Monday, June 17, 2013

IT Specialist and the job he wouldn't take: hospital management's health IT "plan" is a checklist for failure

Received unsolicited on June 14, 2013 from a computer professional whose identity I am redacting.  Posted with his permission:

Dr. Silverstein,

Thank you very much for the many insights and helpful references provided on your "Contemporary Issues in Medical Informatics" ( web site! In performing my due diligence for a position as an IT Director at a small rural hospital, I have come across your writings. 

I originally applied for this position in the hopes of leveraging my IT, project management, compliance and security experience to gain new expertise in healthcare IT. After my initial phone interview with the "CIO" and HR Director, at which I discovered that I would have the responsibility to implement a poorly conceived new EMR project, without the authority or resources to make it successful, additional red flags were raised which required further research. This led me to you.  

I cannot help but chuckle at the organizational, social and project management dysfunctions in medical IT, as described in your "Ten Critical Rules for Applied Informatics..."  (   I have encountered similar dysfunctions in the world of military and commercial IT.  With a little tweaking, your lessons learned are applicable across a wide range of IT disciplines and a good reminder of how to avoid IT project and career failures and achieve successes.

Yet, I understand and have come to appreciate your thesis that medical IT is fundamentally different from business IT. Even though I am convinced that I could do better than most, I have concluded that it is probably wiser for a competent healthcare informaticist to lead HIT implementation projects. I wonder how many such competent informaticists there can be! Unfortunately, since I have no background in medicine, it is probably a little late for me to become one. 

I certainly will not engage in this particular opportunity. What I know of the hospital management's "plan" at this point is a checklist for failure. The reality of this rural hospital, and apparently thousands of similar situations, is unnecessarily and depressingly tragic for patients and clinical professionals. I appreciate your crusade to raise the bar for healthcare IT, and therefore IT in general. Thank you for saving me from jumping in to an untenable situation.

Ironically, and sadly, this letter is similar to others I have received dating to 1999.  Little has changed in nearly 15 years, except that with the rush to implement this unregulated, experimental technology thanks to the HITECH Act, there's likely going to be a lot more patient harm, especially at smaller hospitals new to this endeavor.

-- SS

1 comment:

Anonymous said...

This experience is similar to one I had about a year ago, when I came across an ad for a health informatics director level position for a network of provider facilities. I was appalled to find the position only required a bachelor's degree, no healthcare-related experience, and a few years experience with EMRs. The job description further confirmed misalignment with the director title. I thought I'd apply, having some health informatics background, but primarily to warn this employer of informatics-related issues I was sensing for their EMR implementation.

At a phone interview for the job, I found out the employer was really looking for an individual with enough experience in a specific, niche EMR system to implement it single-handedly, and to train end-users in the system. The interviewer did not disclose the extent to which the clinician end users, who were new to EMRs, were being prepared for the new implementation. Like the IT specialist who shared his experience with a similar job ad in this post, I decided I didn't want the job. I felt I might contribute more to patient care with my feedback to the interviewer, to promote real informatics leadership as a recruitment objective.

I have a hunch these positions are advertised as high level to justify a high salary, which would attract more candidates, and presumably lead to the position being filled quickly. But advertising a job with a nice title and salary does not necessarily increase the odds the right person will be hired. The gross misalignment of title, qualifications, and responsibilities in the health IT director job ad I applied to is more likely to attract poorly qualified candidates. I didn't consider myself an optimal candidate for the job, and yet I was afforded a telephone interview.

How does one justify a high probability of revenue loss - tied to a poorly led mass EMR implementation across a provider network - that is at least an order of magnitude higher than a director's salary? Better to consider the risks for success by taking the time to hire 10 competent IT directors and get it right, than to quickly hire one poorly qualified director and get it wrong.