Large-scale Projects in the Health Sector Really Can Succeed


Here in the UK, it feels almost like it’s every week that we hear of another super-expensive Government-backed IT system that’s overrun by ‘x’ years and cost the taxpayers an additional ‘yada yada’ million pounds.

The latest debacle, for example, is with the NHS’ patient records system. This radical overhaul to the NHS IT network has so far run up of costs of £6.2 billion. Lord Warner, the UK health minister overseeing the project, has admitted that this figure may end up being nearer £20bn.

Parts of the ambitious project are way behind schedule; for example the “Choose and Book” online booking system went “live” two years late. (The fact that it went live at all is to be commended, I’m sad to say).

So it’s encouraging to discover that big IT healthcare projects don’t necessarily have to fail. This case study of the Brazilian National Healthcare System shows that placed in the hands of the right people, projects of that nature can even do pretty well.

From the case study:

“The Brazilian National Healthcare System has been called the largest Enterprise Java application ever built, with over 2M lines of code, and a domain model of 350 classes. The application models all of the domain concepts one could imagine in a country-wide health care system and is bringing a level of automation that is creating enormous value for the public healthcare system as well as for the people of Brazil.”

It’s surprising that Sun Microsystems hasn’t jumped all over this and emblazoned their home page with a big “Powering Brazilian Healthcare!” sticker, for their choice of J2EE as the system’s architectural backbone.

It’s also not entirely insignificant that they used a domain modeling approach to map out the problem domain, and then map the required system behavior with use cases. I find this encouraging because it’s basically the same process that Doug Rosenberg and I describe in our book Agile Development with the ICONIX Process. Goes to show, this sort of approach really works!

I think it’s also very telling that they’ve used code generation to reduce the amount of “code drudgery”, generally making the process much more agile.

The techniques exist to make such projects a success. So, here's hoping that one day we might even be talking about large-scale IT success stories in the UK as well!

About the Author

Matt Stephens is a senior architect, programmer and project leader based in Central London. He co-wrote Agile Development with ICONIX Process, Extreme Programming Refactored, and Use Case Driven Object Modeling with UML - Theory and Practice.