Thursday, July 27, 2006

Anatomy of healthcare IT failure

A stunning story appeared in a California newspaper that is the poster-perfect example of health IT failure and dysfunction, entitled "Hospital vexed by new computer system." Perhaps it should be entitled "Hospital Hexed by Clueless Executives"...

El Camino Hospital's new computerized record system has been off to a rocky start since its launch in March.

Its first few months at El Camino have seen a state investigation, pharmacy errors, dissatisfaction among physicians and nurses, and the departure of the hospital's chief information officer.

Ironically, this hospital was a pioneer in the early days of clinical information technology. Now, this particular project has the appearance of a train wreck in progress worthy of addition to my site on health IT failure:

... ECHO, which stands for El Camino Hospital Online, is the new system that replaced a medical information system that had been in place since 1971. Doctors and nurses must use it daily in the hospital to place orders for medicines and tests, and to track patient records. Eclipsys Corporation created the ECHO software, which cost El Camino $8 million. The transition has been riddled with errors, however, causing the hospital to bring in an outside pharmacy management company, Cardinal Health.

"We've had some issues in the pharmacy, which is one of the reasons Cardinal Health was brought in," said hospital spokesman Jon Friedenberg, adding, "Issues thatpredated ECHO made the ECHO implementation that much more challenging."

Meanwhile, the Centers for Medicare and Medicaid Services, or CMS, received a complaint that prompted a state Department of Health Services survey on May 19 to investigate. "The condition found [to be] unmet was pharmaceutical services," said Mary Frances Colvin, nurse consultant for CMS.

Friedenberg said pharmacy problems were related to "medication order verification and audit," but that the new computer system was not entirely to blame for lost pharmacy order records. The Voice has requested full survey results from CMS, which were not available by press time. El Camino Hospital submitted the required plan of correction to CMS on June 21, and because the survey revealed problematic findings, Health Services will conduct a follow-up investigation by early August.

Some of the people involved have mentioned that what did not appear in the article is that in addition to having spent $8M on the system in the first place, the problems with the new Eclipsys pharmacy system at El Camino are so substantial that the organization has been losing millions of dollars per month directly attributable to problems in the new system. While I don't know if this is true, it would not surprise me.

The article continues:

Some argue that dissatisfaction with ECHO can be chalked up to doctors and nurses experiencing an adjustment period while learning the new technology. But others say both the errors and general unhappiness could have been prevented with more training before ECHO's launch.

Someone else with knowledge of these events writes:

... when the CIO gave a presentation to the board of directors on ECHO's launch, he gave no hints that there were major problems with it. It was the opposite--he only talked about the how great it was going, and brought in doctors who would say the same. The administration felt it was normal for doctors and nurses to respond overwhelmingly negatively to the new system, but didn't provide ample training to try to prevent a lot of that unhappiness. Plus, the system itself had its problems, particularly with the pharmacy, so overall it was a bumpy transition and to top it off, the CIO left the hospital pretty much right after launching the system.

Also from the article:

... Prior to ECHO's introduction earlier this year, physicians were told through a December hospital newsletter that the new computer system would allow them to "be able to do the same functions from the old system, but in a much easier and more intuitive way." This was not the case for many at El Camino, who found the new system to be unwieldy and not user-friendly, and voiced their grievances through a grass-roots survey of doctor and nurses. "When I go over [to the hospital], I can't even find my patient in the computer system," said Larry Epstein, an internist at El Camino. "It's not intuitive."

CIO's plugging "great systems" to Boards, failing to mention problems that clinicians and patients will have to deal with (like counterintuitive and user-unfriendly design and inability to find patients), exemplifies my line about "hospital IT personnel believing that clinicians toil in hospitals so IT people can have great computers and cozy jobs."

Administration felt it was "normal" for clinicians to respond overwhelmingly negatively and neglected training? That is simply stunning if true, especially in 2006. Resources exist on how to handle these issues proactively. Lorenzi & Riley's book "Managing Technological Change: Organizational Aspects of Health Informatics" is but one example.

That executives in healthcare and health IT may have been fatalistically resigned to "clinician opposition" as a given is another significant problem if true. It's another example of a defective organizational culture that leaps before it looks without doing proper due diligence. In other words, it was negligence. Even a simple google search might have led to resources that could have prevented these problems from occurring.

This new case of health IT difficulty makes me increasingly concerned that the existence of resources like AMIA, its 10x10 education program with the goal of creating a cadre of health care professionals (physicians, nurses, and others) versed in informatics to assist with the implementation, use, and success of clinical IT systems, books like Lorenzi/Riley's Organizational Issues in Health Informatics (first released in 1995) and other resources are still ignored or considered "esoteric" by major healthcare systems and management consultants. At a time when hospital money is scarce, especially with regards to costly clinical IT misadventures, this is not a good sign.

Here's a tough question: what might some good reasons be why executives in expensive failures such as this should not be called on to resign?

-- SS


Anonymous said...

Here's another one: The goal of 10x10 is to graduate 10,000 health care pros by 2010 with a basic understanding of Health Care IT. Are those executives ready to sign on the graduates of those programs to assist them in designing and deploying their IT infrastructure?

And where do they belong in the company TOE? Keep them in the Dept of Medicine/Nursing/etc so they keep in touch with their user base? Stick them in IS so they can become part of the team? Place them in their own little department so they are independent of both?

Lots of interesting questions, in addition to the one you asked.

InformaticsMD said...

> The goal of 10x10 is to graduate 10,000 health care pros

No, the goal is exposire of 10,000 to the salient issues in health IT, not to make them experts.

It's bad enough, though, that the experts in Medical Informatics often become Directors of Nothing.


"Ten critical rules about job structure and reporting for applied informatics positions" said...

OK to link your article to