The complexity has led to project delays that both Accenture and Tata Consultancy Services have blamed for recent financial setbacks. A latest quarterly filing from Accenture points out that the company continues to expect aggregate losses on the NHS contracts for this fiscal year to be as much as $150 million.

Few Details
It's difficult to get a clear picture of just how the whole project is going because most parties involved are keeping a low profile. Richard Granger, director general for IT at the NHS, has declined several requests for interviews. Accenture declined to provide details on the project's security features, while BT and CSC said reps were unavailable to speak about the project. Meanwhile, EDS threatened to sue the National Health Service after the agency terminated a deal with the services provider to manage E-mail, saying the vendor wasn't meeting its contract terms. EDS says the NHS made little effort to mutually resolve these issues.

Among the other issues the NHS and practitioners must confront is migrating gigabytes of patient data held by individual hospitals into the national database of medical records. Existing records will have to be linked to a patient's National Health Service number and checked for incomplete data fields before the IT-services providers will accept them for use in the Care Records Service.

Most of the contractors are using software from iSoft plc for the front-end applications that will let health-care workers enter information into the system. But Fujitsu, which is handling southern England's part of the project, chose software provider IDX Systems Corp., then ditched the company in middeployment and replaced it with software from Cerner Corp. BT continues to use IDX, recently acquired by GE Medical Systems, for the central London deployments. Fujitsu wouldn't comment, but an analyst says IDX's Carecast application may not be well suited for the U.K. market. "They don't have a large support presence in the country, and there were issues with Anglicization," says Tola Sargeant, an analyst at Ovum, an IT-research firm.

Britain's National Health Service also has to face up to physicians' resentment. It moved forward with its IT plans but didn't seem to adequately understand the needs of all parties involved. Vautrey says the NHS gave physicians little input into the program's architecture. "That's been a running sore point," he says. "There was a lack of clinical engagement at the procurement stage."

A layer of distrust and skepticism exists among doctors, as well, according to a survey conducted by medical consulting firm Medix. One unidentified doctor wrote that he feared the vendors will build the systems by using U.K. taxes but then claim ownership of the technology and jack up costs for users. And although the NHS says the system will feature smart cards and passwords to give access only to authorized personnel, that hasn't diffused worries over patient privacy. "How can anyone trust that their records [will] be secure when 100,000 people in the National Health Service might be able to access them?" wrote another doctor in response to the Medix survey. "It only takes one rotten apple, and the larger the access, the easier it is for this to happen undetected."

Vautrey is confident the E-records will be secure, but he doesn't think most Brits agree. "The security of public databases does not have a great track record," he says. The public has the right to opt out, and if large numbers do, the project will have been pointless.

Positive Signs
Yet there are signs of progress. More than 100,000 citizens have already registered to access records over the Data Spine, and a general practice in West Yorkshire has become the first in the country to start linking its patients' records to the Data Spine. The system went live in January at Undercliffe Surgery in Batley. Medical staff at the clinic can enter the names, addresses, and birth dates of their 8,700 patients into the national database. More detailed information, such as the patients' NHS numbers, will be stored locally until security controls have been fully tested, according to the National Health Service. And the ability for competing vendors to work together is being aided by the use of standards like the IT Infrastructure Library, which sets out best practices for various IT functions, Accenture's Lacey says.

There's an element of the experimental in this huge health-care IT project, even as rollouts begin. And as lab rats know, experiments can go awry. Says Vautrey: "There's the suspicion that this will be yet another big IT program that will fail." Prime Minister Tony Blair's Labor government and several big tech vendors hope that won't be the case.