Patients are getting "precious little" from the NHS electronic care records system in England, a watchdog says.
The £7bn system to replace paper files is falling further behind schedule and in places where it has been introduced it is not working as it should.
The National Audit Office also said some patients would not even get one as large chunks of the NHS had pulled out.
In conclusion, the NAO said the system was not providing value for money - something the government rejected.
Electronic care records are the key part of the overall £11.4bn NHS IT project.
The scheme was launched in 2002 with the aim of revolutionising the way the health service uses technology and also includes developments such as digital x-rays and fast internet connections.
It is the third time the NAO has looked at electronic records - and each time the findings have been more damning.
The latest report details a range of problems that the programme is struggling with.
In London, all GP practices and more than half of hospital trusts have pulled out, while in the south three-quarters have. However, this has not been accompanied by a proportionate drop in cost.
Meanwhile, the contract covering the rest of country is currently being renegotiated.
Even after such a scaling back, roll out in places that remain part of the system is still proving difficult.
The NAO said it doubted the final deadline of 2016 - which is already six years later than originally envisaged - would be met.
And even in those trusts that have electronic records, there are problems. For example, some hospitals have struggled to introduce electronic prescriptions.
The NAO said the difficulties were caused by a range of factors, including the government being too ambitious, difficulties with technology and the complexity of the NHS.
The problems have prompted some critics to call for the entire scheme to be scrapped - although this is something the NAO stopped short of suggesting.
The government has already announced there will be a review of the project. This is due to start next week.
Tory MP Richard Bacon, a member of the House of Commons' Public Accounts Committee and long-standing critic of the plans, said: "It is perfectly clear that throwing more money at the problem will not work.
"This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients.
"The largest civilian IT project in the world has failed."
But the Department of Health said while the original vision "was flawed", the project still had the potential to deliver value for money.
Dr Chaand Nagpaul, of the British Medical Association, said: "We cannot turn the clock back, but this report provides useful lessons on how best to use resources in the future."