Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties

H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations

A unique new book was published in Nov. 2009, of which I am an associate editor, by the American Health Information Management Association (AHIMA) and the American Medical Informatics Association (AMIA).  The book is entitled ”H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations.”  It is primarily aimed at non-informatics health IT personnel and healthcare management.

This book follows the de-identified case study approach I used in this website on HIT difficulties, started in 1998, itself based loosely on the style of the introduction of the 1994 book "Managing Technological Change: Organizational Issues in Healthcare Informatics" (1st edition) by sociotechnical issues pioneers and medical informaticists Nancy Lorenzi and Robert Riley.

Books such as “H.I.T. or Miss” were difficult to get into print just a few years ago, perhaps due to the influence of the powerful trade organizations of the health IT vendors. 

A summary and ordering page for the book is here, and a PDF of the book front and rear covers is here.

From the summary:

In “H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations”, the editors—all of whom have led successful electronic health record (EHR) and Health Information Technology (HIT) projects—have collected case studies of HIT implementations that didn't go as planned, offering expert insight into key obstacles that must be overcome to leverage IT and modernize and transform healthcare.

Why is it important to study projects that failed?

HIT projects historically have a very high failure rate, and the content and human factors associated with implementing technology have been formidable barriers to the transition. Health systems of all sizes learn—though trial and error—the same lessons and best practices at great financial cost, but those lessons and practices rarely are shared among healthcare organizations.

As a result, the adoption of effective HIT—now a national priority with the passing of the American Recovery and Reinvestment Act of 2009 (ARRA)—remains at a fairly primitive stage compared with IT adoption in every other major industry. In fact, healthcare is the only trillion dollar industry that remains primarily in the paper stage, even though most healthcare data are available electronically.

By studying HIT implementations that failed, the editors are able to document, catalogue, and share key lessons that all project managers of HIT, health system leaders in informatics and technology, hospital executives, policy makers, and service and technology providers must learn in order to succeed with HIT.

H.I.T. or Miss presents a model to discuss HIT failures in a safe and protected manner, providing an opportunity to focus on the lessons offered by a failed initiative as opposed to worrying about potential retribution for exposing a project as having failed.


The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).

Editor: Jonathan Leviss, MD

Associate Editors:

Brian Gugerty, DNS, MS, RN
Bonnie Kaplan, PhD
Gail Keenan, PhD, RN
Jonathan Leviss, MD
Larry Ozeran, MD
Eric Rose, MD
Scot Silverstein, MD

I am quite pleased to see this new book appear. (Note: I will not receive any royalties for sales).