Learning from the “worst fiasco ever”

_69899119_recordsI’m not surprised to see a story today citing the failed NHS electronic patient record system as one of the worst fiascos ever and a £10bn write-off.

A few years ago I had the pleasure and pain to work on an NHS IT project. It was a pleasure to be working on a project that had the potential to have a real positive impact on the lives of millions of people.  The pain was enduring the endless overbearing bureaucracy and complexity forced on us by the NHS.

My team wanted to pull some data from the electronic patient record to assist GPs during prescribing.  We just wanted a few simple pieces of demographic data, such as age, gender and so on. Having looked at the specs we estimated it would take 2-3 months of effort to develop that capability.  The complexity of the design was astounding.

What’s wrong with government IT?

In an attempt to get good value for money for taxpayers, politicians and civil servants push for ever-bigger projects with the aim of removing duplication of effort across many different projects. After all, you don’t want lots of different projects all solving the same problem in different ways, right?

On the face of it, the argument makes sense. But here’s what happens in the real world:

  • Projects with similar goals but competing requirements are merged together
  • Because it’s hard or impossible to get small projects signed-off (remember, you don’t want to duplicate effort!) scope creep ensues
  • A huge amount of effort is spent figuring out how to fit all the requirements into a single deliverable
  • Projects become bloated and impossibly complex
  • And so… projects fail

      An alternative approach

      What if the government took a leaf from the start-up world where entrepreneurs set out to solve a problem in the simplest way possible and deliver quickly so they can gauge success. Because solutions are built around a common set of open standards the various online services all inter-operate.

      Perhaps instead of trying to build a single IT system to conquer them all, government should instead focus on the results they want, and a set of (simple!) common data formats, then leave the private sector to get on with developing elegant solutions to common problems that can move healthcare forward more quickly.
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