Healthcare Information Technology Research & Analysis : Coplan & Company : IT Procurement Management, Project Management, System Acquisition

The Institute of Medicine (IOM), a non-governmental organization that is part of the U.S. National Academies, published a landmark study in 2000, To Err Is Human, Building a Safer Health System. This study, particularly the statistics that 44,000 to 98,000 people die every year as a result of medical error, made patient safety and error reduction priority issues in health care.

Recommendations from this IOM report focused on leadership in government and the health care industry setting a national agenda for reducing errors in health care and improving patient safety. One key outgrowth of this study was effective use of information technology and sharing information among different systems to improve patient safety. In response to this, we have projects underway, e.g., Health Level 7 (HL7) has Medical Markup Language (MML), based on XML for information sharing.

How Did Criminal Justice Agencies Do It?

In 1965, President Lyndon Johnson's Great Society program addressed, among other issues, control and prevention of crime and delinquency. This included a government-funded program to facilitate the exchange of information among criminal justice agencies. It was not until post-9/11 government programs that we saw widespread success. Prosecutors now routinely exchange case information between their own systems and separate systems maintained by law enforcement, the courts and public defender agencies.

A partnership of government agencies and private industries created the precursor to the National Information Exchange Model (NIEM), funded by the Department of Justice (DOJ). NIEM effectively and efficiently expedites sharing critical information at key decision points throughout our nation's justice, public safety, emergency and disaster management, intelligence and homeland security enterprise. The purpose of the public/private partnership was to design develop, disseminate and support enterprise-wide information exchange standards and processes that enable jurisdictions to automate information sharing.

NIEM is not software programs, databases, networks or computer systems. NIEM is cooperation. Through the cooperation of a public/private partnership, we created NIEM and criminal justice agencies now efficiently share information more cost-effectively,improve operations and maintain information for better decision-making. We now have more timely, accurate and complete information to enhance our citizens' safety.

Where Is the Health Care Industry?

We are now in our eighth year since IOM released their ground-breaking study and we have yet to establish and implement an effective solution for sharing information. Why can't we take advantage of the lessons learned from our criminal justice community and NIEM and implement a similar solution that enhances our citizens' safety in health care?

Successfully adopting and sustaining Healthcare Information Technology (HIT) rarely happens. The New England Journal of Medicine recently reported that only 4% of US doctors fully utilized an EMR.  Why does this happen? Post mortems frequently cite project management failures and user dissatisfaction.  For example, Mark Anderson, CEO of the AC Group, Inc. discussed the slow adoption rate of EMR in terms of charting a patient with paper and pen is typically faster than with a computer.

Slow HIT adoption rates raises two questions. How do we improve project management and how do we increase user buy-in? As examples, limited stakeholder involvement reduces project management effectiveness, while neglected workflow redesign erodes user satisfaction. The prevailing attitude of Not Invented Here (NIH) complicates both problems. NIH is the cultural bias of an organization refusing to consider something because it originated elsewhere.

We cannot end project management failures and user dissatisfaction without first overcoming the NIH culture in healthcare organizations. Managing healthcare organizations has many unique challenges. For examples, the industry is extremely information intensive, there are many large and small organizations that must work together, clinical and administrative management often have conflicting objectives, patient care is fragmented and complex, the industry is heavily regulated, privacy is paramount, etc.

Every industry has its unique problems, but they share many common project management and user satisfaction issues with healthcare. Focusing on the uniqueness of healthcare limits taking advantage of project management and user satisfaction best practices in other industries. For example, conducting a stakeholders analysis helps maximize the strengths and minimizes the weakness of stakeholders. Engaging users during planning, definition, acquisition and implementation gives them a vested interest in project success.

How do we as an industry solve the NIH problem together? We must start by saying NIH is not so. It limits us. It is not correct. It is based on a false premise. We must understand we have much in common with other industries. We have to look to successes in other industries and be willingly to apply appropriate best practices or HIT will continue to fail.

I was recently performing Quality Assurance (QA) on a Healthcare Information Technology (HIT) project. The project manager failed to include change management in their project management plan. I asked her why she omitted this. She said her healthcare organization uses the nine Knowledge Areas from the Project Management Institute’s (PMI) Project Management Body of Knowledge (PMBOK), which does not include change management.

I responded by indicating she included product management Technical Knowledge Areas from the Institute of Electrical and Electronics Engineers (IEEE), e.g., requirements preparation, software testing, and training management, so why not include change management there. We cannot do that, she said, because it requires stakeholder involvement. I explained that is precisely the point. Many HIT projects fail because they do not adequately address change management and required stakeholder involvement.

Change management transforms individuals and organizations from the current to a future state. This is what HIT implementation project are all about. While it goes beyond project boundaries, i.e., change management is permanent and project management only addresses temporary endeavors, all HIT projects embrace the long-term. For example, we work with the vendor implementation team during the project and transfer the deployed HIT to vendor support and maintenance that are responsible for long-term system continuation, upkeep and enhancement.

As project managers, we don’t just hand the system over to support and maintenance; we develop plans, procedures and training, which we execute after successful HIT deployment. We need to address change management similarly during HIT projects. For example, we need to:

• Set measurable objectives at the project beginning,
• Assign project objectives to executive management to ensure accountability,
• Conduct a gap analysis with end users to determine the current and future state,
• Identify key changes by individual clinician and prepare one to two "impact sheets" showing clinicians how the new system affects them and
• Assign “resistance busters” or individuals that work with their peers, who are having difficulty adjusting to the new system.

We shouldn’t stop at deployment. We need to continue, just like system maintenance, and employ ongoing process improvement throughout the life of the implemented HIT.

The University of Michigan's Department of Family Medicine developed ClinfoTracker (now commercially available from Cielo MedSolutions as Cielo Clinic) to provide preventive and disease management services at the point of care. Richard Pizzi summarized the study in HIT News on September 5, 2008.

Although ClinfoTracker is not an EHR it performs some functions that are surprisingly similar.  For example, the September 2008 issue of the Medical Journal of the American Public Health Association reported that the University of Michigan Health System (UMHS) completed a study using ClinfoTracker.  The study concluded that ClinfoTracker Best Practice Alerts (BPAs), such as annual pap smears, flu vaccines and blood sugar testing for diabetics, improve health outcomes. The need for a third party product like ClinfoTracker is an example of how healthcare fails to properly use an EHR and unnecessarily increases cost and complexity of HIT.

Don’t good EHRs include BPAs, call lists, reminders and reports on clinical reminder response rates?  I know of several EHRs that don’t require these types of third party add-ons.  For example, on June 11, 2008, the 2007 HIMSS Public Health Davies Award recipient, Neil Calman, MD, President and CEO
of the Institute for Family Health, described how their EHR notifies providers if patients meeting certain criteria should receive specific treatment.  For example, in 2006 new findings indicated women taking ACE (Angiotensin-Converting Enzyme) inhibitors during their first trimester of pregnancy had a high risk of serious cardiac and other birth defects.  The Institute immediately ran an EHR database report and notified all childbearing age women prescribed ACE inhibitors about this new information. The Institute contacted 220 women about avoiding the potential risk of delivering a child with serious birth defects by changing their medication regimen.

Good EHRs include functions like electronic flow sheets to track patients' clinical problems and BPAs for preventive care over time.  The need for third party HIT, like ClinfoTracker to augment an EHR, just underscores that users often fail to properly define their needs and acquire an EHR that does not support them, or they are not fully utilizing their EHR.

A properly managed successful HIT project for an EHR includes thoroughly:

• Planning the project,
• Defining user needs,
• Acquiring a solution meeting these needs,
• Implementing the system successfully and
• Performing ongoing system and user support. 

Leapfrog Group recently completed its annual national Hospital Survey, which identifies top performing U.S. hospitals and the challenge of implementing Computerized Provider Order Entry (CPOE).  On October 14, 2008, Bernie Monegain, editor of Healthcare IT News, quoted Leapfrog’s CEO Leah Binder, who said:

“The 2008 findings…indicate that collectively U.S. hospitals still have a way to go in addressing the technology, workflow and cultural challenges of CPOE implementation. We all need to recognize that installing a system is really just the beginning.”

One of the key challenges is overcoming physician resistance to change behavior.  For example, when replacing customized paper order sets with an electronic, evidence-based version, physicians complain that CPOE makes them “order-takers,” who just sign and date documents.  Nonetheless, applying Evidence-Based Medicine (EBM) to order sets:

• Improves patient care by providing easy access to a repository of evidence,
• Reduces costs due to medication errors,
• Increases patient safety by providing standardization at the point of care,
• Aids implementation of evidence-based practice across medical specialties and
• Provides a return on investment by simplifying the physician order set identification, review and approval process.

To successfully change physician behavior we need to eliminate two conditions:

1. Change Avoidance – People are extraordinarily clever at avoiding doing things in a new way in favor of the status quo.
2. Benefit Reduction – Conversely, people who want to get something done can do so despite the cumbersome nature of the change.  For example, physicians can reap the benefits of CPOE even if they must work with an excessive number of alerts. 

Managing CPOE projects requires effectively changing physician behavior, which involves the following:

• Providing physician leadership, who informs clinicians about CPOE benefits,
• Working with and listening to physicians to fully understand how switching to CPOE threatens the way they currently prepare patient orders,
• Taking advantage of this “threat” by offering a beneficial alternative to the status quo, e.g., providing customized, patient-specific, clinical decision information delivered at the point-of-care,
• Implementing the change with a few small teams (e.g., by medical specialty) and subsequently expanding the implementation to involve more teams, and
• Coordinating the change across multiple teams, throughout an organization, until CPOE is fully implemented.

According to the Medical Group Management Association (MGMA), IT Adoption Remains Low as Costs Outpace Revenue for Physicians. Physicians pay the cost for an EHR while other parties reap the benefit.

According to John Halamka:

To make the equation work, payers, hospitals, pharmacies and other beneficiaries of savings have to gainshare i.e. share the ROI with the providers. At BIDMC, I'm paying 85% of the implementation costs of EHRs for community physicians to better align incentives i.e. doctors do the work, the healthcare system benefits from care coordination and hospitals as one of those beneficiaries can subsidize costs.

I agree with this idea, but will this type of formula work industry-wide?  I fear there will be a complex formula that results in unintended consequences.  For example, the NYTimes article on The Pitfalls of Linking Doctors' Pay to Performance illustrates how a good idea can go awry, especially when trying to change human behavior.

It is obvious that correctly linking a patient to their medical record is critical to the quality of care. Most large providers identify a patient using a computerized statistical match on multiple personal attributes, e.g., name, address, and Social Security number (SSN) .  They then examine the results of the search to select the correct patient.  According to the RAND | Monographs | Identity Crisis: An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System, the average error rate is about 8 percent, increasing with larger systems.  Larger systems are already exchanging clinical information electronically with resulting higher error rates, e.g., Regional Health Information Organizations (RHIOS). Higher Healthcare Information Technology (HIT) adoption will increase incidences of serious medical errors instead of the promised increase in quality of care.

Rand's study states using a Unique Patient Identifier (UPI) that:

...enables disparate health care information systems across the United States to allow authorized users to easily and quickly share critical health information has the potential to enhance safety and dramatically improve the quality and efficiency of the national health care system.

Privacy advocates (e.g.,  Citizen"s Council on Health Care, Health Privacy Project, Patient Privacy Rights, World Privacy Forum) say that using UPI's will add to the already serious healthcare identity theft problem. Rand disagrees with these critics, stating:

Proponents of statistical matching suggest that a UPI scheme will reduce privacy by making all of a patient’s data recognizable and accessible via the single UPI. However, if a statistical matching scheme is made as accurate as a UPI, it provides an identical capability to identify and access patient data by using its matching keys. Furthermore, the matching keys for an algorithm reveal the identity of (and other information about) the patient whose data they identify, whereas a UPI (being just an alphanumeric value) reveals nothing about the patient. And, in contrast to using personal information, being able to retire a compromised UPI and issue a new replacement UPI should facilitate reestablishing security after a breach of a patient’s health information. 

I understand both parties' concerns.  Unfortunately, this issue comes down to how much privacy you are willing to give up to increase your quality of healthcare.  Do we have to have this trade-off?

The American Health Information Community reported sobering news in their Survey: Hospital EHR adoption rate is below 12 percent.  Why is the adoption rate so low?  Why do we continue to pay so much for Healthcare Information Technology (HIT) and continue to see so little progress?

I think about these questions constantly and try to come up with answers.  Some others are doing the same -- for example, in their Capability Maturity Model Integration - Acquisition, version 1.2, November 2007, the Software Engineering Institute at Carnegie Mellon University stated:

According to recent studies, 20 to 25 percent of large information technology (IT) acquisition projects fail within two years and 50 percent fail within five years. Mismanagement, the inability to articulate customer needs, poor requirements definition, inadequate supplier selection and contracting processes, insufficient technology selection procedures, and uncontrolled requirements changes are factors that contribute to project failure. Responsibility is shared by both the supplier and the acquirer. The majority of project failures could be avoided if the acquirer learned how to properly prepare for, engage with, and manage suppliers.

Based on my own experience in HIT acquisition management, I believe another significant area overlooked is change management (how to transition people from the current to the desired future state).  I mentioned several examples for managing change in an earlier post, like:

• Providing physician leadership, who informs clinicians about HIT benefits,
• Working with and listening to physicians to fully understand how switching to HIT threatens the way they currently prepare patient orders,
• Taking advantage of this “threat” by offering a beneficial alternative to the status quo, e.g., providing customized, patient-specific, clinical decision information delivered at the point-of-care,
• Implementing the change with a few small teams (e.g., by medical specialty) and subsequently expanding the implementation to involve more teams, and
• Coordinating the change across multiple teams, throughout an organization, until HIT is fully implemented.

Despite seemingly obvious proof that there is a better way, we continue spending valuable time and money without applying best practices and standards to our HIT projects.  Why do we do this?

The American Medical News reported today that 'Physician Champions' Key to Successful IT Implementation. Well dah!!! HIT industry professionals continue to argue that this industry is unique. While there are many unique attributes to healthcare, why do we keep re-inventing the wheel and identifying project management best practices as something new?

One existing solution is HIMSS. It is a great organization that prepares and maintains best practices for HIT acquisition, contract negotiations, project management, etc. Why aren't we taking advantage of resources like this?

• Initiating
• Planning
• Executing
• Controlling
• Closing

I apply these process groups regardless of project type (e.g., healthcare IT, construction, event planning).

Product management is the "tangible result" of a project. I teach this using the Institute of Electrical and Electronics Engineers (IEEE) technical process groups focusing on:

• Planning
• Designing
• Developing
• Deploying
• Supporting
• Retiring

I apply these process groups based on product type. For HIT I use the Capability Maturity Model Integration for Acquisition (CMMI ACQ) standard.

Change management is how "people" transition from a current to a future state. Because there are no formal process groups, I teach this by focusing on:

• Vision - Defining the problem and identifying the endpoint at the project beginning
• Leadership - Communicating, demonstrating and motivating
• Consensus - Involving front-line and middle management in defining what the project includes and excludes and how they will get there
• Training - Creating individualized training, avoiding technical solutions to human problems, making the environment safe for emotional expression and learning from resistance
• Workflow Improvement - Providing improvement tools during and after the "project" is over

Change management applies to both projects and products.

Hoping future HIT project managers (and the projects they manage) will succeed by only teaching HIT project management is not enough. We must use an integrated approach that combines the disciplines of project, product and change management.

A client of mine once called HIT procurement "a hideous business." She was talking about the abysmal and often unsuccessful process of planning through implementation for a Commercial-Off-The-Shelf (COTS) procurement. I agree with her assessment. It has always been awful, but it doesn't have to be that way. In fact, if we concentrate on doing it well, we can increase HIT success.

I did my first HIT acquisition about 25 years ago. I used a word processor and paper and pencil. It was hideous. I've lost count of the number of my procurements since then, but I decided to make my life easier by starting my own IT acquisition project management company over 15 years ago.

I thought the Project Management Institute's (PMI) Project Management Body of Knowledge (PMBOK) would offer some insight. I was mistaken. In fact, this is probably one of the weakest Knowledge Areas defined in PMBOK (a topic for another blog post). Suffice it to say, I decided to create a web-based software toolkit to support a better IT acquisition approach.

When I got into it, I realized it really was two different approaches.

The first is conventional, like this:

This approach focuses on specifying and acquiring an HIT solution. You prepare line items to describe all user, technical, administrative, contract and any other requirements. You then organize these line items in a database of categories and subcategories and present them for vendor response, subsequent evaluation and selection. Using this database makes the acquisition process easier. It eliminates such problems as reconciling RFP documents, paging through hard copy responses to conduct vendor evaluations, documenting your solution selection, etc. This significantly helps with acquisition. It does little to directly increase HIT implementation success.

The second approach is scripted, like this:

This approach uses scripts to describe your user requirements and line items for all other requirements. You provide these requirements for vendor response, then supplement automated vendor scores with scripted demonstrations for solution selection. This involves users in demonstrations that help them see the best solution in context. This approach directly improves HIT implementation by: Defining measurable objectives, outcomes and risks Preparing user requirements directly tied to project objectives Assigning responsibility for objectives Verifying vendor delivered solutions against contract specifications Identifying and comparing current and future states Improving system adoption by identifying the impact of workflow changes on individuals

Get more information on how this electronic RFP can work for you.

The Institute of Medicine’s (IOM) 1999 publication, To Err is Human, reported that 44 to 99 thousand people die annually due to preventable medical errors costing between $17 and $29 billion yearly. Healthcare is currently in a quality, safety and cost crisis. One IOM recommendation included using HIT to help end this crisis.

• Technology Management – What the project produces, i.e., the hard skills that are tangible and so much easier to address when compared to soft skills, and
• Change Management – How people transition from a current to a future state, i.e., the soft skills that are generally intangible.

Successful HIT requires broadening the definition of project management to include technology and change management. The Project Management Institute (PMI) and the Institute for Electrical and Electronics Engineers (IEEE) provide industry standards for project and technology management, respectively. There are no industry standards for change management. We are on our own to define techniques for successful HIT change management.

Based on my 25+ years of experience, I created the following formulas, which I hope will help others successfully manage HIT change. These include the following:

Successful Change

Unsuccessful Change

My previous posts defined specific ways to address change management. Now it's time to identify ways to integrate them into the five the Project Management Institute (PMI) Process groups so project managers can use them in HIT project, as follows:

Vision includes:

• Providing a plan for the future with the project as a strategic focal point
• Establishing stakeholder commitment before, during and after the project
• Defining objectives and measurable outcomes to be achieved during and after the project
• Assigning objectives to accountable senior executives
• Measuring executive performance by achievement of objectives

• Understanding that an organization structure is a social construct
• Knowing that people instill this structure with ethical order, e.g., rules and relationships
• Realizing people resist change to this ethical order
• Recognizing that crisis, such as a new system deployment creates an opportunity for change
• Being an ardent project supporters or champions of this change
• Focusing energy to take advantage of opportunities provided by crisis
• Offering a new ethical order facilitating change in a nonthreatening way

Consensus includes:

• Involving stakeholders from all levels of the organization
• Requiring teamwork for project tasks, e.g., scope, time, budget, requirements, issue, risk definition
• Involving members from all parts of the organization to increase their personal stake in successful project outcome

Training includes:

• Providing individualized support (e.g., designate “barrier busters” to work with those having a tough time adapting to the new system)
• Using individualized “impact sheets” showing the before and after impact of the system on a particular person’s work. This includes designing individualized impact sheets demonstrating what will and what will not change like the following:

• Creating ongoing workflow improvement teams
• Selecting improvement areas
• Conducting system demonstrations
• Preparing draft workflow improvements
• Obtaining Subject Matter Expert (SME) input
• Encouraging widespread stakeholder review to confirm SME input
• Updating and implementing the improvements
• 
  

The Healthcare Information Systems Society (HIMSS) requested that I speak on Project Management: Ensuring HIT Sustainability Beyond "Go Live" at their 2009 Conference on April 4th. I am really excited about this opportunity to work with my co-presenters, including:

• Kim Brant-Lucich, PMP, 
Director of Process Redesign, St. Joseph Health System


• Charles Garrity, 
Senior Manager, Beacon Partners, Inc.

• Anil Jain, MD
, Managing Director, e-Research, eCleveland Clinic, Director, Quality and Research Informatics, Medicine Institute

I’ll focus on tying HIT project, technology and change management together. Kim will talk about process improvement, Chuck will tackle ROI and Anil will provide a clinician’s perspective.

I am also speaking solo on this topic for the Project Management Institute (PMI) Healthcare Special Interest Group at their March 5th Webinar.

I encourage my readers to attend these and other similar sessions to help advance these important topics and ultimately improve the success of HIT projects. Take a look at this draft and let me know what you think.

Reposted from Get Ready for EHR Failures, But Don't Blame the Software at Software Advice for Electronic Medical Records.

With the Economic Stimulus Bill signed and available to subsidize EHR purchases (for more information see "The Stimulus Bill and Meaningful Use of Qualified EHRs/EMRs"), we are seeing a dramatic increase in electronic health records (EHR) buyer interest. Assuming these buyers make use of the stimulus subsidy to buy an EHR, we expect to see a lot of EHR failures over the next couple years.

Don't get us wrong! We are HUGE advocates of EHR technology. Doctors should be using EHRs. The stimulus subsidy is great. EHR software programs (and software companies) are not the problem.

Our concern is that the subsidies won't change healthcare providers' late adopter mindsets about information technology. Providers may jump at "free software" and try to avoid penalties (starting in 2015), but will they:

• Truly believe in the value of an EHR over traditional paper charts?
• Take a leadership role in advocating adoption of the new EHR in their practice?
• Change their old workflows to match the best practices in leading EHRs?
• Take part in intensive training to learn the new system?
• Ride out the difficult stages of new software adoption and change management?

Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with "free" EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.

The best things in life are free, but that doesn't refer to healthcare IT. We think providers would be far more serious about implementation and adoption if they had to pay dearly for the technology.

Accordingly, here are our thoughts on why IT projects fail and how providers can avoid that fate while still capitalizing on this once-in-a-lifetime subsidy.

When and why do IT projects fail?
In 2007, the U.S. Office of the National Coordinator for Health IT reported that about 50% of EHR implementations failed. IT industry analysts widely agree that software implementations fail because of the customers. It's too easy to point the finger at software vendors or at the software itself, but failure usually is the buyer's fault. In a recent survey, one group identified the following top reasons for IT implementation failures:

• 40% attribute failure to poor planning and communication;
• 20% cite mismanagement and rejection by end users; and
• 15% blame overspending.

Very few doctors use EHRs. In fact, most predictions put EMR market penetration at 10%-15%. We all know why this figure is so low: doctors don't want to use them, practice staff is stuck doing things "the old-fashioned way," etc. Now that Uncle Sam is willing to pay for EMRs (and telling us we had better buy!), a lot more practices are going to adopt them. The scary thing, however, is that the same feelings that have slowed the adoption of EMRs are still prevalent.

Here let me present what I think are 5 critical steps for a smooth, successful EMR implementation:

1. Become a project manager. If you're a physician, you may not consider yourself a business person. However, for this project, you need to become a project manager. If you're lucky, you may have a staff member or consultant that can play the role for you, but don't count on it. First, create a project plan. Outline all the steps of your implementation so you know what changes need to occur by certain deadlines. Stay on top of the plan and hold your team accountable.
   
2. Rally everyone else. Recall that poor leadership and lack of user adoption are frequently cited as contributing factors to IT failures. You need to express confidence in the technology and get your staff on board before the implementation. Show how much easier their lives will be. Get them excited about it. Tell your patients that next time you see them, you will be a computer whiz with a slick EHR.
   
3. Buy the best training you can. The government is paying for it (laugh). Seriously though, you will need the help. It's too easy to skimp on adequate training and ongoing support. Don't risk failure of an investment because you want to save a few thousand bucks. It's worth it. Get trainers in the office, send the staff to training, implement a train-the-trainer program.
   
4. KISS: Keep It Simple, Stupid. No office becomes paperless overnight, so don't try to do everything at once. Ease into your new workflow as much as you can. Adopt advanced features after you learn how to turn on the computer. It is OK to implement bells and whistles after the initial dust has settled.
   
5. Be prepared to practice differently. As much as you don't want to admit it, you will need to adjust the way you meet with patients and how your practice operates. And if you can, make easy adjustments ahead of time. Start carrying a tablet PC or dictating with voice recognition software. It pays to work out the kinks early on.

If you follow these major guidelines - and a lot more small steps in between - you'll have a much greater chance of EHR success. Most importantly, wrap your head around being tech savvy and enjoying the new system. If you don't, you'll pay for it (one way or another).

On March 25, 2009, the New England Journal of Medicine (NEJM) confirmed that we continue to have low Electronic Medical Record (EMR) system adoption rates in our nation’s hospitals.

I’ve posted several times about previous studies confirming this.  For example, the 2008 Annual Hospital Survey from the Leapfrog Group and the NEJM 2008 study on Electronic Health Care Records In Ambulatory Care made this same point in different care settings.  

The healthcare industry just doesn’t get it. One comment from the American College of Physician Executives 2009 Health Care Technology Survey summarizes why we are so unsuccessful:  

My physician and administrative staff has been requesting an EMR for 4 years. We are continually met with the response from IT, “it’s too hard to integrate the systems, we don’t have the resources”, I find it ironic that we continue to meet increased patient demand - efficiency and care measures - while trying to limp along with IT systems that are woefully inadequate. Those in charge of IT decisions are not involved in clinical care and are not await [sic] of the front line user problems/issues. When these issues are brought forward, the IT department appears to carry more weight than patient clinical care…

We need to combine project, technology and change management disciplines to be successful with HIT. Why do we keep missing this critical point?

We've written a book! Dr. Dave Masuda a fellow instructor at UW Medicine and I just completed our book. McGraw-Hill will publish Project Management for Healthcare Information Technology (HIT) spring 2011!

The following individuals provided invaluable comments throughout the book:

• Florence Chang, CIO, Multicare, Tacoma, WA
• Robert Greenless, PhD, former CIO, Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA
• Ernie Hood, CIO, Group Health Cooperative, Seattle, WA
• Beatha Johnson, Director Clinical Information Systems, Virginia Mason Medical Center, Seattle, WA
• Daniel Nigrin, MD, MS, CIO, Children's Hospital Boston, MA
• Michael Zaroukian, MD, PhD, FACP, FHIMSS, CMIO, Michigan State University, Lansing Michigan