brother had MS and died in a fire because of it. This same doctor's clinic treated him at home for no additional charge, and when he lost his job, they continued to care for him at no cost at their office (we drove him there). The doctors repeatedly tell me that most health care is cheap. I have insurance for emergencies only (with a $10,000 deductible now) and my insurance is cheap even though I am a smoker and have a pre-existing condition of kidney stones -- in fact, my lady and I pay less as a household for a year than most people do in a 6-9 months with their overriding policies.

Interesting that you should bring up MS, since my frame of reference is with the same disease.

My mother is a single woman who was diagnosed with MS when I was around eight years old. Her disease is a progressive one, and as such, she gradually lost the ability to operate for periods long enough to sustain a full-time income. Since she was unemployed (and married) at the time of her diagnosis, she was not covered by any private insurance fund, and thus, after her divorce, she fell into the questionable hands of Medicare.

Since that time, I've witnessed our family tossed into bankruptcy proceedings to cover hospital bills that Medicare claimed were out-of-scope. I've witnessed months and years where she was unable to pay for her medication and fell into serious regression. Most recently, I've witnessed her taking part in a completely bogus marriage to a man she barely knew simply so she could be added to his military insurance plan. These are the sort of things that the poor in our country deal with when they have chronic or terminal diseases.

Your friend and you are very lucky to find the sort of treatment that he did, but that's certainly not a commonality, or even a rarity. I would say that's a goddamn miracle -- and I certainly would not assume that because you were accepted for insurance with kidney stones that somebody with a terminal disease would have an easy of a time as you. I've been gainfully employed for years and have been frantically searching for a 'family plan' that would also covered my disabled mother and have been greeted routinely with incredulity and flat-out "no, we don't do that"s.

So, yes, I think I can justifiably use the "what about the poor" argument since that's the reality I know. I'm not sure how the system appears to those who don't actually need it -- I just know the dismal reality of attempting to get health care without money in this country. Regardless of what the rhetoric states -- it's not easy, or pleasant, and most of the time, it's impossible. I thank the powers that be daily that I'm now in a situation where I can provide financial support to my loved ones instead of expecting them to rely on a broken system to keep them intact.

Re:Keywords: Government. Health Care. Disaster

[Ford Prefect]

Interesting that you should bring up MS, since my frame of reference is with the same disease.

A friend of the family had a particularly severe form of multiple sclerosis.

Over roughly a decade, she went from walking with a stick, to using a manual wheelchair, to using an electric wheelchair, to having nerves in her legs cut to stop the spasms, to undergoing many, many operations and treatments to lower the pain and to keep her comfortable, to dying.

She was in her thirties. Everyone was amazed she lasted that long.

I seriously doubt the treatment from the NHS was remotely near perfect, but she had all necessary drugs, equipment and carers provided - her house was fitted with stair-lifts, bed-lifts, bath-lifts, ramps and so on, replaced as needed while her disease progressed. Many visits from carers to wash her, dress her, and later change her colostomy and catheter bags, supporting both her and her husband. (Somehow, they managed to turn a blind eye to the 'tomato plants' on her window-sills.)

Re:

[HeavenlyBankAcct]

Because our government provided health care is an unmitigated disaster because of the fact that it's shoehorned into, and forced to compete within, a "free market" environment which is wholly profit-driven. Removing the health care system from the world of profitability, and placing it into the umbrella of 'state-funded entities', creates an entirely different environment -- one where medical professionals won't be scared shitless to accept government insurance.

I hate to hammer a cliche, but America is

Re:

[jdavidb]

My lady's brother had MS and died in a fire because of it.

Was this very recently? It seems like not long ago you were writing about him and recent events at a hospital.

Re:

[dada21]

Different brother :)

Her brother that passed in the fire was:

http://goliath.ecnext.com/coms2/gi_0199-784260/Man -dies-in-fire-at.html [ecnext.com]

9/11/04. Man does time fly. Crazy.

Re:

[dada21]

My business partner's wife died of cancer last week (24 years old). Her chemo was $40,000+ a month for over a year, I believe.

My insurance plan covers emergency room visits, but also medical emergencies such as chemotherapy and surgery. It does not cover doctor's visits for headaches or colds or allergies or the like (actually, it does but the deductible makes it stupid to use insurance).

I am thrifty with my life (small home, old cars, cook at home more than we eat out), so I can save a great portion of m

Re:

[Maxo-Texas]

The hospitals will *still* bill you in some cases and you have to *prove* to them that they are wrong.

In my case, it was bout $11,000 bucks worth of charges.

Watch out for them billing you for items which have negotiated charges. They say "This is a $110 test and the insurance company paid $90. You owe us $20." Then you check with the insurance company and it turns out the total price for the test is $90 to that insurance company. $110 is the "street" price with no discounts.

And of course they hit you wi

Re:Keywords: Government. Health Care. Disaster

[Ford Prefect]

Is this compassionate conservatism in action?

You forget. The compassion in compassionate conservatism is the lovely warm feeling one gets in one's heart when scattering breadcrumbs at Christmas to those poor, adorable, starving orphans.

Charity will help out the most needy, remember?

Fuck anyone who's suffering from an unfashionable or distasteful illness; they only brought it upon themselves. The good old mom-and-pop doctor will solve everything else - that's what capitalism is for!

Compassionate Conservatism

[metamatic]

A Compassionate Conservative is riding in the back of his limousine when he sees a man eating grass by the roadside. He orders his driver to stop and gets out to investigate.

"Why are you eating grass?" he asks.

"I don't have any money for food," the poor man replies.

"Oh, well, you can come with me to my place to eat!"

"But I have a wife and two children."

"Bring them along too!"

So they all climb back in the limo. As they're driving along, the poor man says "Sir, you are too kind. Thank you for taking all of us with you."

"No problem, I'm glad to do it," says the Compassionate Conservative, "The grass at my place is almost a foot tall!"

Re:

[InsaneGeek]

And I'm providing a point that I have direct experience with this, I've not gotten any impression that you do. That you don't have anybody in your immediate family who is of working age and is unable to work because of a physical ailment, my wife has those.

If you are talking about intensive treatment, than I suggest you look around and tell me how much "intesive" treatment you get in other countries? You don't get intensive treatment, you get emergency treatment and a line for ailments. There is nothing

Re:

[Ford Prefect]

When a competitive free market group of companies goes after work, they have to balance their profit versus their ability versus the good use of their time.

This NHS case is one of the government using the free market, and of the free market bidding low and then screwing the government for every penny it has.

Re:

[kwiqsilver]

I'm not even sure what the point is of this IT upgrade. What exactly do they need this system for? Doctors work fine with paper charts and files -- this is a ridiculous amount of money -- what is the benefit and how do the costs make the benefit still beneficial?

You must be some sort of freedom loving capitalist if you can't see the benefit here:
$24B in spending directed towards growing a government bureaucracy, and lucrative contracts for politically connected companies (does Halliburton have a UK divis

Re:

[bateleur]

You aren't American by any chance?

The government healthcare system here in the UK is actually good, particularly if you happen to live in the South East. The idea of "less money for private health care" is pure comedy. Why would I want private healthcare?

This IT screw up is unfortunately typical, but that's actually because the government's contracting out of IT functions is consistently terrible. A new system actually is badly needed... they just had no idea how to go about buying one.

Re:Keywords: Government. Health Care. Disaster

[passthecrackpipe]

get this - Halliburton *has* a UK division, and they are actually the main project management company responsible - they received all the cash from the UK government, and are responsible for handing out the money to the subcontractors that build the various systems. I have been involved in the past in several different aspects of the tendering and scoping of parts of this project. It outright disgusting

Re:

[saudadelinux]

I'm not so sure private enterprise is the panacea you seem to believe it to be [wikipedia.org].

Re:

[Marxist Hacker 42]

In this case though, I think that they are [wikipedia.org]. In other words, they've already done the job very sucessfully, why reinvent the wheel? I'm usually as against corporations and corporatism as you are, but that's no reason to throw out their work when it does work.

Re:

[dada21]

I applaud you for your support of that free market provision in WebMD, MH. We don't see eye to eye very often, but in this case, I'm happy we can.

Enron was never a free markat fiasco -- it was a government disaster. Enron was repeatedly given loopholes in the law to use (which were closed AFTER the fact). The more you read about Enron [mises.org] and the other companies that ripped off the investors, the more you see that the State was the biggest predator in the situation. A free market in energy works, except whe

Re:

[zxnos]

1. government
2. ???
3. disaster

sounds about right...

Re:Keywords: Government. Health Care. Disaster

[El Torico]

I have what I call the "oh, crap" words and phrases list. If I see more than two of those words in a project file, I know that the project will be a huge steaming pile.

The article has no less than eleven of those warning signs.

transform
Accenture
Gartner
government
Microsoft
management consultant
Computer Sciences Corp.
in the world
comprehensive
leading-edge

I am not at all surprised that this is a gargantuan boondoggle.

Re:

[johnjaydk]

Accenture is sufficient for a major fuckup. Been there done that and have the scars to prove it.

Re:

[supersnail]

England is probably the best place in the world to have a heart attack,
should you choose to have one.

If you keel over in London you should get a paramedic equiped
with defibrilator within 10 minutes, quite often an actual doctor
will be traveling with the paramedics. If its serious and traffic is bad you
get a chopper to the hospital where serious case are treated immediatly.

You can get to the operating table within an hour.

And all this without a single check for medical insurance or endless
calls to your HMO t

Re:

[Hijacked Public]

What is the mess in the USA? My brother's kid drove his ATV into the side of a barn and twisted himself all up. Probably 20 minutes after I called 911 a helicopter showed up and whisked him away, and this was way out in the boonies.

I don't recall any questions about insurance until long after we drove to the hospital ourselves. I realize that there are some serious problems but I fail to see the difference between the situation here in Indiana, USA and the one you describe in London, England.

Also, Denmark's

Re:

[Cederic]

within 10 minutes

And how often is that target met?

quite often an actual doctor will be traveling with the paramedics

I've never yet seen that. Not denying it happens, but challenging its frequency.

you get a chopper to the hospital

Which is funded entirely by charity - no Government funding for the air ambulances.

And all this without a single check for medical insurance or endless calls to your HMO to get the treatemnt approved.

And all this for just £400/month! Yep, that's how much of my money goes to t

Re:

[RocketScientist]

A friend of mine and I ware having a discussion about healthcare.

He lives in Canada.

My proposition: So, you go out skiing and screw up your knee. Doctor pops a brace onto it and sets you up for a specialist, who recommends scoping the knee, fixing it, and a physical therapy regimen. How long until you get surgery in Canada.

His answer: 6 months.

If I wasn't out of physical therapy inside of 6 weeks I'd be finding someone to sue.

Our system in the US is way more expensive. It also works, it works quickly, an

Re:

[InsaneGeek]

Are you so sure about that????

http://www.pittsburghlive.com/x/pittsburghtrib/s_3 07614.html [pittsburghlive.com]

Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. "Britain has one of worst survival rates in the advanced world," writes Bartholomew, "and America has the best."

If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to

Re:

[rasilon]

But yet for all the arguments above, the NHS still delivers a more efficient and cost-effective service than the private sector...

Re:Keywords: Government. Health Care. Disaster

[shawn(at)fsu]

I'm sorry but did you even take time to read the article? I ask because you make statements about saying stuff like this: When a competitive free market group of companies goes after work, they have to balance their profit versus their ability versus the good use of their time. If you bid a job and win it, there's no going back and asking for more. But that's exactly what the article talks about. Accenture was the prime, or at least had the majority of the contract and they screwed up spent a lot of the governments money and quit .

Then you talk about universal health care? What does that have to do with TFA? If I had to guess I would just say you read the title and picked out some of your favorite arguments that had nothing to do with TFA and strung them together to get a +5 insightful. Congradulations you know how to play to the mindless sheep.

Re:Keywords: Government. Health Care. Disaster

[misleb]

Imagine if we all went to dinner and had to pay our own meals. We'd all get what we could afford -- burgers for some, steaks for others, soup for the few. Now imagine if we decided to split the bill equally. At first, we'd still buy what we used to, but some people would realize they could now afford steaks for just a little more cash out of pocket. When other people subsidize your irresponsibility, you become irresponsible. Eventually, everyone's buying steaks -- and all our costs go up. In government-run healthcare, everyone orders steaks, but the added bureacracy means the costs are well over the average steak -- and everyone expects to pay for soup.

So what you are saying is that poverty must exist in order for you to maintain your high standard of living.

-matthew

Re:Keywords: Government. Health Care. Disaster

[bockelboy]

(Side note: The US is the only industrialized country without national healthcare, spends twice as much per patient in healthcare, and yet is not a world leader in healthcare - it often ranks last among industrialized nations in certain categories. It seems that the statistical odds are at least against private healthcare right now).

I would normally agree with you (big government bad, free market good), but you're forgetting one small thing: The Veteran's Administration.

Here was a crappy, failing hospital system run by the US government that has completely transformed itself in the last couple of years. It has successfully deployed a completely electronic patient bookkeeping system (a nurse friend has told me that most of the (privately owned) hospital she works at runs off 3x5 notecards). The administrative overhead is comparable to private hospitals. It is able to negotiate much deeper drug discounts than Medicare and other private hospitals. It works closely with medical schools so its personnel costs are much lower, yet it has experts in many veterans-related fields (things like PTSD, making fake limbs, etc). It rates as one of the top hospitals in quantitative healthcare surveys (which measure things like, "For patients with X, how many of the standard operating procedures Y are usually followed").

In fact, it's done its job so well that - while the costs of private healthcare have *far* outpaced inflation the last couple of years - its budget has been increased at a *slower* rate than inflation.

Of course, like any other large chain of hospitals, there are surgery mistakes and lawsuits. The mistakes are much lower than the national average but, because it's run by the government, are much higher profile when they do happen.

The VA is a good case study of how the government could do healthcare much better than private industry. Its success should be analyzed, studied, and possibly replicated at a much larger scale.

Re:

[kabocox]

I'm not even sure what the point is of this IT upgrade. What exactly do they need this system for? Doctors work fine with paper charts and files -- this is a ridiculous amount of money -- what is the benefit and how do the costs make the benefit still beneficial?

As I said before... duh.

Sidenote: One of my lady's best friends runs a huge network for a hospital chain that is in the process of combining with another hospital. She's told me repeatedly that the biggest costs for her MIS department is integrating

Private sector failure, not government

[ph1ll]

This is not a government project.

It is a project paid for by the government but not a government project.

From TFA:

"Accenture proved the big winner ... Computer Sciences Corp. (CSC) was awarded Northwest with West Midlands; BT beat out IBM to get London; and a Fujitsu-led alliance won the Southern region. BT was also given the contract to build both the N3 network and the National Spine, while yet another vendor, Paris-based I.T. services provider Atos Origin (formerly SchlumbergerSema), was commissio

Re:

[Doctor Memory]

One of my lady's best friends runs a huge network for a hospital chain that is in the process of combining with another hospital. She's told me repeatedly that the biggest costs for her MIS department is integrating all the bureacratic changes that the government requires -- paperwork, forms, etc

When I used to do LIM systems, I once did one for a UK-based pharmaceutical R&D company. The work broke down to roughly 40% effort to make the software function correctly, with the remaining 60% going towards w

Re:

[CodeBuster]

The law provides write-offs for businesses that offer health insurance, but individuals don't get that write-off, so health insurance is pushed onto the company which incurs additional overhead. We also see people using insurance for basic healthcare costs, which means that insurance companies spend money on non-emergency situations, so the cost goes up.

They are trying to change this here in the United States by introducing the tax deductible health savings account, which is a step in the right directio

Re:

[hairpinblue]

> If, as you maintain, more government == more disaster wouldn't it stand to reason that these socialist model health systems would be doing worse than the US system?

Only if they truly have more government. If you look at total cost of government there really isn't any nation in the world which is as expensive as the US. If you diligently keep track of your taxes--on your paycheck, at the cash register, at the pump, extras for sin taxes and luxury items, real estate, utilities, taxes on shipping which

Windows troll?

[smittyoneeach]

Windows troll?
Obvious. Droll.
Redmond tops neither
The IRS hole
Or a clean and sparkling soul.
Burma Shave

Re:

[giafly]

This might be the most expensive boondoggle, but a disaster is where peoples lives are lost. There are better examples of computer disasters.

Many lives will be lost. People who can't trust the medical system are less likely to get diagnosis or treatment and some of them will die. This affects a whole country, so the numbers will quickly add up.