It’s not just poor planning and unclear goals that lead to healthcare IT failure.
It is not uncommon to read commentaries from healthcare thought leaders about healthcare IT projects that fail, either failing to meet objectives, failing to come in on time/on budget, or failing entirely. Within the provider community there seems to be an abundance of anecdotal stories of EHR and other technology failures. Some of these stories are perpetuated by the EHR software vendors themselves. Right after a practice has had a very promising demo from software vendor A, software vendor B comes in and says, righteously, “Oh, we just deinstalled system A in a practice. It was a disaster but now they are very happy.”
These stories, some no doubt real and some perhaps not, tend to stir up angst about healthcare IT projects in general and EHRs in particular.
However, it is useful to look at HIT project horror stories in the bigger picture of all IT projects, across all industries. According to general studies of IT project success, the following rather dismal statistics are the norm:
• Roughly 1/3 of all major IT projects meet user expectations, financial budgets, and timeframes;
• Roughly 1/3 of all major IT projects are only marginally successful;
• Roughly 1/3 of all major IT projects fail in one or more of three major areas - expectations, timeframes, and/or financial budgets.
(Source: Betts, M., “Why IT Project Fail,” Computerworld, Volume 37, Issue 34 (2003; online))
Why do IT projects fail? Here are the major reasons, and they affect not only healthcare but other industries as well:
1. Poor planning, and unrealistic time or resource estimates: We have met with medical practices that have not even begun their analysis of EHR vendors who have said, “We are going to go live by August 15.” They have set themselves up for failure. We also had a practice that wanted to make sure they had their most experienced and knowledgeable people involved with the EHR project. But when it came time to allocate those resources, the practice said those people were too valuable to the practice. So they put less-experienced people on the project, which negatively impacted its success.
2. Unclear goals and objectives: It is critical to understand and clearly define the goals and objectives of a project. For example, for an EHR implementation, a reasonable goal is to have X number of providers using the system by Y date. Another one would be to eliminate X number of paper charts by a certain date.
3. Objectives changing during the project: Many times a practice will substantially change its structure in the middle of an IT project, and not re-scope the IT project accordingly. They may add or reduce providers. They may align themselves with a new hospital or clinic, or add a completely new line of medical services. This needs to be taken into account with any HIT implementation that may be going on.
4. Lack of executive support and user involvement: The members of any organization can be divided into one of three camps: (1) champions who are fully committed to the project’s success; (2) those who are opposed to the change; (3) those who are in the middle - think of them as fully supportive of whichever side “wins.” In a medical practice, the fence-sitters in the third group can actually spell disaster. Their tacit support when everything looks promising will wither when the real hard work starts, and they will usually be some of the first who say, “I told you this wouldn’t work.”
5. Failure to communicate and act as a team: This is closely related to the previous issue, but it can manifest itself in slightly different ways. Withholding important communications, or failing to read and understand communications, is a recipe for failure.
6. Inappropriate skills: Frequently the people assigned to an EHR implementation get selected because they can spell IT. And sometimes only those who are gung-ho are on the team. There needs to be a balance of experience and skill level across all departments and functions - clinical, business office, billing, scheduling, supplies, etc.
It is critical that all the appropriate skills, planning, and management go into an HIT project before, during, and after implementation. Failure to understand and avoid the problems that plague all IT projects will almost guarantee certain failure.
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