Category Archives: IT projects

Cerner system “too entrenched to be scrapped”

By Tony Collins

A report by Deloitte on problematic Cerner installations at some hospitals in Australia calls for the government to appoint a chief medical information officer to oversee computer projects across the State.

The Deloitte report is a reminder that new IT in hospitals can have good – and adverse – safety implications for patients.

Obtained by the Sydney Morning Herald under Australia’s Freedom of Information Act, the Deloitte report is said to accept complaints last year that the system put patients’ health at risk by providing insufficient alerts to clinicians when messages did not reach their destination.  Deloitte found no evidence of harm to patients.

Though the Deloitte report is specific to the Cerner “FirstNet”  system as installed at some emergency departments in New South Wales, the idea of a chief medical information officer is arguably a good one for the UK where the Department of Health’s CIO (currently Katie Davis, interim Managing Director, NHS Informatics) is not responsible for the medical implications of IT go-lives in NHS hospitals.

New systems bypass the sort of regulation that helps protects the public against harm from medical devices. After hospital IT disasters there is no requirement for a genuinely independent investigation, as happens after airline crashes.

The Sydney Morning Herald [SMH] reports Deloitte as saying that the FirstNet system, which was installed to help run emergency departments across New South Wales, is chronically underfunded.

Deloitte was asked to report on the system after some hospital staff last year lost confidence in the software and returned to manual record-keeping.

Despite continuing problems and excessive time spent on data entry, the FirstNet system is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, said Deloitte.

”With some exception, FirstNet reporting is inadequate for effective governance of [emergency department] operations,” said Deloitte as reported by the SMH.

Nurses and doctors had complained that the system increased the amount of time they spent at a screen and reduced contact with patients. But the Deloitte report said more time spent on data entry ”was essential to realise the eventual benefits of an eventual [electronic medical record]”, such as greater accuracy of test results and medicine orders.

Upgrades were improving safety at some hospitals but needed to be across the state.

The government should appoint a chief medical information officer to oversee computing projects across the state, and pay for continuing development and training for FirstNet, said Deloitte.

The Health Minister, Jillian Skinner, said clinicians did not want to scrap FirstNet because they didn’t “want to start anew”.

The list of hospitals that have had serious problems after IT installations is growing, in part because the increasing use of technology in healthcare. Though hospital staff tend to learn in time to manage new systems, the unanswered question is whether patient care and treatment – and potentially their health and safety – should be damaged in an unregulated way until the problems are solved or mitigated.

Below is the UK list where it is known that the installation of new IT has caused serious disruption.  Any effect on individual patients has gone unreported:

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury

**

Links:

Does Hospital IT need airline-style certification?

Hospital computer system found lacking – Sydney Morning Herald

Jon Patrick’s essay on the effectiveness and impact of Cerner’s FirstNet system in some hospitals in New South Wales.

Good news: IBM-led shared services company is recognised as “failing”

By Tony Collins

After years of depicting problems at an IBM-led shared services company, Southwest One, as teething, Somerset County Council has conceded that the venture is failing.

The Conservative leader of Somerset County Council Councillor Ken Maddock used the word “failing” nine times in a speech on Wednesday about Southwest One, a company run by IBM on behalf Somerset County Council, Taunton Deane Borough Council and Avon and Somerset Police.

Southwest One’s contract, which was signed in the early hours of a Saturday morning in 2007, was doomed from the start, in part because of the complexity of the arrangements and in part because of pervasive secrecy that antagonised hundreds of Somerset council staff who were already opposed to the joint venture; and they were the very staff who were seconded to Southwest One to make the venture work. [It’s a truism that staff, if they are motivated, will often make their way around difficulties but may be overwhelmed by them if not motivated.]

Last month Campaign4Change set out in detail some of the most disruptive and continuing problems at Southwest One; and we said the difficulties could not be tackled in earnest while Somerset council and its partners were portraying the venture as a success. On 31 January 2012, our post was mentioned on the website of the local Conservative MP Ian Liddell-Grainger.

The good news now is that the council has, this week, for the first time, spoken of Southwest One in unequivocally negative terms. No longer is every council criticism of the company qualified by a positive comment, such that one cancels out the other.

Whether our post last month has made any difference is not important. What’s pleasing is that IBM and Southwest One’s partners are free to make progress, now that Somerset has told it like it is. Much of the credit for the council’s emergence from its long, self-administered anaesthesia lies with Dave Orr who has campaigned for years to highlight the failings of Southwest One, as has Liddell-Grainger.

Maddock’s speech on Southwest One

Maddock’s speech to a full council meeting is reported at length by the Somerset County Gazette and by Liddell-Grainger.

Maddock said

“As an administration we inherited a partnership that promised a huge amount, but it was not delivering. Southwest One’s accounts year on year show losses, staggering losses just published of £31m, and failures to hit modest savings targets.

“We have bent over backwards to try to make this partnership work. But we have to state clearly that our primary duty in looking after the public’s hard earned money is to make sure we get the best possible deals, that we get the best possible value for the public’s money.

“I have to say that Southwest One is failing this test.

“We are currently looking at all our services and all our contracts to see whether we are doing the best we can for our customers,  whether we are providing the best possible services for our customers and at the best possible prices for our customers.

“I have to say that Southwest One is failing this test.

“We need a Council that can cope with future government cuts and rising demand. We will need to be efficient and flexible.

“I have to say that Southwest One is failing this test.

“Sadly, Southwest One is failing. It is failing to deliver promised savings; failing to cope with a changing financial landscape; failing to be flexible enough to adapt in challenging times and provide the best possible value for money.

“To make up for this failure, we will now accelerate our extensive review of everything that the council does: Almost half our most vital services are carried out by private sector or not for profit organisations – we will look to increase this where appropriate.

“We will encourage social enterprises, partnerships, communities and voluntary groups to get more involved in what we do and what we run. We will look to put the customer at the heart of what we do.

“And we will do this whilst we continue to do all we can to make Southwest One work. But I have to be clear; it is failing; it is inflexible; and it is intransigent. We are therefore looking at all the options available to us.

“I do have one final message for Southwest One – and that is to the staff and our Somerset County Council colleagues and secondees working there.  The message is this: This continuing failure is not about you. It is about the contract, the complications, the failed technology, the missed opportunities, the lack of promised savings.  It is about Southwest One itself, not about the people working for it.”

Comments on Maddock’s speech

Some of the comments on the Somerset County Gazette website were apt. One said “Somerset County Council has finally come to accept what we, the minions, have known for years: South West One is a failure and a pretty expensive one…”

Another said

“At last SCC admits to what everyone in the real world knew from day one …”

Comment:

One of the lessons from IT disasters in the private and public sectors is that things often start to improve once the main parties own up to the seriousness of the problems. The good news, perhaps, is that Southwest One may now be at its lowest point. It has at long last purged its bowels, so to speak.

Ian Liddell-Grainger’s website.

Southwest One gets £10m IBM amid “staggering” losses.

IBM struggles with SAP two years on – a shared services warning?

CSC may cut 500 jobs after NHS write-off – end of NPfIT?

By Tony Collins

CSC has confirmed in a statement to Techweekeurope that it may cut 500 jobs on its NHS account.

“We can confirm that, regrettably, we have recently started a formal 90-day consultation process in the UK which could reduce the number of people working on our NHS account by up to a maximum of 500 people,” CSC told TechWeek Europe.

“This action is necessary mainly because we have now substantially completed many key development activities with NHS, and are now moving away from a focus on development work.”

CSC told The Register that it regretted having to take put jobs at risk, but it was necessary because its NHS workload was getting smaller.

CSC has confirmed it is to write-off almost $1.5bn (£957m) as a result of its involvement in the National Programme for IT (NPfIT).

Comment:

CSC is by no means quitting the NHS. Its NPfIT contract is still in force although it remains unrevised, out of date and subject to legal discussions. CSC has large numbers of UK trusts and GP practices as customers, which will need support and upgrades. If it cuts 500 jobs this may indicate the effective end of the monolith that was the NPfIT which will continue in a much diminished, though still expensive, form, largely because of contracts between the Department of Health and BT.

It appears that the dismantling of the NPfIT has begun in earnest, thanks largely to Cabinet Office officials, its Major Projects Group, the Cabinet Office minister Francis Maude, David Cameron and the Department of Health’s Managing Director of NHS Informatics Katie Davis.

The campaign to stop a new deal being signed with CSC was led by the Conservative MP Richard Bacon, a member of the House of Commons’ Public Accounts Committee who was concerned that a new deal would not be good value for money.

It’s to be hoped that CSC will manage to find other work for the 500. The company says it hopes to achieve the job changes through voluntary redundancies and redeploying people within other parts of its business, without the need for compulsory redundancies.

Techweek europe article that includes CSC’s statement.

MP contacts No 10 and Cabinet Office over future of the NPfIT.

How the Dutch are taking a closer look at the energy efficiency of software

By David Bicknell

I am in Amsterdam to speak with a Dutch SME about its work examining the energy efficiency of software.

The Software Improvement Group (SIG) and the Hogeschool van Amsterdam (HvA) have come together to create the Software Energy Footprint Lab (SEFL).

The lab will enable researchers to examine such questions as:

  • How do different database management systems compare with each other in terms of energy consumption?
  • How do different programing languages/compilers compare in terms of energy consumption?
  • How do asynchronous requests compare to synchronous requests in terms of energy consumption?
  • How do unsigned integer arithmetic operations compare with signed arithmetic operations in terms of energy consumption?
  • How accurate are software energy profiling tools?

The laboratory will have computers rigged with sensors to measure the flow of electric current into each of the computer’s components. Specially crafted programs or generic benchmarks are then run with the sensors reporting on where the current is flowing to and how much of it is flowing to each component.

The relationship, which I’ll learn more about today, builds on the knowledge of electronics from the HvA together with SIG’s work into the technical quality of software which provides insight into the quality of organisations’ software projects, and therefore, the quality of their software suppliers.

US Government to send in troubleshooters to sort out underperforming IT projects

By David Bicknell

The US Government wants to formalise a plan to send in specialist troubleshooting teams to rein in failing IT projects.

Federal chief information officer Steven Van Roekel  said the Office of Management and Budget (OMB) – which oversees the preparation of the US federal budget and supervises its administration in government agencies – is to create government-wide teams to take on the most problematic IT programs.

VanRoekel said agency CIOs also will continue to run TechStats, a government wide tool to shine light on and turn around underperforming IT projects. The critical details of a project’s health that are generated by a TechStat session reveal project strengths and the potential weaknesses that could lead to catastrophic failure.

As well as TechStats, VanRoekel said he will formally launch IT SWAT teams according to a US report.  The concept has already been used to help the Office of Personnel Management sort out its struggling USAJobs.gov portal.

“We assembled a team of the best and brightest IT people across government and they evaluated the USAJobs infrastructure,” said Van Roekel. “They sent me back a bunch of recommendations we now are having OPM implement and take forward. It is a great program and I’m excited to take that concept government-wide.”

VanRoekel said the goal is to bring together other teams of experts throughout 2012.

Links

Ian Watmore: ‘Majority of projects go very well and the public never hears’

Will the BRICS learn the lessons from developed nations’ limp track record of IT project delivery?

By David Bicknell

There’s not much doubt of the hot spots for IT spending over the next few years:  the BRICS.

According to this piece on ZDNet, while Europe remains transfixed viewing a Greek tragedy, other countries, notably the BRICS, are pushing ahead in terms of IT spend. 

Research firm IDC suggests that total IT spending will grow 5 percent in 2012 with emerging markets, smartphones, storage and software at the head of the pack.
 
Although European IT spending is likely to remain weak for the foreseeable future, spending in BRIC countries (Brazil, Russia, India and China – this seems to exclude ‘the S’ of South Africa) will see double-digit growth rates:
 
  • Brazil IT spending will rise 9 percent;
  • Russia will increase 11 percent;
  • India will  be up 16 percent;
  • And China’s tech spending will jump 15 percent

That spending means we can expect large increases in new IT projects – or perhaps I should say business projects delivered through IT.

Will the BRICS do a better job of the project management and delivery of these IT projects than we’ve managed in the developed world? Well, let’s just say there’s plenty of useful best and worst practice for them to take on board.

Links

Russia last in BRICS for faith in business

Can Brazil drive innovation?

Veterans Affairs lines up contractors for landmark health records IT project

By David Bicknell

A US IT project is being developed to provide  US military veterans with instant electronic access to their health and benefits information and other services.

According to Federal Times, the Veterans Affairs Department is now working with companies it already has on a $12 billion information technology contract to help it develop the Virtual Lifetime Electronic Health Record (VLER)

Last July, Veterans Affairs awarded 14 contractors, including CACI, Harris and Hewlett Packard Enterprise Services, a place on the departments Transformation Twenty-One Total Technology( T4) programme. The 15th and final spot is reported to have gone to SAIC.

Under the “five-year indefinite-delivery, indefinite-quantity task-order contracts”, vendors will provide program management and strategy planning, systems and software engineering, and other support.

The T4 contract has already been the subject of multiple bid protests – presumably because it appears so lucrative – including one filed last year Standard Communications in the U.S. Court of Federal Claims.

According to Federal Times, “nearly 39,000 US military veterans in 12 regions across the country — including Indianapolis, Richmond, and San Diego — have signed up to have their health information shared electronically among the Veterans Affairs, the US Department of Defence (DoD), and private health care providers.

“When participating veterans receive care, their physicians can request their laboratory results and other health data using the Nationwide Health Information Network (NwHIN), a project led by the Health and Human Services Department to provide a secure, standards-based method of sharing health information over the Internet. However, veterans must first agree to have their health information shared.”

The next project milestone for VLER will be this summer when Veterans Affairs and DoD decide how to expand health information exchange pilots nationwide.

Will the project succeed? It’s too early to say, although there are already some suggestions that the project has too many mouths to feed. One comment on the story so far argues that (the project) “has way too many contractors and staff involved. As we say, there are too many chiefs and not enough workers. It’s my bet that we will be talking about the 100 million dollar failure of the EMR at the expense of the US Taxpayers with in the year. They aren’t even getting the right type of people involved in the process. This is mainly a group of systems geeks and executives. They are leaving out the Health Information Management Professionals and the Medical providers…. it’s a boon doogle from the start, but at least the contractors are making money.”

Links

VA announces expansion of Virtual Life Electronic Record

10 Lessons Learned from Linking VLER to private health orgs

Veterans Affairs CIO on VLER progress

Why effective project management should focus on people, not just processes

By David Bicknell

I recently read an interesting post in the Gallup Management Journal which argued that when it comes to project management, most organisations put their practices before their people.

In other words, they place more emphasis on ‘rational’ factors, such as the process itself, and rather less on emotional drivers that could actually deliver project excellence – actually, just a project success would do! – such as their employees’ engagement with the project and company.

The piece, by Benoit Hardy-Vallee, points out that, “Project management is integral to the business world. Milestones, kickoff meetings, deliverables, stakeholders, Gantt charts, and work plans constitute the everyday world of most managers, whether they are called “project managers” or not. Given the vast experience organisations have with project management, it’s reasonable to wonder why all projects aren’t completed on time, on scope, and under budget.”

It argues that cost and time overruns on IT projects have had a profound effect on national economies, and suggests that one estimate of the IT project failure rate is between 5% and 15%, which represents a loss of $50 billion to $150 billion per year in the United States. In Europe, although the figures look pretty dated, they are still staggering in size: IT project failures  cost the European Union €142 billion in 2004.

What’s more, the piece argues, this trend is here to stay. With an ever-growing need for accessible and integrated data, organisations require larger platforms to manage supply chains, customer relationships, and dozens of other crucial systems.

“Mega-software projects are now common in private and governmental organisations, and development is not slowing down, especially in emerging economies.”

The blog argues that large projects, especially those in the IT sectors, already have a poor record. And forcing team members to adapt to project management processes and procedures only makes it more likely that the project will fail.

It goes on to suggest that a different, more powerful behaviour-based project management might be a better way of  enabling project groups to gain higher levels of emotional commitment and performance from their team members, as well as increased levels of emotional involvement from stakeholders to help improve both engagement and performance.

“A typical project management approach focuses on processes, policies, and procedures. Every task and step is described in detail by a set of rules.  Many companies implement rigid processes that dictate behaviour and use statistical methods to control quality (such as total quality management, kaizen, lean management, and Six Sigma). Process guides and rulebooks support work practices, while quality control systems assess and improve these practices.

“The problem with a single-minded focus on processes and methodologies is that once people are given procedures to follow, compliance replaces results. Everybody is concerned about how to do the job, not about the outcome if the job is done well.

“Companies that take this approach do so for valid reasons: They can’t manage what they don’t measure. More importantly, they can’t let projects run without any direction, hoping for the best. However, by relying on managing only these rational factors, organisations fail to harness the power of human nature by engaging employees’ emotions.”

The article concludes: “It’s time to update project management not with more methodologies, but with more emotional content. Employees’ and stakeholders’ disengagement can make a project fail, but behaviour-based management can make projects succeed.”

Gallup Management Journal

Bridging the divide: an engineered approach to IT projects

The State Auditor in California recently criticised a planned high speed rail system between San Francisco and Los Angeles because the project suffered from critical, on-going oversight problems. In this guest blog, Bob Evans, founder and Managing Director of TestIT Software Assurance, explains why it is critical to have a ‘single source of truth’ for any IT development, to provide the required level of cohesion, discipline, control and transparency that should be expected from any engineering project.

The risks associated with developing or changing IT systems are well documented. IT failures always bring despair and reputational damage to all involved.

Do you remember the scene in Blackadder where General Melchett suggested that walking slowly (again) towards the German machine guns would be “the last thing they’d expect” – and so “that’s what we’re going to do”? This seems to be the attitude found in many IT procurements. What’s needed is a fresh, radical and innovative approach, especially in these changed times where senior management focus is on delivery and cost.

Keeping Control

Establishing and maintaining control of an outsourced project is the single, most important part of IT development; it is imperative for the purchaser to remain in full control at all times. In all of the failure scenarios that we have researched, it is obvious in every case that control has been lost, with always calamitous consequences.

The nature of the procurement process and inevitable time pressure means that the requirements of a new software system aren’t always well-defined at project inception. Typically, specifications are incomplete or ambiguous and put together from a range of disparate sources, with non-existent internal process and control. The “silo” attitude that is often encountered across departmental organisations is usually a key factor here.  Requirements that are not made clear at the start of the project will inevitably lead to confusion, delays, additional cost and even to dispute.

And if a contract is awarded on the basis of a flawed specification, the chosen vendor is in a strong position to justify delays and ramp up the costs. When planned schedules are missed and costs spiral out of control, well intended remedial actions can then create new, unforeseen problems, leading to even more rework.

The culture of care and diligence found in many traditional engineering environments is sometimes lacking in the IT industry and in our experience, engineering discipline is usually the first casualty when pressure is applied. Very quickly, the focus shifts to fire-fighting and a project loses sight of its objectives. It’s like building a bridge – but when halfway across, only fitting every other bolt.

 Contrived Tests

It’s no surprise that applications that have seemingly passed an Acceptance Test, when deployed on a live system, prove to be problematic. Validating the effectiveness of an IT system is typically a contrived process – put simply, tests are designed to pass! They would be – they are usually designed, controlled and often even run by the software vendor.

If you were buying a used car from a local garage, you’d get the RAC to come along and check out the mechanics. You wouldn’t even think of asking the mechanic who worked at that garage to do the inspection would you? But invariably this is the case in IT.

As discussed above, it is imperative that full control of the project remains with the purchaser. But without, continual up to date feedback and independent metrics, it’s hard to know what’s really going on. And the critical decision – when to go live – cannot be made with confidence.

Agile Development

The concept of Agile Development has been round for many years. However, it is still to be seen whether this approach can really work on a large, complex project. A properly managed set of sprints – with precise objectives, proper controls and diligent, independent validation at appropriate times may indeed lead to a more rapid and successful conclusion. However, it should be noted that as development continues, the needs of the business will necessarily change. If controls are not adequately maintained, no process – not even “Agile” ones – can keep up. What is delivered is what the vendor believes is required, rather than what is actually required by the business. And no matter what methodology is used for developing software, at the end of the development cycle it is essential to verify, independently and thoroughly, that the product meets the needs of the business.

The Agile Manifesto focuses on “working software over comprehensive documentation”. Documentation is of course often cumbersome. However, minimising the amount of information while maximising the value of the information is what’s really needed.

When it’s too late – and organisations end up mired in a legal dispute, we’ve been called in to play the part of the pathologist. It is soon apparent that the project was doomed from the start – no spec, no metrics, no control, no hope. Suppliers who didn’t listen, purchasers who didn’t actually know what they needed in the first place.

But there is another way. The Maritime and Coastguard Agency recently used independent software assurance to ensure success of its high-profile CERS/SVD project. There was an acknowledgement right from the start that requirements were bound to change and controls put in place to manage this. There were efficient, timely tests – not at the project end, but continuous tests, right from project inception. There was an approach that asked:  “What can we do given the available time and budget?”, rather than the popular “one-shot, whistle and bells” approach. And there was pro-active searching for and identifying issues early on – when the supplier was still on site – which meant that remedial actions were fixed by the supplier, at no additional cost to the project. Independent, constantly updated metrics also meant that the Maritime and Coastguard Agency stayed in complete control.

It isn’t rocket science. But for IT projects, the discipline driven by an engineering-based approach is generally more likely to lead to success. That’s why bridges get built – and IT projects often don’t. 

TestIT Software Assurance

CIOs must lead business change with consumerisation, Cloud focus

By David Bicknell

Some work published by PwC in the US has argued that top-performing U.S. organisations show greater mastery in how they leverage digital technologies by the way they embrace consumerisation, the Cloud and social media.

The management company’s Digital IQ survey says these companies are offering mobile tools for customers, measuring data through social media, mobilising applications to the public cloud and are applying innovative use of business intelligence. It also finds that most enterprises are still playing catch-up on the consumerisation of IT.

PwC believes the CIO plays a critical role in the planning process for increasing a company’s Digital IQ. It argues that CIOs must be excellent at managing the internal factory, but also excel at mobilising new plans into action.  

The Digital IQ findings call for business leaders — and, in particular, today’s CIOs — to lead their organisations to change and innovate from the inside out. The report findings suggest that excellence in IT has not been commoditised and is still differentiating as a competitive advantage. Indeed, IT-enabled, multi-channel connections with customers can make a marked difference to business results. But to succeed, today’s CIOs — and the C-suite more broadly — must excel at not just managing internally, but also mobilising new plans into action.

PwC argues that a high Digital IQ requires the CIO to find better ways to sift through and drive insight from the increasing torrent of data streaming from every manner of device and interaction, and to create a platform that can deliver these capabilities across a varied set of changing mobile devices.

PwC’s survey showed that 63 percent of respondents revealed their greatest challenge is the inability to gather, understand and act on customer data. Fifty-eight percent cite an inability to quickly understand and adopt the new information technologies needed to be competitive.

“Consumerisation of IT is on the rise, and in the Survey we continue to see a need to serve the mobile customer, move to cloud services, and use data more effectively,” said Chris Curran, principal at PwC. “Organisations that have an integrated strategy—which includes technology—seem to perform better.”

For those interested in the consumerisation of IT, the Corporate IT Forum is holding a summit on the subject in London on 22nd February.  You can find out more details here