Original URL: http://www.theregister.co.uk/2009/04/24/john_suffolk/

Her Majesty's CIO braces US for Obama HIT

Health Info Tech? Good luck

By Rik Myslewski

Posted in Government, 24th April 2009 05:04 GMT

Her Majesty's Government Chief Information Officer, John Suffolk, says the US can expect a tough slog as it implements Barack Obama's Health Information Technology scheme.

Speaking this afternoon at a public-sector technology forum hosted by Wyse Technology in San José, California, Suffolk drew on his experience in setting up the UK National Health Service's information system. And from a San José conference room, it was difficult to tell what was reality and what was embroidery.

Referring to the integration and standardization of information from the federal down to the local level, he claimed that in the UK, "You can go into any one of our local authorities and get the same benefits you'd get in any of the other 399 because they're all connected up to the federal systems."

The reason for this integration is simple, he said. "Citizens neither know nor care what the dividing lines of government are. If you want to put food on the table for your children, you don't care who's providing that money. And our job is to make it absolutely seamless from a government's perspective."

And he made some rather bold claims about the availability of UK government services: "Every single thing that we need to do online is online. There is no transaction that a citizen cannot do online if they wish to do it online."

He did temper that boast with a bit of realism, saying that "Today it's very, very common in a rural area to speak a hundred different languages - in the city it's always been 150, 160 languages" before asking the assembled CEOs and CIOs, "How many of your websites are in 150 different languages?"

None, of course, raised a hand. Suffolk then commiserated, "Although we've put everything online, it's only to a segment of the population."

When a questioner ask what Suffolk's work with the NHS would lead him to advise the US, which is just beginning to construct a similar information system, Suffolk began sardonically: "First of all, let me just say 'Good luck!'"

He then went on to explain the scope of the challenge. "The NHS service, of which I am a fantastic fan, in the UK has 1.3 million public servants. I think it's the world's second-largest organization. And of course, it's not one organization. It's 30,000 organizations."

But according to Suffolk, the challenge of getting the NHS system up and running was not one of hardware and software. "The challenge is not technology - we've put the world's largest virtual private broadband network in," he said, going on to claim that "We have given citizens total choice and booking services, so that you can examine your doctor, examine the hospital, read the medical dictionaries. And it's all web 2.0 - [you can] listen to people who've had a knee operation or any other strange operation they may have had, check all the MRSA, success rates, failure rates, and then go and book - all online. The technology is relatively easy - it's just a scale issue."

The problem is people, their differing opinions on what should be shared, and - in some cases - their larceny. According to Suffolk, "The biggest issue is getting professionals to agree on what data they're going to share. 'Well, I don't think you should share any data on my customers, my clients.' Well, I want to have it all. 'Well, you can't.'

"So the challenge is actually...commonality of view in terms of what success looks like. What happens if people just say 'No!' because they can. Professional people can say 'No!' Citizens can say 'No!' Do all citizens want their information shared? What are you going to do if they say 'Well, no!'"

When pharmacists go bad

Suffolk's example of how a health information system can combat larceny and fraud revolved around the NHS's national digitized prescription system. "You know the whole story about how you can never read a doctor's handwriting? Well, it's damned true," he said. "And people do die because of it. You put in electronic prescriptions, and that problem begins to go away.

"It also begins to take away all the fraud. You go to your pharmacy, you go get your prescription, and they say, 'Oh, I'm sorry, sir, I don't have that brand of drug - here's this generic one.' And they charge the government one and they take the price of the other. If you're a pharmacist - and 99.999 percent are fantastic people - but if you're slightly on the edge, are you going to rush to install that system? Of course you're not."

Installing an entirely new system will, as Suffolk put it, "flush out a whole host of things. You're going to come across problems that have been lying there for a hundred years which you've never had to address before."

Nevertheless, he said, "I believe that it's exactly the right thing to do, but it's probably one of the toughest things you'll ever do because you're dealing with people and culture in a way that's probably never been done before."

And Suffolk believes that the problems, infighting, criticism, and expense are worth it. "The NHS program gets a lot of criticism in the UK for the amount of money it's spending," he said, "but I genuinely believe that we will look back in ten years and say, 'You know, without putting in that technology on a national basis for every citizen, we probably couldn't have kept the Heath Service going in the way that we're doing it at this moment in time.'"

Will health information technology succeed in the US? The challenges are grotesque: America is lumbered with 50 jealous state governments, innumerable private insurance companies, a maze of for-profit and non-profit hospitals, and a culture that can at times be best defined as "Hell with you, Jack - I got mine."

The UK, on the other hand, has the unifying force of the NHS, a less divisive regional system, and a population one fifth the size of that of the US.

Suffolk avoided giving direct advice other than "Be realistic how tough it's going to be and manage expectations" and "Get all the issues on the table."

After all, the problem isn't rooted in IT. As Suffolk said, "We can crack the technology."

It's not hardware or software. It's that headstrong liveware.

Bootnotes

More from Her Majesty's Government CIO

On cloud computing: "People often ask me what's my definition of the cloud and what do I think of it. I have to say it's a bit like driving into fog at high speed without your lights on. Half the time, we're not quite sure what the hell is in a cloud - and if I'm meant to protect citizen data, then how can I protect it if I don't know what I'm protecting it on? But I have no difficulty using cloud in an unclassified kind of way."

On thin-client computing: "For the love of me, I can't understand why we put a big, heavy lump of tin on the desk, when all that most people do is contact-center office stuff. It's a complete waste of investment. The vast majority of the 5.5 million public servants do not need a big lump of tin."

On truth in marketing: "Tell me why you can't create a secure PC for a consumer. It's a very simple question. Well, we can't. And yet we never tell a consumer who buys a PC - it doesn't say anywhere - 'This PC is not safe.' Does it? We talk about the world's greatest inventions, and yet we never tell a consumer: 'This PC is not safe - and oh, by the way, when you put on all this additional stuff ... like firewalls, it's still not safe.'"

On the information glut: "One week's worth of newspapers - whether be it The Wall Street Journal or The Times - is greater than all the information you would have received in your lifetime in the 18th century. Take a single piece of fiber and you'll have 1,900 CDs a second - and accelerating away."

On change: "How many of you are keeping up with the rate of change? The answer is that nobody is. And therefore one of the biggest challenges for us as an IT industry is that ... we have no understanding of the consequences of the decisions that we are making. And I believe that to be true in most other walks of life as well."

On the economic Meltdown: "We're in broadly the same economic position as you good folk: we have no money." ®