Sunday, December 19, 2004

Healthcare IT Becomes an Adolescent ... or has it?

By Jim Molpus, for HealthLeaders News, December 16, 2004

Healthcare IT Becomes an Adolescent

Or has it?

    Healthcare clinical information technology has been a kid for a long time. The parents-vendors, the government, providers and payors alike-have beamed proudly at the thought that this gangly kid would one day contribute to society. But so far the kid has just sort of skated along.

    After all, these parents have shelled out a lot of money, worried incessantly and planned diligently to raise the child. Now they are hoping the kid will realize that the time has come to learn how to work as part of a team and just generally grow the heck up ... After years of putting off large IT projects because of concerns about compatibility, cost and integration, some of the largest health systems in the country spent hundreds of millions on products with acronyms like CPOE, EMAR and PACS. Wisconsin-based Aurora Health Care is spending $163 million to create a common electronic medical record for its 14 hospitals. Baylor Health Care System in Dallas is launching a five-year, $119 million IT initiative. Allina Hospitals & Clinics in Minneapolis will shell out some $200 million over four years. And giant Sutter Health in California will spend a whopping $1.2 billion in the next decade.

    On the implementation side, the industry learned from past mistakes, with many large projects making sure to include clinicians in selection and system design issues, and in providing enough support when systems went online.

Where is the evidence that the industry has "learned from past mistakes?" That would imply a significant body of literature on the lessons learned from healthcare IT failure.

A google search on "health IT failure", "healthcare IT failure", "healthcare information technology failure", "healthcare IT problems", etc. brings up very little on a worldwide basis.

"Including clinicians in selection and system design issues" is so obviously necessary that one has to ask why this hasn't been the case for the past several decades. One can go further and ask if clinicians are being "included" in selection and design issues in superficial ways, not as true leaders, in order to maintain MIS hegemony over this juicy piece of hospital territory.

From the same journal, HealthLeaders News, Nov. 2004:

    Big Spenders: The industry is replete with examples of IT projects that have run over budget, missed deadlines, and either stalled or failed outright. Many computerized order-entry projects founder, according to data compiled by KLAS Enterprises LLC, an Orem, Utah software evaluator. In its analysis of how some 200 hospitals use their CPOE systems, KLAS gave top ranking to Evanston (Ill.) Northwestern Healthcare last spring. But the vast majority of the hospitals surveyed barely registered on KLAS' usage scale, which analyzes how deeply the order systems penetrate a hospital's clinical work flow. In another widely cited example, Cedars-Sinai Medical Center, Los Angeles, scrapped its order-entry effort in 2003 after physicians rebelled.

Another problem is that there are few if any metrics on the efficiency of healthcare IT implementations. There is also little cross-institutional comparison. How would one tell if a project that is deemed "successful" was implemented at the best possible cost, or filled with costly delays, false go-lives, patchwork, massive additional expenditures, or even outright corruption?

The experiences in the U.K. suggest healthcare IT is far from being an "adolescent."

If the great body of literature that the Healthcare IT industry is using to avoid multimillion dollar mistakes is hiding somewhere, could someone please point me to it?

-- SS


Kevin C. Fleming said...

Is it the practice of IT to publish their mistakes or repairs? If not, I think they they would do well to imitate other scientific fields in this regard.

Anonymous said...

Great Article. It took me back 7 years ago. I did google some of the terms you mentioned in your article, "health IT failure" pulled 380,000,000 results in 0.1q seconds

Thanks again.
Interested in Healthcare IT Development. Now, how long is it going to take the kid to become fully mature ? I mean can communicate with other systems easily, and can Exchange information across the nation.