Britain scraps top-down plan for health data network

As Great Britain debates changes in its National Health Service, one of its first steps was to dump its plans for structuring a national health information network. The decision comes after nearly a decade of struggles to get the network up and running.

The program, designed as a top-down mandate that forced physicians to adopt one of two health information technology systems chosen for them by the government, was unpopular among physicians from the start.

The NHS is still hoping the network will be built. But this time, the government is taking a bottom-up approach, giving physicians and local authorities more control -- much like how the U.S. is building its own national health information network.

Under the new program, physicians and hospitals will be able to use existing health IT systems or implement new ones of their choosing. Many physicians already had systems in place when the program was launched a decade ago and were unhappy with the prospect of switching.

"I do not believe the U.K. adequately took into account individual physician preferences with regard to how they practice medicine, which led to breakdowns in the adoption of the technology," said Ron Wince, president and CEO of Guidon Performance Solutions, a global management consulting firm. "There are elements of the [electronic medical record] technology which can be the same standard communications and data exchange protocols, but at the physician level, there must be the ability for very smart and talented physicians to have a choice in the way they treat patients."

Bottom-up approach

Some describe the proposed overhaul of the U.K.'s health care system as a bottom-up approach. It will give primary care physicians more control over their patients' health care. The plan was outlined in a white paper published in July by Andrew Lansley, U.K. secretary of state for health.

When the U.S. launched its plan to create its own national health information network, Great Britain's experiences provided significant lessons, even though the two countries' health care systems are different. The NHS is a single-payer model.

Even though Britain's plan made sense for that country at the time of implementation, "the correct lessons have been learned," said Simon Stevens, executive vice president of UnitedHealth Group and president of its Global Health division.

In the United States, any intent to have a one-size-fits-all system for a population of more than 300 million "wouldn't have been a feasible approach anyway," said Stevens, who was former British Prime Minister Tony Blair's health policy director before joining UnitedHealth.

Dr. Azeem Majeed, professor of primary care and head of the Dept. of Primary Care & Public Health at the Imperial College Faculty of Medicine in London, said what's important is not merely choosing between a bottom-up and a top-down approach.

"Whatever approach is used, there needs to be a very high level of engagement with clinicians so that any IT solutions that are implemented are useful to them and help them in their day-to-day work," he said in an e-mail to American Medical News.

He said central government funding and support has advantages. "In primary care, there is now very high uptake of electronic patient records, because the government has reimbursed the costs for primary care physicians. For this reason, the U.K. is one of the world-leaders in the use of [EMR] systems in primary care."

Various surveys have put EMR adoption by U.K. primary care physicians at 90%, just behind the Netherlands and New Zealand. EMR adoption by U.S. primary care physicians, depending on the survey, ranges from 20% to 25%.

Despite the change in approach, some elements of the top-down U.K. network will remain in place, such as an e-prescribing system and a picture archiving and communication system used by radiologists.