Tuesday, August 18, 2009

Lessons Unlearned: Health IT Failure, Act 2

The following appeared on the HISTalk site on 8/14/2009 from a writer with the screen name UCSFWatch:

From UCSFWatch: “Re: UCSF CIO’s e-mail. The GE Centricity Enterprise project is in full stop mode.” The attached and unverified e-mail from CIO Larry Lotenero says this: “The medical center’s Senior Management Group has engaged Kurt Salmon Associates (KSA) to assist us with a review of our IT clinical strategy. We are doing the review because we are dissatisfied with our progress to implement clinical applications to support the care of our patients. KSA will arrange interviews with many of you to capture your insights for the strategy planning. They will be on-site to begin their interviews on August 18. If KSA contacts you, I ask that you be as flexible as possible with your schedule to accommodate this process. We expect to receive a final report before November. For now, all activities associated with developing the GE clinical system should immediately be put on hold. Despite this action, we remain fully focused on our goal to complement our excellent clinical care providers with equally excellent clinical applications as soon as possible.”

If true (as it likely is), I find this remarkable.

I would have to refer to it as "UCSF Healthcare IT Failure, Act 2" for reasons just below.

I find it remarkable that this resource- and money-wasting scenario (with possible adverse patient care repercussions) can occur:

  • In a state that's in a severe economic crisis,
  • With an EHR product, Centricity, that is the descendant of Logician that others have implemented successfully (including myself, speaking from experience),
  • With GE, a major global high technology vendor, presiding over this new failure at a major academic medical center,
  • With ample preventive material available in books, journals on the web about such failures (e.g., at the many pages and links here and here, as just a few examples).

This last point raises additional questions:

  • Do they think the materials found via such searches frivolous, useless, or not credible?

Finally, it is quite remarkable that the best UCSF can do is hire yet another expensive management consulting firm to try to remediate this failure. What are UCSF IT personnel paid to do, exactly?

Perhaps AMIA, AHRQ, HHS and others in the administration need to focus less on new research on figuring why these situations occur, and devote resources to ensuring modern knowledge of HIT failure scenarios already extant is leveraged.

If not, we're likely (as I fear) to have a lot of UCSF Act 2's in the next few years, as organizations attempt to implement HIT by 2014 so as to not be penalized by HIT provisions in the ARRA act.

Perhaps (again, if the HISTalk note is true), we need to bring back the likes of "Neutron Jack" (Jack Welch, well known for laying off less than stellar divisions at GE), and perhaps the Governator needs to "terminate" the roles of the leadership of this project.

Gov. Schwarzenegger had a way with those
who fiddled around destructively with computers...

See other disappointing stories about events at UCSF on this blog at this link.

-- SS


Anonymous said...

I worked for UCSFMC IT for over 10 years and I am not suprised with this at all.

IT leadership/managers did not/do not trust their staff and often make decisions based on their limited "knowledge/understanding" of technology. They have historically based decisions on vendor dog and pony shows rather than reality. Upward mobility in IT is based on favortism rather than technical expertise or performance.

A director and a manager have "step(ped) down from their leadership roles and will be leaving the organization to pursue other opportunities."

The CIO will "will lead the activities of the CIS group"

The department is too manager heavy to get any real work done and their project management office is about 4 years behind the curve.


InformaticsMD said...

I remind that these games ultimately come at the expense of patients, which could include any of us at any time, often unexpectedly.

Patients do not become ill, nor do doctors and other clinicians toil in hospitals, so that IT people can have spiffy computers and comfy jobs.

-- SS

Anonymous said...

UCSFMC IT management has historically let vendors dictate the rules regarding application security and functionality while IT staff have notified them numerous times of these shortcomings. You would think they would have learned something from their ongoing PICIS debacle....


InformaticsMD said...


Anonymous said...

Article date: March 3, 2003
Picis Wins Contract at UCSF Medical Center for Integrated OR Management and Anesthesia Automation System; End-to-End Solution Delivers Patient Care and Financial Decision-Making Advances.

(the link is kinda wonky): http://www.highbeam.com/doc/1G1-98264513.html

UCSF Medical Center, one of America's top 10 hospitals, has contracted with Picis for its award-winning perioperative solution to automate all of the organization's high-acuity areas, operating rooms (ORs) and anesthesia locations with one comprehensive solution.

The medical center, which is part of the University of California, San Francisco, plans to implement Picis' PeriopSuite solution ...

The application has been notoriously buggy with SQL locks/client side app freezes a daily multiple occurrence. UCSFMC has been unable to leverage the vendor to fix the issues. Apparently the cheap price on the app was due in part to allowing the place to be used as a test-bed.

An expired security certificate on their PICIS web interface in not inspiring (which will return with a Google search of "UCSF Picis").

I guess that's what happens when an RN with zero IT experience is the application support/developer....


InformaticsMD said...

I do not vouch for the above comment, but I am familiar with Picis' ICU system a number of years back ("Serious clinical computing problems in the worst of places: an ICU). The vents surrounding that project, complicated by faulty software and cavalier and arrogantly ignorant IT personnel, led me to start my website on HIT failures.

Anonymous said...

The UCSFMC CIO is a signee on the "exec's demand": http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/12/29/BAH51H1GA1.DTL&tsp=1

I have heard of several lawsuits and settlements taking place recently within the IT department under his watch. Harassment, favoritism, and ineptitude were the highlights and the revolving door of management continues....