Grand Jury: Ventura County, Calif., Mishandled Electronic Health Records Transition

In Ventura County, California, "the function of the Grand Jury is to act as a civil oversight of county and city government, special districts, governing boards, personnel commissions, school districts, and humane officers. It is their responsibility to insure that government is serving the best interests of Ventura County's citizens" (http://www.ventura.org/grand-jury).

Even under such a grand jury, the need for true Health IT experts (instead of amateurs) seems to have gone unnoticed.

A 2013-2014 Ventura County Grand Jury conducted an investigation in response to information received regarding the implementation of a new Electronic Health Records system by the Ventura County Health Care Agency (VCHCA).

Ventura County Grand Jury Final Report "Healthcare Records Processes and Procedures" (full PDF at http://vcportal.ventura.org/GDJ/docs/reports/2013-14/Healthcare_Records-05.29.14.pdf)

From the May 29, 2014 Ventura County Grand Jury Final Report "Healthcare Records Processes and Procedures" (full PDF at http://vcportal.ventura.org/GDJ/docs/reports/2013-14/Healthcare_Records-05.29.14.pdf).  Read the full report.  Any reader of this blog or my Drexel HIT site at http://cci.drexel.edu/faculty/ssilverstein/cases/ will recognize very familiar patterns.

Here are some highlights:

In April 2012, VCHCA hired an independent Information Technology (IT) consultant to oversee the EHR implementation; however, he was not authorized to be project manager.

An "independent IT consultant" who had no formal Medical Informatics expertise is a likely explanation for all that followed.  (Even if he did, his relegation to "internal consultant" was an attempt to seduce failure into rearing her ugly head.)

The Grand Jury found that, beginning with the authorization of the Cerner contract in October 2011, there was a lack of a dedicated and experienced project manager to oversee, track, and report all tasks related to the EHR implementation. The absence of a recognized standard project plan, as shown in the Project Management Institute’s A Guide to the Project Management Body of Knowledge (PMBOK® Guide), contributed to staff being inadequately prepared for using the new system and to a problematic EHR system implementation by VCHCA.

Lack of a "recognized standard project plan" was likely the least of the problems.

The Grand Jury found hiring of “contract staff” did not support project needs. The Ventura County Board of Supervisors’ (BOS) approval of additional funds allowed for the hiring of deployment staff. Hiring did not commence until August 2012, and continued after the VCHCA system “go-live” date of July 1, 2013. This indicated a lack of planning and diligence in pursuing the necessary qualified staff.

Lack of enough "contract IT staff" was likely the least of the problems.

The Grand Jury found that staff training on the new equipment was insufficient, leading to a lack of experience and knowledge with all components of the EHR system. There was a period of inefficient and delayed patient care.

Billing processes were significantly impacted, requiring manual intervention, taking additional time.

These are symptoms of what was likely truly lacking.

The Grand Jury found that VCHCA ordered the user hardware in May and June 2013, too late to allow proper time for configuring of computers, hardware testing, and user familiarization.
 
The Grand Jury found that VCHCA had until the end of December 2014 to implement the new EHR system to avoid federal penalties.

The Grand Jury found that VCHCA had to be on the EHR system for 90 days prior to September 30, 2013, to qualify for full Meaningful Use funding, therefore July 1, 2013 was selected as its go-live date.

It was all about money.  Still, that was not the likely problem.

The problem was likely leadership by healthcare IT amateurs**, lacking formal cross-disciplinary expertise in medicine and clinical computing.

Without that expertise, empowered in top leadership roles, these projects will fail or will be seriously impaired, at great cost.

If you don't believe me, believe the NIH (http://hcrenewal.blogspot.com/2009/12/onc-defines-taxonomy-of-health-it.html).

While the 'Grand Jury' investigation of a failed health IT project may be a first, and is not a bad development in my mind, perhaps the members of the Grand Jury need to read a bit more.

-- SS

** I am a radio amateur, a formal FCC designation for those licensed to use radio and who have some knowledge, but who are not formal radio telecommunications engineers (unless they have the required formal education, training and experience, of course).