Category Archives: IT projects

Summary Care Record plods on

By Tony Collins

Pulse reports that the Summary Care Record database had 13.1 million records by 22 March 2012, which is around the number the DH had expected for April last year.

It reports that the figures have prompted David Flory, deputy NHS chief executive, to call for ‘rapid further progress’ on the rollout.

In his latest quarterly report on NHS performance, Flory highlighted the SCR as an area for improvement. “Implementation does not meet expectations and rapid further progress is needed,” said Flory. “While performance has improved, the rate of this improvement is beneath the expected trajectory.”

The number of patients with an SCR has almost doubled from around seven million a year ago. Sixteen PCTs have more than 60% of patients with an SCR.

Critical Mass

In February, Kilburn GP and SCR director Gillian Braunold was reported in Pulse to have said the rollout has reached a ‘critical mass’ in some areas. Out-of-hours providers, and those in urgent care and hospitals are viewing about 1,600 records a week.

Braunold said information within the SCR was changing some therapeutic decisions. She also said there was also evidence from areas where end-of-life care plans had been uploaded to care records that more patients were dying in their preferred place.

Nurses at NHS Direct are to have access to care records and the DH is working on plans to replace HealthSpace and enable patients to access their full patient record.

Comment – The devil’s in the detail

It is difficult to put Dr Braunold’s comments into context without published independent evidence of which there is little or nothing that’s recent.

In public, NHS Connecting for Health has never wavered in proclaiming the success of the SCR but it has sought to control authoritative information on the SCR programme.

CfH commissioned an independent UCL report on the NPfIT SCR  “The devil’s in the detail”, but asked researchers to, for example, delete the cost of the SCR programme. CfH also removed passages from official SCR documents it gave the UCL researchers.

The final UCL report , which said in a footnote ” financial data deleted at the request of CFH”,   found that there were inaccuracies in the SCR database. UCL researchers also learned that the SCR database could not be relied on as a single source of truth.

Some CFH staff found the notion of possible ‘disbenefits’ of the SCR difficult to conceptualise, said the UCL report.

There is no doubt that an accurate and well-populated SCR would be useful, especially for out-of-hours doctors. They need to know – at least – what drugs patients are taking and what if any adverse drug reactions they have had.

As the DH tells patients: “Giving healthcare staff access to this (SCR) information can prevent mistakes being made when caring for you in an emergency or when your GP practice is closed.”

But a national database is not the way forward. It is unlikely to be trusted as accurate or up-to-date. It would be better to give patients and clinicians access to locally-held NHS-sourced information. We’ll report more on this separately.

Meanwhile the SCR plods on at a high cost – more than £220m so far. BT, the SCR’s main supplier, will be pleased the programme is continuing, as will those civil servants and consultants who have been involved with the programme for several years. But whether the database is of real value to doctors and patients we don’t know for certain. The DH tends not to publish its independent advice.

Summary Care Record a year behind schedule, DH warns – Pulse

Why ignoring the human factor can lead to failed IT projects

By David Bicknell

In a column for the Wall St Journal, Frank Wander, a former CIO of the Guardian Life Insurance Company, has warned that ignoring the human factor is a sure route to the failure of IT projects.

He points out that, “Sixty years into the information economy, information technology projects, especially large ones, still fail, or under-perform, at disheartening rates. Trillions of dollars of collective project experience, and, what long ago, should have become a predictable undertaking, remains an area of dissatisfaction. Yet, the performance of our technology infrastructure (devices, networks, storage) has made quantum leaps forward over that same time period.”

He argues that workers are the most expensive, but least understood tool. In the insurance industry, for example, talent represents 63% of IT cost, according to a 2011 Gartner report.

He concludes: “As an industry, we must remove this blind spot, recruit the best talent, nurture it and unlock the full productivity potential by designing social environments where the chemistry enables IT to flourish. Companies that understand this, and embrace it, will win; the rest will compete in a race to the bottom.”

Fast-growing BRICS countries face IT challenges, says economic think tank

Much has been written about the economic potential offered by the BRICS countries: Brazil, Russia, India, China and South Africa.

And yet, despite improvements in many drivers of competitiveness, the BRICS still face important challenges to more fully adopt and leverage IT, according to the latest  Global Information Technology Report 2012: Living in a Hyperconnected World, published by the World Economic Forum.

Despite efforts over the past decade to develop information and communications technologies (ICT) infrastructure in developing economies, a new digital divide in terms of ICT impacts persists,  the Forum says.

Even for the fast-growing BRICS, an insufficient skills base and institutional weaknesses, especially in the business environment, present a number of shortcomings that stifle entrepreneurship and innovation.

It’s not unreasonable to argue that they may have something to learn about delivering successful IT projects too, as developed countries have had to do. Alternatively, they may have some insight to pass on.

When it comes to leadership in IT adoption and usage, it is the usual suspects, Sweden (1st) and Singapore (2nd) that top the rankings in leveraging information and communications technologies to boost country competitiveness.

Switzerland (5th), the Netherlands (6th), the United States (8th), Canada (9th) and the UK (10th) also show strong performances in the top 10.

It is equally perhaps no great surprise to find that ICT readiness in sub-Saharan Africa is low, with many countries showing significant lags in connectivity due to insufficient development of ICT infrastructure, which remains too costly.

Even in those countries where ICT infrastructure has been improved, the Forum suggests, ICT-driven impacts on competitiveness and well-being trail behind, resulting in a new digital divide.

China

At 51st place in the rankings, China leads the BRICS countries. Yet, the report says, “this should offer little consolation in light of the important challenges ahead that must be met to more fully adopt and leverage ICT.

“China’s institutional framework (46th) and especially its business environment (105th) present a number of shortcomings that stifle entrepreneurship and innovation, including excessive red tape and long administrative procedures, lofty taxation amounting to 64 percent of profits (124th), uncertain intellectual property protection—it is estimated that almost 80 percent of installed software in China is pirated—and limited or delayed availability of new technologies (100th).”

In terms of readiness, the country ranks only 87th in terms of its infrastructure and digital content, mainly because of its underdeveloped Internet infrastructure.

In terms of actual ICT usage, although the figures remain low in absolute terms, they should perhaps be considered in light of the sheer size of the country.

ICT usage by businesses is significant (37th). China is becoming more and more innovative and this in turn encourages further and quicker adoption of technologies. The Chinese government is already placing significant hopes in IT as a catalyst for future growth, because more traditional sources of growth are likely to dry up.

The efforts of the government in promoting and using IT are reflected in China’s strong showing in terms of government usage (33rd). For the time being, though, the overall impact of IT on the economy remains limited (79th).

India

However, contrast China’s position with India and you find that India, ranks nearly 20 places behind in 69th position.  India delivers a very mixed picture, with encouraging results in some areas and a lot of room for improvement elsewhere, notably in the political and regulatory (71st) and business and innovation environments (91st).

Extensive red tape that stands in the way of businesses and corporate tax is among the highest of all the countries analysed by the Forum. For instance, it typically takes four years and 46 procedures to enforce a contract in India. Starting a business is longer and requires more paperwork than in most countries. Other variables fare better, such as the availability of new technologies (47th), the availability of venture capital (27th), the intensity of local competition (31st), and the quality of its management schools (30th).

One of the weakest aspects of India’s performance lies in its low penetration of ICT. The country ranks 117th in terms of individual usage, with 61 mobile subscriptions for every 100 population, a relatively low figure. Only 7.5 percent of the population uses the Internet; just 6 percent of households own a PC and broadband Internet remains the privilege of a few, with less than one subscription per 100 population.

“The big story is how India is falling behind in relative terms as far as its overall measure of technology and competitiveness is concerned,” says Soumitra Dutta, Roland Berger Professor of Business and Technology at INSEAD, a co-editor of the report. “A few years ago, India was ahead of China.”

Brazil

Another member of the BRICS, Brazil, positioned in 65th place, benefits from  strong levels of business ICT usage (33rd). These, combined  fairly advanced levels of technological capacity (31st) in particular segments of its industry, allows the country to achieve one of the strongest performances of ICT-enabled innovations in the Latin American region, both in terms of new products and services (29th) and more efficient processes (34th).

However, despite these strengths, its overall business environment with burdensome procedures to create new businesses (138th) and high tax rates (130th), in addition to its high mobile phone tariffs (133rd) and poor skills availability (86th), hinder the potential of the Brazilian economy to fully benefit from IT and shift toward more knowledge-based activities (76th) at a faster pace.

That said, Brazil is now the seventh largest ICT market in the world, with £106bn spent in 2010.

World Economic Forum Global IT Report

Desktop virtualisation may solve corporate data challenge but success relies on project clarity

By David Bicknell

I recently read a blog by Clarence Villanueva which made the worthy point that although many organisations now have smartphones and iPads, they still need to get corporate data on them.

Recent surveys  have suggested that 27% of companies support the iPad today, while another 31% plan to support it in the future. As Villanueva points out, as organisations begin to support connected devices such as iPads and smartphones, they will want to connect them to their enterprise data and applications. One solution for achieving that is desktop virtualisation.

According to Villanueva’s blog,  desktop virtualisation is an option because:

  • It facilitates employee access to enterprise data and applications from any platform-neutral device.
  • Certain solutions allow you to convert your existing laptops/desktops into thin clients, enabling you to lengthen the life cycles of the equipment, and
  • Patch management and updates are controlled more effectively, potentially lowering internal management costs.

The problem, as the blog points out, is that many organisations don’t know where to start on desktop virtualisation. And that hints  at some IT project problems further down the line, because solicitation of information from suppliers is messy.

As the blog says, “As companies reach out to these vendors, Forrester sees that incomplete information is shared and/or project goals are unclear, which results in confusion to the vendor and multiple rounds of questions and answers.

“One of the ways to overcome this challenge is to focus on internal collaboration and organise yourself before going out to market. The transformation of the desktop from the traditional status quo to a virtualised environment is complicated — it requires the collaboration of a variety of people. Desktop virtualisation  projects affect a multitude of business and IT areas….successful projects enlist the help of companies’ internal desktop management, networking, storage, security, and software licensing professionals for a unified solution.”

One organisation that seems to be making some headway on desktop virtualisation by knowing where it is headed is National Air Traffic Services (NATS).

The company recently gave a presentation on its move to a virtualised desktop environment as part of a business growth strategy that will see it target new international regions, new services and partners, and involve it in possible merger and acquisition activity.

NATS believes adopting desktop virtualisation will give it the ability to, according to Gavin Walker, its head of information solutions, “..scale at a fast pace….a key requirement.” 

NATS has 6000 employees, including operational. technical and general office workers who all have different user profiles in their use of IT. Many of them work across multiple sites, which is why NATS wants to have remote access to the corporate network from anywhere at any time.

It also wants to use the Cloud to enable it to scale as and when required and to adopt role-based computing with integrated identity management to help it deploy services and applications based on user profiling to improve the users’ experiences.

NATS says it has now completed the planning and discovery of the desktop virtualisation project, and by working with a virtualisation company, Point to Point,  now has a scaled down version of the desktop virtualisation system with Office 2010. The version, dubbed ‘Springboard’ has been rolled out to 100 people across the organisation, including NATS’ chief executive Richard Deakin and his executive team.

“Getting stakeholder investment can be a challenge as IT is seen to be taking money away from tbe bottom line,” says Walker. “Springboard helped us to demonstrate immediate results and provided an indication of what the system would be able to do once in place. This really is a change management programme supported by technology.”

Other Links

Computer Weekly: NATS delivers Office 2010, Visio and MS Project on virtual desktops

HMRC picks an SME – and saves itself £50m

By David Bicknell

HM Revenue & Customs (HMRC) cut the cost of an Internet Explorer upgrade by up to £50m by awarding a contract to an SME, instead of a major systems integrator.

According to an article by Bill Goodwin on Computer Weekly, HMRC chose a small US company to upgrade from Internet Explorer 6 to IE9, after it found that large IT suppliers were unable to offer a cost-effective solution.

The Redmond-based company, Browsium, managed to complete the work for £1.28m, against quotes of £35m to £50m from much bigger companies.

Goodwin reports that HMRC CIO Phil Pavitt believes the contract will act as a proof of concept for other government departments facing similar IE6 upgrade problems.

IT is from Venus, the Business is from Mars

By David Bicknell

Monday morning and another week for IT and the business to work together in the best interests of the organisation – though if you were to read this article from the Wall St Journal, you might think otherwise.

The  piece, “IT is from Venus, non-IT is from Mars”, by research scientist George Westerman from the MIT Centre for Digital Business, suggests  that in many companies, the relationship between IT and business leaders is a very troubled marriage. Miscommunication is rife, leaving executives struggling to figure out what’s working for the company, what’s not, and how to improve the situation.

The article argues that ‘the marriage’ can be saved, provided IT and business executives have a clearer understanding of the needs of both sides, how they work and the challenges they face. That means business leaders and IT executives must talk with each other about their operations and about how IT can help the company fulfill its goals, instead of talking past each other about how one side or the other is preventing that from happening.

The article cites four separate studies by researchers at MIT that show that transparency—clear communication about IT performance and decision processes—is the best predictor of the business value of IT. These studies all show that transparency creates an environment that improves both IT performance and the IT/Business relationship.

The article discusses four areas where IT and non-IT executives fail to understand each other clearly, and how transparency can help bridge the gap between two completely different interpretations.

On IT Cost and Performance:

The Business says: “IT costs too much; we’re not getting the service we’re paying for.”

IT says: “Given our budget constraints, we’re doing really well.”

On Risk Management:

Business says: “I want it this way.”

IT says: “We can’t do it that way.”

On Prioritisation:

Business says: “I need this right away.”

IT says: “Sure, but three other executives just told me the same thing.”

On Accountability:

Business says: “Why do you make me go through all of this bureaucracy?”

IT says: “Our methodologies are how we make sure everyone does the right thing.”

The article concludes that “creating transparency takes extra time and effort on everyone’s part, especially IT’s. But this is one project that definitely pays. Transparency around performance and decision processes improves the business value of IT and builds trust between business and IT people. As everyone learns to work better together, IT becomes part of the company’s business-level decisions and initiatives, not its own world. When that happens, the marriage of IT and the business side is really working.”

Is Choose and Book failing?

By Tony Collins

Choose and Book, which is one of the limited successes of the NHS National Programme for IT, may be “withering on the vine” says Pulse.

It reports that the Department of Health is investigating a fall in the proportion of GP referrals made through Choose and Book. Several PCTs have described Choose and Book as “failing”.

Pulse says that the Government’s notional target is for 90% of GP referrals to be made through Choose and Book, but the latest figures indicate usage has fallen from a high two years ago of 57%, to around 50% in January 2012

Initiated in 2004, Choose and Book is now in use in every PCT and provider organisation across the NHS in England, including many independent sector organisations that deliver services to the NHS under a standard, national contract.

Choose and Book provides patients with the offer of choice of hospital and clinic and a booked appointment.

The Department of Health told Pulse that there have been falls in use in some areas but it was committed to ‘embed Choose and Book into daily clinical practice’.

Choose and Book was classified as ‘failing and worsening’ in February board papers from Bristol, North Somerset and South Gloucestershire PCTs, says Pulse.

DH press release in 2003

A Department of Health press release on the award of a contract for an electronic booking system to Atos said in October 2003 said

“By the end of 2005, every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs.”

Pulse suggests the drop in interest may be because GP practices are no longer paid to use Choose and Book.

Through “local enhanced service” payments to GPs, primary care trusts have given family doctors a strong reason to use Choose and Book. The payments to GPs have ranged from about 50p to about £4 for every patient booked through Choose and Book. That funding is drying up.

A locum GP who commented on Pulse’s website suggests that Choose and Book will fall into disuse without financial incentives: “I couldn’t fit it [a Choose and Book appointment] into a ten minute consult what with QOF [quality and outcomes framework, part of the GP contract] the patient’s list etc – had to do referrals at the end of the day, so never used it.”

Comment

The failure of Choose and Book to reach anything like the original target of 100% use throughout the NHS shows the fallacy of paying people, in this case GPs, to use national IT systems.

New IT should be so needed that its use doesn’t depend on special payments to the end-users. Choose and Book was trumpeted by some major suppliers as a simple and obvious solution – rather like an airline reservation system; and after years of bedding down the technology works. But GPs cannot be forced to use it.

The Department of Health had considered the NPfIT  to be the centre of universe, and that doctors would want to use it for the common good.

The fact is that GPs  care only about their patients – which is as it should be – and if they consider the system detracts from the time spent with their patients the common good becomes an abstract, indeed meaningless, concept.

Choose and Book was always a good idea, a fun thing to work on. But does a 50% take-up after nine years justify the hundreds of millions spent on it? The Department of Health is hopeful the scheme will eventually succeed. But then the DH has always been confident the NPfIT would succeed.

DH to investigate fall in the use of Choose and Book – Pulse.

Standish Group: the role of the executive sponsor in IT projects

By David Bicknell

The US-based Standish Group has published a series of excellent pieces on its blog over the last few days over the role of the executive sponsor in IT projects.

The blog features an interview with Eugene Bounds, senior vice-president at Booz Allen Hamilton.

Bounds says, “I was first reached by the then current executive sponsor of a project called “RightIT.”  RightIT helps organisations optimise their IT investments.  The project combined the capabilities of IT, PM and cost.  He had the expertise in IT and he wanted my expertise in programme management and finance.  I eventually became the executive sponsor for the RightITTM project. 

“The first thing I did was to establish frequent and standard meetings; so, every Friday we had a team meeting.  My commitment is to be available for guidance and status reviews.”

Bounds adds, “As executive sponsor of the RightIT project, I thought it was critical to understand who on the leadership team would be affected or could gain benefit from the RightIT project.  I then reached out to these colleagues to establish an advisory group. 

“As part of the advisory group, I established monthly meetings.  This gave me an opportunity to get direct stakeholder feedback and support.  If we were producing an artifact, I wanted their thoughts on it to make it better.  I wanted to make it packaged and ready to go.  Of all the things I did as an executive sponsor, this was the most important.”

“The problem is that project managers have their own view and language.  The project manager looks at the project tactically.  He or she looks more in the weeds of the project or the details to try to get it done.  The executive sponsor tends to look at it as a strategic event.  He or she will look at the project on how it aligns with the goals of the organisation. 

“In the project management profession we have our own language and plenty of acronyms.  So there is a gap and it really is up to the project manager to fill the gap.  We cannot expect the executive sponsor to understand the PMBOK (project management body of knowledge) and all of its artifacts and processes.  It is up to the project manager to make that translation.  Executive sponsors on the other hand have the responsibility to ensure that the project manager makes that translation.”

The Standish Group points out that the executive sponsor is “the owner of the project. As the owner of the project, the full weight and responsibilities of the success or failure of the project falls squarely on his or her shoulders. The executive sponsor, for better or worse, owns the outcome. The executive sponsor has no right to abdicate his or her executive responsibility. He or she cannot blame the project manager, the IT executives, users, stakeholders, reluctant peers, vendors, or software developers.

“The sole responsibility for a successful outcome rests on the shoulders of the executive sponsor.  The sponsor may not be an executive of the organisation, but he or she is the chief executive of the project. The word ‘executive’ symbolises a higher level of responsibility. It is more powerful than just ‘sponsor.'”

How the Government plans to ensure IT projects have a lifetime cost of under £100m

By David Bicknell

The Government has issued a Procurement Policy Note that sets out its thinking behind the policy that individual ICT contracts or projects should have a lifetime cost of less than £100m.

It says the £100m limit will apply to all future ICT projects, “unless a strong case can be made that doing so increases the overall cost to the taxpayer, notably increases the risk of failure or increases the security threat to the public body or Government as a whole.”

It adds that in future, “government IT contracts will be more flexible, starting with two areas (application software and infrastructure IT). The Government is introducing set breakpoints in IT contracts so there is less money locked into large lengthy contracts. The Government will look to disaggregate future contracts and deliver more flexible, cheaper solutions. This opens up opportunities for SMEs and reduces the cost to taxpayers.”

Its guidance, which takes effect from 1st April, applies to all central government departments, their agencies and non departmental public bodies and is particularly intended for those with a purchasing role.

In background notes, the briefing says:

  • The £100m threshold relates to all ICT contracts or projects where the total value over the life of the contract exceeds £100m regardless of how the contract is funded. It includes frameworks as well as individual call offs from frameworks. A case may be made for exemption from this policy on the grounds of national security or continuity of a critical Government service.

Based on this, the policy aims are as follows:

  • To reduce the risk of single supplier failure within a large project;
  • To increase competition and innovation by enabling more suppliers to bid and take part in projects, thereby increasing value to the taxpayer;
  • To procure contracts in a way which ensures maximum possible benefit to the maximum number of parties – for example, ensuring that infrastructure/services which are procured can be used by more than one department.

In a foreword, Cabinet Office minister Francis Maude says:

“The Government believes that business is the driver of economic growth and innovation, and that we need to take urgent action to boost enterprise and build a new and more responsible economic model. We want to create a fairer and more balanced economy, where we are not so dependent on a narrow range of economic sectors, and where new businesses and economic opportunities are more evenly shared between regions and industries. This guidance is founded on a desire to minimise the risk around high value contracts and ensure that Government always seeks the best possible value for money when procuring large ICT contracts.

“In the Coalition Programme the Government made a commitment to promote small business procurement in particular by introducing an aspiration that 25% of government contracts should be awarded to small and medium sized businesses. To deliver this aspiration the Prime Minister and The Minister for the Cabinet Office announced, on the 11th February 2011, a far reaching package of measures to open up public procurement to small and medium sized enterprises. The Government ICT Strategy, published at the end of March 2011 outlined a new approach to ICT procurement that improves contract delivery timelines and reduces the risk of project failure, enables greater use of SMEs, a much shorter timescale and lower costs to all parties.

“We will end the practice of attempting to cover every requirement in great detail and cover every legal eventuality in every project and contract, thereby increasing the procurement cost and timescales to all parties to unacceptable levels. We will do this by focusing on the 80/20 rule, simplifying to the core components of the requirements at every level and at every stage of a project.

On SMEs, G-Cloud and Open Systems, the policy note says procurement will:

  • Ensure value for money, competition and innovation by ensuring that small and medium sized enterprises (SMEs) are freely able to bid. Ensuring that any procurement process we use does not unnecessarily exclude them due to price, risk or resource associated with bidding activity. This includes reviewing our criteria and evidence required as part of the contract award process for items that might be relevant to a large company only. However, SMEs will be treated no differently in evaluation of capability, financial stability, or their ability to provide ongoing support, etc.
  • Ensure visibility of innovation and encourage mass purchasing of solutions available from both within the public sector and the private sector by creating a quality assured Government Cloud based procurement vehicle for Government, which enables all sizes of organisations to showcase their products, services, solutions etc. This service would also enable government to market and sell any unwanted assets it might own.
  • Encourage and maximise the use of Open Source/Open Standards whenever possible and where it represents a value for money solution, allowing department to re-use code, designs, templates etc. ensuring that work is not duplicated.

Comment

The Government’s aspiration to have individual ICT contracts or projects with a lifetime cost of less than £100m is a worthy one. But the proof of the pudding, as always, is in the eating. And we haven’t seen the pudding yet.

CIO behind FBI’s Agile-developed Sentinel IT project to leave his post

By David Bicknell

The US CIO behind one of the world’s highest profile public sector Agile IT projects is to leave his post and return to the private sector.

Chad Fulgham, CIO at the FBI will leave next month having overseen the creation of the FBI’s Sentinel case management system. Sentinel replaces the FBI’s outdated Automated Case Support system, with the hope that it will transform the way the FBI does business by moving it from a primarily paper-based case management system to an electronic work flow-based management system of record with enhanced data sharing capabilities.

“When I was hired as the CIO, it was understood Sentinel was going to be one of my top priorities,” said Fulgham. “Today, I can tell you the software coding is done, the new hardware is in place, and it has been quite impressive during initial performance testing. We have trained hundreds of FBI special agents and employees, and it will have a lasting impact on this organisation.”

In a press release announcing Fulgham’s departure, the FBI said that “using a progressive Agile software development methodology, partnering with industry, and employing an aggressive deployment schedule, Sentinel is scheduled to be implemented in summer of 2012.”

The US Inspector General recently issued a report into the use of Agile in the Sentinel project. You can read the report here

The US magazine Information Week has also covered the story

Lifting the lid on Agile within a public sector IT project