The Atomic Human

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Lorenzo and the NHS National Programme for IT

Period: 2002–2011

Historical Context

The NHS National Programme for IT (NPfIT) was launched in 2002 as the world’s largest civilian IT project, with an initial budget of £6.2 billion that eventually rose to £20 billion. A central component was the Lorenzo patient records system, developed by iSoft and CSC. The program aimed to create a single, integrated electronic health record system for 60 million patients. However, Lorenzo faced persistent delays, technical issues, and resistance from healthcare workers. By 2011, the program was dismantled, having delivered only limited functionality at a few hospitals despite massive expenditure. The failure highlighted the challenges of imposing centralized technological solutions on complex human systems.

Relationship to The Atomic Human

The Lorenzo scandal illustrates several key themes from the book:

Divide and Conquer vs. Complex Reality

Like the failure of expert systems described in Chapter 3, Lorenzo’s architects attempted to reduce the complex, context-dependent work of healthcare into discrete, programmable components. This mirrors the book’s critique of how early AI approaches failed by trying to decompose human expertise into logical rules.

Information Topography and Devolved Authority

The program’s centralized approach conflicted with the NHS’s devolved decision-making structure, echoing discussions in Chapter 2 about how information flows through organizations. Just as Eisenhower needed to balance central control with devolved authority, healthcare systems require flexible local adaptation rather than rigid standardization.

Model-Blinkers and Institutional Momentum

The continued pursuit of the program despite mounting evidence of failure demonstrates the “model-blinkers” concept from Chapter 10. Like Planck’s observation that science advances “one funeral at a time,” institutional commitment to the grand vision prevented adaptation to reality.

Cultural Context and Human Systems

The project’s failure reflects themes from Chapter 5 about how human intelligence emerges from cultural context. The attempt to impose a universal system ignored how medical practice relies on local knowledge, professional relationships, and evolved workflows.

Technical Debt and System Complexity

The program’s collapse exemplifies the “intellectual and technical debt” discussed in the Epilogue, where complex systems become unmanageable as no individual or group fully understands their operation. This connects to the book’s warnings about the risks of creating systems beyond human comprehension or control.

Power Asymmetries and Accountability

Like the Horizon scandal, Lorenzo demonstrates themes from Chapter 12 about power asymmetries in technological implementation. The distance between decision-makers commissioning the system and healthcare workers who would use it created misaligned incentives and lack of accountability.

The Lorenzo case validates the book’s emphasis on understanding human systems before attempting technological transformation. It shows how ignoring evolved social and professional practices while pursuing grand technological visions can lead to costly failure. The experience informed subsequent NHS digital projects, emphasizing user-centered design and gradual evolution over revolutionary change.