Britain Reconsiders its Top-Down Health IT Approach

Late last month the British Department of Health issued a press release that stated it was dismantling its National Programme for IT. The program was created in 2002; the decision to change course has made by the Cabinet Office’s Major Projects Authority, which said, “it is no longer appropriate for a centralized authority to make decisions on behalf of local organizations.” It also said, “We need to move on from a top-down approach and instead provide information systems driven by local decision making.”

A few days later Steve Lohr, in the New York Times Bits blog, referred to Britain’s IT policy initiative, originally billed as the world’s largest civil information technology program, with a budget of about $19 billion. In his view, the digital IT project was as a “slow-motion train wreck.”

What are the implications for the push for healthcare IT in the United States, which, as Lohr notes, is about to hand out $20 billion in incentive payments over the next five years? He asked the opinions of two health policy experts in the U.S., both of whom criticized Britain’s top-down approach and sought to differentiate Britain's project from the approach being taken in the U.S.

Dr. David Blumenthal, the Obama Administration’s first national health coordinator, commented that physicians and healthcare professionals have to be part of the process, adding that the digital health effort needs to be a collaborative effort. Dr. David J. Brailer, who held the same position under the Bush administration, noted that the British experience was a warning, and that confrontation with doctors was a main reason behind its failure.

Those opinions dovetail with the British government’s assessment. One of the findings in the British government report that served as the basis to pull the plug on the current approach emphasized participation at the local level: “The view of a single all encompassing service which delivers full integration does not line up with the needs of clinicians on the ground and should be simplified to fit the current and future environment.”