It's enough to make some British citizens sick. More than 30 community hospitals in the United Kingdom could close because of funding shortfalls, patients routinely face months-long delays in getting appointments for procedures that would be commonplace in the United States, and staffing shortages have forced many health facilities in the country to limit their hours. It seems there's a pressing need for resources to be directed at recruiting medical personnel and keeping hospitals afloat. So why is the country's National Health Service spending more than $10 billion over the next 10 years on a health-care IT-modernization program that ranks as one of the world's largest IT-outsourcing contracts?

Queen Mary's Sidcup will be the first of 42 London hospitals to deploy patient-management software, with which it's set to go live by Nov. 28. But that effort is only a small piece of the National Health Service's massive project to digitize medical histories, diagnostic tests, prescriptions, and appointments of more than 50 million U.K. citizens. Questions continue to surround this huge effort, including concerns about software support, delays in pulling together the critical network infrastructure, and integration with physicians' existing IT systems.

In the face of that, charges that the government doesn't have its health-care priorities and funding straight are coming fast and furious. "Money should follow patient demand," Conservative Member of Parliament and Shadow Secretary of State for Health Andrew Lansley said two weeks ago, in a statement to the press, after the release of new figures showing a big decline in the number of beds available for patients in NHS hospitals. The government has "supplied more money to the NHS but lost control of costs," he charged.

	The United Kingdom's ambitious, billion program to use IT to modernize the nation's health-care system is running into trouble Photo by Adrian Dennis/AFP

U.S. Vs. U.K.
It's enough to make you think twice about the United States' own flawed health-care system, but not so fast. The United Kingdom is taking the megagovernmental IT-project approach, in contrast to efforts stateside to digitize electronic health and other medical records, including private and state initiatives and some federal grants under the general guidance of national health IT coordinator David Brailer. President Bush has set his own 10-year goal for getting there.

However, the federal government has earmarked less than $200 million for pilot projects. That's small change to drive an effort that, in the face of disasters like Hurricane Katrina and threats such as avian flu, looks increasingly critical to the nation's ability to provide fast medical care during a crisis, not to mention to saving billions of dollars a year that are now lost to errors, misdiagnoses, and duplicate tests because of inadequate access to information. Despite the challenges, if the United Kingdom gets it right, its experience could provide valuable lessons for those following in its footsteps. But the record for pulling off such a large-scale government IT project, on either side of the pond, isn't encouraging.

The potential benefits of the United Kingdom's National Programme for IT--as the project, launched last year, is dubbed--are impressive. The plan includes a Care Records Service that would provide an electronic record of all of a patient's interactions with the health-care system, accessible to doctors, pharmacists, nurses, and emergency personnel throughout the country. So, for example, an ambulance crew attending to an unconscious person will know he's allergic to a particular medication. Through the Choose and Book system, patients will be able to view information electronically about health-care options and facilities before they book a medical appointment online. The National Prescriptions Service lets doctors electronically transmit prescriptions to pharmacists with an eye toward reducing errors and fraud. The program also calls for a digital archiving and communications system for the storage and transmission of medical records, which could put an end to the cumbersome process of retrieving film from previous physicians and help eliminate lost X-rays. The plan's rollout is in the very early stages; the NHS says that as of this month nearly 50,000 electronic prescriptions have been generated, and just over 11,000 people have used Choose and Book.

However, some applications that have been deployed to support Choose and Book are incompatible with existing Patient Administration Systems already in use at hospitals and clinics. "These systems don't talk to each other," says Dr. Richard Vautrey, head of the IT committee at the British Medical Association, a group that represents U.K. physicians and can make nonbinding recommendations to the NHS about the project. "It's proving very difficult to link all these systems in a meaningful way; you can't start to share information." Many smaller clinics have software that works for them, he says. "Should they be expected to throw that out?"

Fiber Network Lags
More broadly, the project hinges on the buildup of a national backbone fiber network, known both as the Data Spine and N3, being constructed by British Telecom. The company admitted this month that it's as much as a year behind schedule, according to major U.K. newspapers, including The Timesof London and Financial Times. BT also is handling patient-management software deployments in London, representing $2.9 billion of the contract. A lot of coordination falls to BT because everything has to connect to the Data Spine. Other companies involved include Accenture, which has won $3.5 billion in contracts to implement the program in England's eastern and northeastern regions. Computer Sciences Corp. has a $1.6 billion deal for the northwest and west midlands, and Fujitsu has a $1.7 billion contract for southern England. Several other vendors, including Agfa, Atos Origin, and Tata Consultancy Services, also have secured significant pieces of the work.

"It's a large, challenging, complex project," concedes Ken Lacey, global managing partner for health and life sciences at Accenture. It's the scope and scale that present the difficulties, he says. "We're not breaking boundaries in terms of technological advances," he says.