The British EHR Experience

Great Britain has a largely public system of both paying and providing for health care.  The National Health Service has undergone significant “reforms” over the last two decades.  One part of those reforms was an ambitious plan to create nationwide electronic health records.  One record would be a summary, easily exchangeable among and available to all providers and one would be a detailed care record of all of each patient’s care.  The project was organized and run centrally, and primarily executed with large regional contracts with major IT vendors like CSC and Accenture.  A recent report from Britain’s National Audit Office sums up the rather sorry state of the project.  (NAO Report)

Perhaps the most telling statistic is that Britain started with four contractors and one has quit and another been terminated, with a third in serious negotiations that may result in termination.  The system was supposed to be up in the whole country by 2010 and now estimates are that perhaps that will occur by 2015-16, but not likely for all providers.  A major problem has been the need to customize the national design for local needs.  The functionality provided to date is nowhere near what was in the original design.  As more local input has been allowed, interoperability concerns are rising.  A classic example of a bungled large, centrally driven IT project.

Although there are many reasons to be concerned about the US government’s attempts to encourage more IT use, particularly in the creation of the backbone for health information exchange, it is also unlikely that we will encounter the same issues Great Britain’s effort has.  The US has wisely allowed providers to choose and implement their own systems, which should avoid top-down decisions that don’t meet individual provider needs.  While implementation will be difficult, the projects are scaled down to the individual physician practice or hospital level, which is more manageable.  On the other hand, it is still not clear that we will avoid the interoperability questions that Britain appears to have even in a centralized project.