Britain ponders its sickly $20 billion e-health experience

BRITAIN’S push for e-health records won the “most appalling project” prize in the annual Big Brother awards of Privacy International in 2004. That, it turns out, was only the beginning of the project’s troubles.
It is eight years and £12 billion ($19.9 billion) since Britain set out to establish a shared e-health record for 50 million citizens as a central plank of its overhaul of health and computers, in what was dubbed the world’s largest civilian IT project. Now the rollout of e-health records is over time and over budget, dogged by savage criticism and languishing from lack of use.
Earlier this year, doctors called for a boycott of the system after it was found one in 10 records uploaded contained out-of-date information, including errors about patients’ medication and drug allergies. This threatened patient safety, they said.
Earlier controversies erupted over patient consent. Britain has an opt-out system; patients must apply to be exempted from having a shared e-record and, if they don’t, their consent is “implied” and the record uploaded. But research showed many people had not received notification of the system and did not know it existed. Some who tried to opt out were told they must first have a face-to-face session with an “adviser”, and others were told they could no longer receive health care if they did not have an e-record.
A study published this year in the British Medical Journal found doctors did not often use the new records. They were accessed in only 20 per cent of medical encounters in which one was available (1.5 million are uploaded to date). When they were used, e-records led to longer consultations. While they “added value”, particularly with complex medication regimes: “We observed no cases in which [they] unequivocally made care safer, or in which absence of one seemed to make care unsafe.”
The authors concluded the benefits of shared e-records were “more subtle and contingent” than anticipated and that implementation was a lot of work. They also noted: “No country with a population above 5 million has successfully introduced a shared electronic patient record.”
There are fears the health IT revolution might end up costing up to £50 billion – half the annual health budget. In 2007, when the House of Commons public accounts committee found the scheme’s pilot projects were two years late and unlikely to offer any benefits to patients any time soon, its chairman warned the project was turning into “one of the biggest IT disasters of all time”.

First published in The Age.