England's $17 Billion Tech Cure-AllEngland's $17 Billion Tech Cure-All

The British like to boast that they revolutionized rock 'n' roll. Now England wants to revolutionize medicine with a $16.9 billion technology plan for its national health–care system.

National Health Services, which is run by the United Kingdom's Department of Health, late last week was close to selecting the main contractors that will help the country wire hospitals, clinics, and doctors so they can share medical records on 50 million patients electronically-and let patients take better charge of their health care via the Internet. The country will spend $3.9 billion on the project in the first three years and another $13 billion over the next seven years.

The plan involves creating a broadband network over which records can be shared, prescriptions can be sent electronically, and patients can book doctor visits. Booking appointments is notoriously slow today; the goal is to reduce the maximum wait for an outpatient appointment to three months. The system will also include access to locally stored clinical data and the creation of a single, centralized database to hold some administrative data on every English patient. (The plan doesn't yet include other parts of the United Kingdom.)

If it works, England would become the world's best–networked health system, far surpassing the United States, which-like most countries, including the United Kingdom-relies heavily on paper–based processes with sprinklings of digitization and automation. Where computerized record systems exist in the United States, poor integration of incompatible and disparate systems limits their value.

IBM, BT, and Lockheed Martin are the three vendors contending for the largest piece of the contract, to be the service provider that creates and operates an integrated care–records system. Accenture, Cap Gemini Ernst & Young, Cerner, Computer Sciences, Fujitsu, Patient First Alliance, PlexusCare, and SchlumbergerSema are vying along with those three to run regions of the network.

The U.S. government is taking a different approach to networking the health–care system. It doesn't have the power to mandate such a sweeping initiative, but it's encouraging private health–care providers to deploy technologies such as electronic health records and computerized drug order–entry systems. In recent months, the Department of Health and Human Services has embraced technology standards, such as messaging protocols, for the Medicare and Medicaid systems that the feds hope private health–care providers will adopt. The U.S. government also is trying out financial incentives to increase health–care providers' adoption of patient–related technology.

England's approach won't be easy. The $17 billion budget might not be enough to accomplish such an unprecedented task. Integrating all those information systems holding tens of millions of patient records is a huge technical challenge, says John Halamka, CIO at CareGroup Health System, which runs five hospitals in the Boston area. "This project is Big Dig in scope," says Halamka, referring to Boston's multibillion–dollar, federally funded highway project that's costing much more and taking longer than government officials originally projected.

The lack of a widely accepted, nationwide patient ID system in England also could be problematic in validating the accuracy of patient information, just as the lack of a national patient ID system holds back information sharing here, says Halamka, who lectured at several U.K. universities last year and met with members of Parliament and the then–minister of health, Lord Philip Hunt. However, the United Kingdom is in the midst of implementing an ID system, including assigning health–system numbers at birth to babies in England and Wales.