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Quora Answer : Healthcare Innovation: In an era when vast amounts of data are crunched for reletivly trivial reasons (say Facebook) whats so difficult about making digital system for the NHS? And why every time it is attempted it's a massive failure (and why do they still get paid for it?)

Nov 8, 2014

Facebook (and similar) had the luxury of growing whatever was doable at the time. They didn't sit down in 2004 and say "here's what we need by 2014, let's design a big project to get there". They'd have almost certainly decided the WRONG thing for 2014 in 2004, and they'd never have been able to get it made.

Instead they did something small-scale that worked in 2004 (in just a couple of universities) and iterated and grew from there.

The big problem with something like the NHS or the American ACA systems is that they don't have or don't give themselves the luxury of that incremental and exploratory path.

That's partly of necessity : they already have x million users and have specific requirements in terms of privacy / functionality from day one.

It's also partly self-inflicted. It seems that the management (both in government and in the private contractors) doesn't have the insight or capability to even try to organize big projects in a more agile way, as an iteration of improvements to an initial seed, rather than as a single big project. Despite this being well known as the best way to do things.

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