Clinical Informatics

Information System Failures and the NHS


  1. Introduction and Context of Information Systems Failure at large and in the NHS

  2. The Definition of Information System Failure

  3. The causes of Information System Failure

    1. Pre-implementation
    2. During Implementation
    3. Post-implementation

  4. Managing Individual and Organisational Change

  5. Conclusions

  6. References


From the review of the literature, one can conclude that the failure of Information Systems is endemic and continues to occur at an alarming rate and scale.

Although the amount of knowledge in this field has increased, the challenge appears to be in getting the information into the realms of those actively practising in the industry, but who may not be formally trained in their fields nor have "the incentives" to practise Continuing Professional Development (CPD).

The other problem is that research will inevitably lag behind the exponential increase in our computing and networking capabilities, which then leads on to an equivalent increase in complexity of Information Systems implemented in the real-world.

The causes of failure are multi-faceted and multi-factorial, which confounds the problem. However, a simple yet strict definition of failure may be a crucial starting point that is thus far missing.

With a clear definition, it would enable early and rapid identification of failing projects, subsequent instigation of immediate corrective efforts and further analysis for future research. A consensus on this very important issue is thus essential for all parties involved.

Managing change is a crucial part of avoiding failures, and it is imperative that it is made a part of formal training for management and Information Systems students. Non-technical skills such as communication, understanding of human and organisational cultures are also essential parts of the curriculum as well.

Special emphasis on the NHS organisational structure, culture and internal work-flows of the clinical staff should be made compulsory for those taking part in implementation of clinical Information Systems in the NHS.

Last but not least, provisions needs to be made within contractual agreements to ensure that there is transfer of technical expertise from the contracted software companies to local NHS Information Technology teams.

Access to the source code and full documentation of the software engineered for the NHS must also be made available to these teams to enable future modifications to adapt to changes in evidence-based medicine and to any future changes in the way NHS services are provided, nationally or locally.

This will also help to ensure "survivability" of these clinical Information Systems in the event of unforeseen proprietary software company withdrawals from the project, commercial failures and bankruptcies.

Although using "free-market" forces and "open-competition" may be a rational way of obtaining the best software at competitive prices, it leaves the NHS open to the risk of bearing many white elephants, if management of the risks mentioned above are not included within each and every contractual agreements.

It also predisposes the NHS to fragmentation in the realms of health informatics, as each region marches forward with their own brand of proprietary applications and operating systems.

This may also lead to a situation where the NHS may have many different proprietary software providing the same function in different regions, each incurring a separate set-up, future upgrade and support costs.

There are no easy answers to the issues raised above. However, long term commitment from all stake-holders is necessary as a basis for action.

In addition to developing a consensus definition of "Information Systems failure", putting more emphasis on accountability, long-term involvement, transfer of technical expertise and stringent contractual agreements with the proprietary software engineering companies would be the first steps needed to address the issues discussed above.

Ultimately, it is conceivable that open source software and systems will have to brought on-board as the inherent nature of proprietary software are not conducive to many of the needs of a "constantly changing open source publicly-own and publicly-accountable organisation" like the NHS...

To quote Douglas Carnall,

"Software engineering will become a profession more like medicine and the law: in which practitioners earn a fair hourly reward for their experience at interpreting, evaluating and applying knowledge from a specialized domain to the benefit of their clients.

Current models, which restrict the sharing and development of knowledge, are certainly counterproductive and arguably unethical. Open source is the future: all we have to do is built it."

[This article was completed in 2006. Since then, there has been some progress where openEHR is now being involved in the development of the national Electronic Health Care Records for the NHS (now known as the NHS "Care Record Service").

It has also been a very uncertain time for the NPfIT project, now transformed into "Connecting for Health". Many of the risks described in this article in dealing with proprietary software and companies have come to bear and had to be risk-managed accordingly.

With the removal of all Primary Care Trust and Strategic Health Authority from the NHS organisation structure by the new Conservative and Liberal Democrats government, it will be interesting to see how many proprietary software contracted by the previous Labour government for the NHS will be rendered redundant due to the change in the data sets, flow of funding and targets of service provisions as a result.

The British Computer Society is now known as the Chartered Institute for IT

The 10 year contract which the Labour Government signed to provide proprietary software and operating systems to the NHS and NHS staff will expire soon. It will be interesting to see what transpire next...]


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Page Updated: 17 May, 2017

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