Thursday, March 15, 2007

Problems found in UC Davis EMR project

In a previous post "Yet another clinical IT controversy: UC Davis" , I wrote about the clinical IT efforts at UCD apparently being subject to the same types of problems noted at other UC schools, as posted by Roy Poses for instance here, here and here.

An audit was done of the clinical IT project. At this location is a PDF of a Sacramento Business Journal article about the health IT problems and a believed massive overuse of consultants at UC Davis. (The audit report itself can be found at this link.)

A key observation is that "there's nothing to show why existing staff was not assigned to do what the university paid outside consultants $17 million to do."


I have stated that it is absurd to believe outsiders can know your business better than you, and it's even more absurd to believe it OK for outsiders to know your business better than you. While this pithy advice can be debated as a matter of strategy, I have also stated that healthcare IT is an experiment and a "work in progress" for the foreseeable future and that healthcare organizations need significant in-house expertise to keep up with the necessary changes, adjustments, modifications, extensions, interfaces, etc. that are a constant feature of this somewhat chaotic oil-and-water mix of IT and the "hiding in plain sight" complexities (a phrase coined by informatics researchers Nemeth & Cook) of clinical medicine. Heavily outsourcing these functions is unwise.

One can only speculate on the rationale for the $17 milllion of outsourcing, but "quid pro quo", behind-the-doors, golf-course handshake wheeling and dealing comes to mind as a possibility. Or perhaps it occurred due to a profound misunderstanding of what is tactical and what is strategic in healthcare IT.

The audit itself was somewhat superficial in scope, in that it excluded the product produced by the consultants and in sampling expenses used a time frame after the major consultant expenses incurred. It is interesting in that it showed that the project, due to be completed in December 2006 at $76 million, is only half done with current cost at $85 million. The audit alleges "no wrongdoing." You can be the judge of whether wrongdoing, mismanagement, or other ills affected this project.

In a sad footnote to this story, the outspoken health IT blog HISTalk had posted some of my commentary on this matter and on the former head of the health IT project at UC Davis. I had pointed out what I took as that person's lack of appreciation of the value of formally-trained medical informatics specialists based on my interactions with him a decade ago when he was a senior executive at Cerner. He confidentially negotiated with and hired a physician who was just finishing a postdoc at Yale's Center for Medical Informatics (which was certainly his right), where I was a faculty member with significant IT and management experience prior, while not wishing at all to speak to me and deflecting me to HR who gave me the traditional HR runaround (which was also his right, but I felt was revealing about strategic attitudes re: informatics expertise).

As a result of my HISTalk comments, I received the following unsolicited email from the former postdoctoral fellow -- a physician who I had helped select for the fellowship, and had always treated with the utmost respect and collegiality. This physician now runs his own obstetrics health IT company (just a year ago I had as a personal favor to him initiated referrals to several hospitals I thought might be interested in his company's products). Here is what he had to say:

Date: 01/06/2007 09:22PM
Subject: HISTalk

You are a horse's ass, and a pariah beyond rehabilitation. And I've tried on numerous occasions to help you get beyond your paranoid fantasies and fabrications (when no one else would even talk to you, much less be seen with you).

Almost every statement you wrote in HIStalk is either totally wrong or your own pufffed up delusions.

Don Miller

I pointed out to my former student that while those who "wouldn't talk to me" had reasons of their own making related to my ethics and temerity in actually defending myself against academic abuses, and while I admit I'm opinionated about MD's actually leading their profession and leading health IT via moving past stale business-computing-style thinking, I thought his message was way over the top and that apologies were due.

None came.

Healthcare IT is indeed still an area where angels should fear to tread.

-- SS