Is clinical IT mayhem good for [the IT]
business? UK
Clinicians are
being asked to become entirely dependent on clinical IT in performing their
roles, and the data from the clinical IT will undoubtedly be used to alter
clinical power structures, reimbursement, and liability.
Blind faith in the IT and business "experts" is a sure path to hell.
Here's an example of the issues clinicians face from the providers and
implementors of this technology - mostly non-clinicians. This collage of issues
comes from the former head of the
"Sometimes we put in stuff that I'm just ashamed of ... Some
of the stuff that Cerner has put in recently is appalling ... Cerner and prime
contractor Fujitsu had not listened to end users ... Failed marriages and
co-dependency with subcontractors ... A string of problems ranging from missing
appointment records, to inability to report on wait times ... Almost a dozen
cancelled go-live dates ... Stupid or evil people ... Stockholm syndrome
-identifying with suppliers' interests rather than your own ... A little
coterie of people out there who are "alleged experts" who were
dismissed for reasons of non-performance."
It is quite literally amazing how a national program to implement health IT,
that has spent billions of dollars to date, is plagued by the same problems I
observed and started writing about a decade ago at this website. Every one of the above issues, and more, are
found even in organizational-level clinical IT projects.
One wonders if anyone will learn from these issues.
I tend to doubt it. The motto of this industry may well be "Clinical IT
mayhem is good for [the IT] business."
This is unfortunate. I am a strong advocate of clinical IT, but as I have
written on many occasions, clinical computing and business computing
(management information systems) are different subspecialties of computing, and
clinical IT will significantly benefit healthcare quality, efficiency and
costs, but only if done well.
In getting clinical IT 'done well", it's not about "process" and
"six sigma" and "business process re-engineering." There
simply is no substitute for brains, integrity (conflict of interest and
integrity being polar opposites), proper expertise, and significantly less
arrogance from the IT industry about how virtual clinical tools should
be developed and deployed.
Granger says he is 'ashamed' of some systems
provided
E-Health Insider, 10 Jul 2007
http://www.e-health-insider.com/news/item.cfm?ID=2854
The departing head of the NHS IT programme Richard Granger has said he is
ashamed of the quality of some of the systems put into the NHS by Connecting
for Health suppliers, singling Cerner out for criticism.
Going further than he before in acknowledging the extent of failings of systems
provided to some parts of the NHS - such as Milton Keynes – the Connecting for
Health boss, said "Sometimes we put in stuff that I'm just ashamed of.
Some of the stuff that Cerner has put in recently is appalling."
He said a key reason for the failings of systems provided was that Cerner and
prime contractor Fujitsu had not listened to end users. "It really isn't
usable because they have building a system with Fujitsu without listening to
what end users want. They have taken some account but they then had to take a
lot more. Now they are being held to account because that's my job."
The latest remarks, quoted in an interview in the current issue of CIO
magazine , appear to
make a nonsense of Granger's June statement that unless agreement was reached
between Computer Sciences Corporation and iSoft over its acquisition by IBA
Health, Cerner could wind up as the system used across the whole of the English
NHS.
In December 2005 Nuffield Orthopaedic Centre became the first NHS site to go
live with Cerner Millennium under the NHS IT programme. It has since suffered a
string of problems ranging from missing appointment records, to inability to
report on wait times. The Millennium system – now installed at six NHS
locations in the South – remains unable to directly integrate with Choose and
Book or meet 18-week reporting requirements.
In April, 79 members of staff from Milton Keynes NHS Trust signed a letter
outlining their frustrations at the Millennium system, stating: "In our
opinion the system should not be installed in any further hospitals.
CfH said there had been some "unacceptable problems" with the new
system installed at
At the end of June, David Wrede, a senior consultant at
Speaking at the BMA's annual representative meeting on 29 June Wrede said:
"We should have a public inquiry. The people who made the original Cerner
contract should be brought to book and as Cerner Millennium R0 [release zero]
is not fit for purpose…" The motion calling for a public enquiry was
passed.
The first Cerner installation by BT, the NPfIT contractor in
Granger also cast further light on Accenture's departure from the NPfIT
programme at the end of 2006, describing their relationship with sub-contractor
iSoft as a failed marriage, in which they had failed to realise their
co-dependency. He contrasted the relationship with iSoft with Accenture's
performance on Picture Archiving and Communication Systems with Agfa as its
sub-contractor. "When they work with a mature, high quality vendor that
recognises Accenture as in charge and they're doing it their way, you get a
quite good deal and they'll do the job."
The CfH boss goes on to state that he has been careful to avoid Stockholm
syndrome -identifying with suppliers' interests rather than those of the NHS -
as problems have mounted.
"One supplier asked for an extra £500m to deal with cost overruns. He
received a succinct refusal but there are many places where the response would
have been different; where threats of bad publicity and contract disputes would
persuade an organisation to start bunging millions of pounds a month in
addition to the existing contract, just to cover up," says Granger.
Elsewhere in the in-depth valedictory interview carried out ahead of Granger
announcing his resignation, he rounds on critics and erstwhile colleagues,
saying. "Either people are really stupid or evil. It's difficult to be
compassionate with people who claim that suppliers are going out of business
because they are not getting paid or they were withdrawing from wishing to do
business with the NHS. At the same time, they are saying they [the suppliers]
have been bunged millions of pounds that weren't budgeted for. It's stupid or
wicked."
He reserves particular ire for so-called experts. "There is a little
coterie of people out there who are alleged experts and who worked on this
programme. They were dismissed for reasons of non-performance or in one case,
for breach of commercial confidentiality.
"He actually sent our financial model to a supplier and that's why we
suspended him. He then resigned which is an answer in itself."
Granger continued: "Who contributed evidence to the public accounts
committees? For just about every figure quoted as an expert in this programme,
I've got HR files on them. They generate a piece of opinion that often
substantiates their world view."
Link
The full CIO article can be read at
http://www.cio.co.uk