A three-hospital integrated delivery system
invested approximately a quarter of a million dollars in online access to its
financial databases, as part of an "executive information system."
Gerald Nussbaum, a consultant with Hamilton HMC,
First, the intranet as set up suffered from technical problems. It lacked sufficient server capacity and lacked adequate bandwidth. Worse, it suffered from flawed programming such that database queries timed out, causing report requests to fail.
But basic technical errors weren't the only problem. The reports that were produced were not formatted to print in a way that staff members desired or were accustomed to, causing frustration even when reports were produced by the system. [From Health Data Management, Nov. 1999, p. 62.]
Such basic technical and workflow errors are often secondary to basic mismanagement by project leaders, either due to micromanagement by their non-knowledgeable superiors, or by direct acts of commission or omission due to insufficient skills and insights in information science, healthcare, and IT itself.
It must be remembered that IT is only a raw tool. Only with proper insights in the domain area, in information science and in user interaction design (a research area that addresses how computer applications behave, communicate and inform) can IT be implemented to facilitate delivery of useful information. This is especially true in complex healthcare environments.
It often surprises me when adverse outcomes in healthcare IT are treated differently than adverse outcomes in other fields, such as in clinical medicine itself. If a contractor builds a building with an inadequate foundation and concrete and the building collapses, this is attributed to incompetence at best, and criminal behavior at worst. If a clinician fails to diagnose a cancer or has an adverse patient outcome due to suboptimal therapy, this is called malpractice.
Yet, in healthcare information technology it seems such words are forgotten when the causes of failure are dissected. Instead, one sees or hears only milder, indirect words. One never hears that a patient's adverse outcome resulted from "delayed clinical progress and cost overruns due to technical or sociological issues." The term malpractice is used. Yet, one rarely hears terms such as mismanagement to describe why clinical computing or other healthcare IT projects fail. It is ironic that healthcare IT seemingly gets treated preferentially or with "kid gloves" compared to the very field it is supposed to facilitate: clinical medicine. The dynamics of this phenomenon deserve further study.