It's hard to imagine a better environment in which to test a government-run health information technology system than Britain's National Health Service. The system is fully socialized, with a single government payer, universal enrollment, and doctors employed directly by the state. There are roughly 60 million beneficiaries, which is big enough to see if the system can scale, but perhaps not so big that it's sure to be overwhelming. It's popular enough that in 2010, the country's conservative party successfully ran on a health platform where the top item was a promise to increase spending on the system every year. In other words, it's about the best possible testing ground for instituting a complex, integrated system of computerized health records through government oversight.
And yet it still hasn't worked. As Greg Scandlen notes, it seems that the country's health system is canceling a multi-year, $20 billion Health IT project after a report concluding that it was impossible to deliver on the plan's ambitious goals. The Independent reports:
A plan to create the world's largest single civilian computer system linking all parts of the National Health Service is to be abandoned by the Government after running up billions of pounds in bills. Ministers are expected to announce next month that they are scrapping a central part of the much-delayed and hugely controversial 10-year National Programme for IT.
Instead, local health trusts and hospitals will be allowed to develop or buy individual computer systems to suit their needs – with a much smaller central server capable of "interrogating" them to provide centralised information on patient care. News of the Government's plans comes as a damning report from a cross-party committee of MPs concludes that the £11.4bn programme had proved "beyond the capacity of the Department of Health to deliver".
The NHS's failure isn't the only government-managed health IT debacle. The 2009 stimulus package included $30 billion to help fund a major health IT rollout here in the U.S. In addition, doctors are spending an average of about $40,000 each to build out electronic health records systems in their offices. But as Marketwatch reported last summer, "even after all that expense, few physicians will be able to send patient records to other doctors who could benefit from having rapid access to medical histories."
As with so much bureaucracy, the biggest problems with publicly managed health IT systems tend to be practical in nature—poor administration and unexpected challenges with implementation. According to The Independent, "The project has been beset by changing specifications, technical challenges and clashes with suppliers, which has left it years behind schedule and way over cost." Technology contractors walked out on the project or failed to deliver. Leadership inside Britain's health service was unable to cope with the competing demands of elected officials and on-the-ground project management. It was a typical bureaucratic mess.
This is not to suggest that electronic health records are themselves a bad idea. But these government-funded efforts to encourage their use don't have a great track record.
