Monday, October 28, 2013

Over At The Health Care Blog, Aneesh Chopra Distorts IT Failure Reality

I feel sorry for President Obama.  I really do.  He's been deceived by IT hyperenthusiasts who, in addition to their hyperenthusiasm, probably heaped him a big helping of plain old lies.

I warned of this in my Feb. 18, 2009 Letter to the Editor published in the Wall Street Journal (at, third letter):

Dear Wall Street Journal:

You observe that the true political goal is socialized medicine facilitated by health care information technology. You note that the public is being deceived, as the rules behind this takeover were stealthily inserted in the stimulus bill.

I have a different view on who is deceiving whom. In fact, it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants.

For £12.7 billion the U.K., which already has socialized medicine, still does not have a working national HIT system, but instead has a major IT quagmire, some of it caused by U.S. HIT vendors. [That project, the National Programme for IT in the NHS or NPfIT, was since abandoned - ed.]

HIT (with a few exceptions) is largely a disaster. I'm far more concerned about a mega-expensive IT misadventure than an IT-empowered takeover of medicine.

The stimulus bill, to its credit, recognizes the need for research on improving HIT. However this is a tool to facilitate clinical care, not a cybernetic miracle to revolutionize medicine. The government has bought the IT magic bullet exuberance hook, line and sinker.

I can only hope patients get something worthwhile for the $20 billion.

Now, more spin and misinformation by Aneesh Chopra, senior fellow at the Center for American Progress, and the former U.S. chief technology officer in the Obama Administration over at the Health Care Blog at a piece "What's Next For" (

Like a cybernetic Rasputin, Chopra writes:

The launch of certainly didn’t go as planned. Due to technical errors, millions of Americans were sent to the functional equivalent of a waiting room before they could enter the shopping portion of the site.

Historically, projects of such complexity and demand have encountered early problems yet still often achieve great success. While much of the commentary has focused on coding problems, the site still has the potential to spur innovation — be it public or private —  that will result in quality improvement and lower costs.

(Note the definitive "will", without evidence.  Mr. Obama's probably been hearing a lot of non-evidence-based wishful thinking about health IT in recent years.)

The statement about future success is belied, for example, by the National Programme for IT in the NHS (NPfIT) failing and going "pfffft" as just one example ( and other links).

More generally, there's this article by Shaun Goldfinch, formerly at the U. Otago in New Zealand:

"Pessimism, Computer Failure, and Information Systems Development in the Public Sector."  (Public Administration Review 67;5:917-929, Sept/Oct. 2007, Shaun Goldfinch, University of Otago, New Zealand). 

Unfortunately it's not freely available, but a free first-page preview is at


The majority of information systems developments are unsuccessful. The larger the development, the more likely it will be unsuccessful. Despite the persistence of this problem for decades and the expenditure of vast sums of money, computer failure has received surprisingly little attention in the public administration literature. This article outlines the problems of enthusiasm and the problems of control, as well as the overwhelming complexity, that make the failure of large developments almost inevitable. Rather than the positive view found in much of the public administration literature, the author suggests a pessimism when it comes to information systems development. Aims for information technology should be modest ones, and in many cases, the risks, uncertainties, and probability of failure mean that new investments in technology are not justified. The author argues for a public official as a recalcitrant, suspicious, and skeptical adopter of IT.

Article start:

The majority of information systems (IS) developments are unsuccessfu1. The larger the development, the more likely it will be unsuccessful.

Though the exact numbers are uncertain and depend to some extent on how success is measured, something like 20 percent to 30 percent of all developments are total failures in which projects are abandoned. Around 30 percent to 60 percent are partial failures in which there are time and cost overruns or other problems. The minority are those counted as successes (Collins and Bicknell 1997; Corner and Hinton 2002; Georgiadou 2003; Heeks and Bhatnagar 1999; Heeks 2002, 2004 ; Iacovou 1999; James 1997; Korac-Boisvert and Kouzmin 1995 ; Standish Group 2001, 2004).

A U.S. survey of IS projects conducted by the Standish Group in 2001 found that success rates varied from 59 percent in the retail sector to 32 percent in the financial sector, 27 percent in manufacturing, and 18 percent in government. Overall, the success rate was 26 percent. In all, 46 percent of projects had problems, including being over budget and behind schedule or being delivered with fewer functions and features than originally specified. Another 28 percent failed altogether or were cancelled. Cost overruns averaged nearly 200 percent. Th is success rate varied dramatically by total project budget: For projects under US$750,000 the success rate was 55 percent; for those with budgets over US$10 million, no projects were successful (SIMPL/NZIER 2000).

More recent Standish Group (2004) estimates saw a success rate of 29 percent, but 53 percent of projects had problems and 18 percent failed. A New Zealand government study judged 38 percent of government projects a success, while 59 percent involved problems and 3 percent were a complete failure or were cancelled. Government success rates, at 31 percent, were slightly higher than private sector success rates. Above the NZ$10 million mark, however, the success rate for both was zero (SIMPL/ NZIER 2000). One study of hundreds of corporate software developments found that five out of six projects were considered unsuccessful, with one-third cancelled outright. Of the two-thirds that were not cancelled, price and completion times were almost twice what had originally been planned (Georgiadou 2003). The Royal Academy of Engineering and the British Computer Society (2004) found that 84 percent of public sector projects resulted in failure of some sort.

The sums involved in such projects can be staggering.  A study of IS developments in the British public sector estimated that 20 percent of expenditures were wasted, and a further 30 percent to 40 percent led to no perceivable benefits (Wilcocks 1994). In 1994, the U.S. General Accounting Office reported that spending of more than US$200 billion in the previous 12 years had led to few meaningful returns.

The article is extensively referenced, and nothing has changed since it was published.  While the article's cost from the site is $25 (US I think), it is well worth reading for anyone involved in large public sector IT projects.

Especially, the President of the United States and his staff.

It is my belief the same actors who've misled him about health IT and the supposed ease of building a national insurance portal for 300 million+ people are going to mislead him about remediation of the latter, resulting in yet more embarrassment, and perhaps eventually patient harm and death when someone, somewhere, is denied care or has delayed care due to insurance loss.

Finally, I note this in Chopra's bio at the Health Care Blog Piece:

Aneesh Chopra is a senior advisor at The Advisory Board Company

The Advisory Board Company ( is:

... a performance improvement partner for 165,000+ leaders in 4,100+ organizations across health care and higher education.

The Advisory Board Company has been an advisor on hospital management and technology for decades.

Perhaps they're another piece in the puzzle as to why hospital executives are implementing bad health IT ( technology in droves, such as in the ED where many underprivileged people get primary and emergency care.  (See "Quality and Safety Implications of Emergency Department Information Systems: ED EHR Systems Pose Serious Concerns, Report Says" at, for example.)

After all, with senior advisors to a major healthcare organization consultant in denialist roles, if the IT's bad now, it will be just great in ver. 2.0.

(See "The Denialists' Deck of Cards: An Illustrated Taxonomy of Rhetoric Used to Frustrate Consumer Protection Efforts" by Chris Jay Hoofnagle, available at

The same Denialist Deck of Cards is being played, I fear, to frustrate taxpayer attempts at hemming in waste ... and to frustrate the President of the United States' efforts to leave a good legacy.

-- SS


Steve Lucas said...

As a business person I have a different view of what happens around this situation. After time and time again referencing Apple I noticed a former Apple CEO making the rounds stating that Apple would never introduce a product such as the Health Exchanges with out testing and certainly not as bad as has been shown.

Other references have also been interesting such as Facebook cost less to bring to market than the Health Exchanges.

In a recent comment I noted how we may be at $1B in cost for this project in a couple of years. Government, always looking for way to lead, may reach this number before the end of this year.

Maybe from the government’s view point we will then be talking about real money?

Steve Lucas

Live IT or live with IT said...

Oh my, how true your take is on the HIT marketplace. I got out almost as soon as I heard the government was getting involved in healthcare informatics. The architectures used by the mega vendors are ancient and there is no pathway to a modern system architecture. See the lack of ability for most to incorporate new handheld devices or for most systems to integrate pieces from different vendors.

Its sad. These folks managing things are not technically savvy or understand healthcare operations. I don't know what their skills are, maybe sales.

Pres. Obama will likely be quite disappointed that his signature effort will be diminished due to mismanagement of HIT in one form or another.

Sad predictable mistake as most large system projects fail. What was done to change the way things are done to attempt to get a better result? If you listen to the techno-talking-head representatives from the vendors, it was business as usual. No different methods for procurement, design, development or testing.

Why expect something different than the norm when normal methods are used?

Sad ... could have been avoided.

InformaticsMD said...

Live IT or live with IT said...

Pres. Obama will likely be quite disappointed that his signature effort will be diminished due to mismanagement of HIT in one form or another.

The term of art is "information technology malpractice."

-- SS

Steve Lucas said...

Live IT

Many, many years ago my attorney wife was excluded from a large IT project for which she was a leading expert on policy. Watching from the side lines she would talk about the mess they were creating and how would I change things.

I am not a computer guy but did want to know why they were not using a GUI instead of a code driven system? The answer was the head person said he expected to retire in 30 years bringing that system on line. That system still uses a long code to bring up every page and there is no menu to move around in the file.

As long as open ended contracts and politicians are in charge we will never see a system brought in on time and on budget.

Steve Lucas

Anonymous said...

Going forward, these systems, even when 'WORKING" WILL NOT BE TRUSTWORTHY.

What was Chopra doing during this IT debacle,exact;y?