U.K. taking American-style approach to health IT

Government officials in the United Kingdom are formalizing plans to end its centralized National Programme for Health IT and replace it with a strategy similar to one being pursued by the U.S. -- one that relies on physicians and local communities building a national health information network from the bottom up.

The existing U.K. program, launched in 2002, has been criticized by doctors and embroiled in controversy almost since the beginning. A report issued in June by the Cabinet Office's Major Projects Authority legitimized many of those criticisms. It found that about $9 billion had been spent on a program that "let down the [National Health Services] and wasted taxpayers' money," according to a statement by U.K. Health Secretary Andrew Lansley.

Under the new plan, announced Sept. 22 as still under development, the National Programme for Health IT no longer will exist. Implementation of health IT systems and the building of a national health information exchange will be the responsibility of the local NHS trusts. The government said it will continue to work with existing vendors to deliver the systems that local NHS participants choose to adopt. The service no longer will rely on a one-size-fits-all approach.

The government also is partnering with Intellect, a technology trade association representing U.K.-based technology vendors and professionals, to help small and medium-size vendors compete for some of that business. A new Cabinet-level oversight committee that will monitor future health IT investments is being established.

"In a modernized NHS, which puts patients and clinicians in the driving seat for achieving health outcomes amongst the best in the world, it is no longer appropriate for a centralized authority to make decisions on behalf of local organizations," the government's Dept. of Health said in a statement.

The MPA report said a lot of the waste could have been avoided if the Dept. of Health had consulted with health care professionals from the start. The top-down approach was unpopular among physicians who wanted the freedom to choose their own health IT systems. Many physicians already were using electronic medical record systems when the program was announced and didn't want to switch to another one picked for them.

In an email to American Medical News, the British Medical Assn. said it "supports a move away from nationally imposed IT systems. Local choice of accredited systems, which can be tailored to support local needs, is the way forward. However, it is important that centrally accredited standards are maintained so that information can be shared between providers to ensure a joined-up health care service."

The strategy is similar to that being used by the U.S. Dept. of Health and Human Services. Federal incentives encourage American physicians to adopt health IT systems that are certified to meet interoperability standards. Communities form health information exchanges made up of users of those interoperable systems, and the HIEs eventually will connect with one another to form the National Health Information Network.

A year ago, Lansley wrote a paper describing needed changes to that country's program, which included a switch from a government-centered, top-down approach to one like that in the U.S. Lansley's plan is being formalized with the Sept. 22 announcement that the Dept. of Health called the "acceleration of the dismantling of the National Programme for IT."

However, several aspects of the program, including the electronic prescribing network, will remain in place. Other remaining programs include "Choose and Book," a program that allows patients to select the date, place and time of appointments online, and "The Spine," the network on which patients' summary of care records are stored and transferred. Also left in place are a physician networking system, an emailing system, and a picture archiving and communication system. These programs account for about one-third of the money spent thus far, according to the MPA report.

Katie Davis, managing director for informatics at the U.K. Dept. of Health, said she will announce this fall what work will continue and the framework for how IT systems will be delivered to the NHS.