U.K. E-Health Records Failure Makes U.S. Plan Shine

Perhaps the United Kingdom should have taken the U.S. approach to health IT. Seems like the Brits might be thinking that, too.

The failure of the United Kingdom's troubled, $20 billion-plus National Health Service National Programme for IT, launched in 2002 and officially declared dead last month, serves several lessons for the United States as it rolls out its own $27 billion health IT program.

Granted, the U.S.'s own $20 billion-plus Health Information Technology for Economic and Clinical Health, or HITECH Act, stimulus program, set up to entice doctors and hospitals to trade in their paper patient charts for digitized record systems, is too young to call a success, or to predict being one.

But it's clear from the U.K.'s centrally procured, mandated, and government-run health IT project that a heavy-handed approach to force clinicians into using e-health records--even when the docs and nurses are employed by the government-run health system--doesn't work.

But even if British clinicians were willing to accept a system forced on them, the U.K still made some serious errors in its top-down approach by wasting a lot of time and money haggling over bloated vendor contracts for a one-size-fits all system.

[Which healthcare organizations came out ahead in the InformationWeek 500 competition? See 10 Healthcare IT Innovators: InformationWeek 500.]

By contrast, the U.S. approach of making health IT use voluntary--even while healthcare organizations are being encouraged to do so with financial incentives from the government--helps get buy-in from clinicians.

"The use of incentives, certification of records, and centrally adopted standards provides a framework for national interoperability, but allows each provider to pick the particular record that makes sense for them," said Dr. David Blumenthal, President Obama's former coordinator of national health IT.

"This combination of structure and flexibility is more appropriate to the United States context than the U.K. approach," said Blumenthal in an email interview with InformationWeek Healthcare.

Indeed, the U.K.'s government decisionmakers were often far removed from the clinical user and "clearly didn't understand the technology," said the chief technology officer of an international health IT vendor, in an InformationWeek Healthcare interview, who asked not to be named "because we still do business in the U.K." And when changes needed to be made to individual applications or programs to better fit clinicians' needs, it was impossible. "The process is buried in bureaucracy," he said.

Unlike the U.K.'s centralized procurement model for purchasing and implementing health IT systems, in the United States doctors and hospitals have a great deal more freedom in picking out the health IT solutions that best meet their needs and workflow.

Sure, that's been a difficult process for many healthcare providers. U.S. clinicians must pull out their own wallets and pick out IT systems from dozens of choices and then use the technology "meaningfully," as prescribed by the U.S. HITECH Act's requirements, if they hope to get a financial reward. But this approach is probably a lot easier to swallow than the "you're using this and will like it," strategy that flopped in the U.K.

Also, with U.S. doctors and hospitals paying for the purchase and implementation of their health IT, docs have financial flesh in the game to use these systems rather than watch them collect dust. On top of that, competition among healthcare providers in the U.S. is another big incentive to leverage health IT for new innovative uses.

The U.S. also has gone out of its way to get input from healthcare stakeholders--including hospitals, doctors, patient groups, payers, technologists, and others. In fact, the entire HITECH Act rulemaking process for Meaningful Use stages 1, 2, and 3 has taken so long in large part because the U.S. government has been bending over backwards in asking stakeholders for input, through standards and policy workgroups, and also by asking the public for feedback, before finalizing the requirements of the incentive programs.

"The U.K. treated the creation of an electronic health information system as a technology project, akin to the procurement of a technology solution," said Blumenthal. "In fact, the creation of an interoperable, private, and secure nationwide electronic health information system is a complex, social, economic, and technical endeavor that requires both a bottom-up and a top-down approach," he said.

"It also requires policies that are flexible and adaptable, and that change in response to experience and technological developments. We must avoid centralized, mandated solutions, but need to create the conditions that can make local providers successful in adopting and meaningfully using HIT," according to Blumenthal.

It seems the U.K. has realized that point--albeit too late in the game. On its website, the U.K. Department of Health said: "We need to move on from a top-down approach and instead provide information systems driven by local decision-making. This is the only way to make sure we get value for money and that the modern NHS meets the needs of patients."

Sounds a little like the U.S. approach, doesn't it?

It's too soon to know whether U.S. healthcare providers will jump on the IT bandwagon en mass, but one thing's for certain: the United Kingdom's health IT project was too top-heavy.