A landmark report published Sept. 10 by a King's Fund (London) think tank finds England far advanced in its £12.4 billion ($24.8 billion) quest for an electronic health system, but concludes it will never reach its avowed Holy Grail, the system-wide integration of detailed patient records capable of guiding care delivery.

This damning conclusion and the 300 pages of criticism of the Connecting for Health (CfH) program will not be easy for the British government to ignore, as it was written by the founding father and chief architect of the program, Sir Derek Wanless.

The House of Commons, in a separate 117-page report published by the Health Committee Sept. 13, affirms the vital importance of electronic patient records for the future of healthcare in England but goes on to cite a "worrying lack of progress on implementing local systems."

The Commons report blames the two-year delay in implementing clinical software on "unclear communications" between the centralized development group and hundreds of local sites where the software is expected to work.

Hospital staff told the Commons committee they were "at the bottom of the food chain" and often excluded from planning between CfH and firms now developing the go-live interface with caregivers.

Wanless' 2007 report, "Our Future Health Secured?" offers a broader review of National Health Service (NHS) funding and performance over the five years since Wanless' 2002 report, "Securing Our Future Health," that according to The Guardian was "implemented almost to the letter."

NHS received a 50% budget increase for hiring medical staff, boosting wages and improving delivery for a healthcare system universally regarded as the worst in the European Union (EU).

The Wanless report recognizes a remarkable turnaround in care delivery as a result of a £43 billion re-engineering effort (Medical Device Daily; April 9, 2007), but five years into the program he turns his lights to the centerpiece of his 2002 vision, an IT-enabled healthcare system.

In 2004 NHS launched CfH, called the world's largest IT project, by awarding contracts valued at £4.7 billion ($9.4 billion) to a dozen firms, with the biggest winners being iSoft (Banbury, UK), British Telecom (BT; London), Accenture (New York), and Computer Science Corp. (CSC; El Segundo, California).

The sweeping scope of England's effort to digitize healthcare and bring it online makes it the most-watched benchmark among 26 other EU members who are at different stages of development toward e-health.

The Wanless report acknowledges that BT has successfully delivered the central data spine that powers record exchanges, a contract valued at £620 million ($1.2 billion).

The Choose and Book scheduling system also is seen as working, though a majority of doctors refuse to use it. The British Medical Association (London) roundly criticized the system, but stopped short of calling for its suspension.

While the e-prescription system has been delayed, currently 11% of daily prescriptions are moving through the system, according to an August update from the director-general for NHS Finance.

The Wanless report also credits CfH with building some unexpectedly useful systems, including the Secondary Uses Service, a healthcare planning, clinical audit and research tool; the Personal Demographics Service; and the Quality Management and Analysis System for assessing the work of general practitioners.

Yet as beneficial as these programs have proven to be, the core objective, or Holy Grail, remains a centralized system for electronic health records, he asserts.

Wanless concludes that this pivotal accomplishment is still years away and warns that "the extent to which the NHS will benefit from these substantial investments remains unclear."

The CfH implementation has advanced against a tumultuous backdrop of churn and turmoil among key suppliers that dominated discussion over the past few years and often obscured the uneven advances for the central function of patient records.

Last year Accenture threw in the towel on implementing systems for the North East, Yorkshire, Humber and East Midlands, leaving £2 billion ($4 billion) on the table that was largely picked up by CSC (MDD; Feb. 27, 2007)

The biggest winner in contract awards, iSoft, today finds itself on the ropes, accepting a takeover by IBA Health (Sydney, Australia), which will grow seven times in size if it is able to swallow its competitor.

Adding to iSQoft's woes, in June before the Commons Health Committee the head of CfH, Richard Granger, said he is considering dropping iSoft's Lorenzo software in favor of Cerner's (Kansas City, Missouri) Millennium as the national system across England, according to E-Health Insider.

The success of CSC in England depends on iSoft delivering Lorenzo, and IBA is betting the ranch that Lorenzo will become its lead product globally, according to the Gartner Group (Stamford, Connecticut), so no one is counting Lorenzo out of the competition.

The Wanless report pushes software performance back to the front and center of the debate saying there is a lack of clear goals against which savings can be measured.

He adds that CfH is now pursuing "a high-cost, high-risk strategy that cannot be supported by a business case. What is clear is that thus far the additional funding has not produced the improvements in productivity assumed in the 2002 review."

Healhcare costs have increased over five years in England, Wanless notes, and there is no evidence to support the belief that the substantial investment in the quality of care and IT support will help reduce spending levels in the future.

"Without significant improvements in NHS productivity, and efforts to tackle key determinants of health, such as obesity, even higher levels of funding will be needed over the next two decades," he says.