Our middle school child is in the middle of a family consumer science project (home economics) to organize one room in our home. He has redefined the project so that he reorganizes during commercials, and he is seven hours into a project involving our walk-in closet.
While watching the news it occurred to me that something is missing from my life, I do not belong to a gang, not even a little one. So, I have decided to start one, a white collar gang of consultants. A rough and tumbled, manicured group of professionals.
Instead of gang emblem, I am thinking each member of the gang will have their own embossed business card. We will come up with creative gang nicknames. For myself I am vacillating between ‘Dr. Knowledge’ and ‘The Voice of Reason.’ Instead of Harleys, we will roll through town to our national rallies on monogrammed Segways, and instead of leathers we will dress in Armani.
Mothers will hide their children from us as we power noiselessly down Main Street at four miles an hour, and their CPA husbands will turn green with envy. We might not win many fights, but we will have the satisfaction of knowing we are smarter than those who beat us to a bloody pulp.
Sounds too good to be true, doesn’t it?
There are days when it doesn’t pay to be a serial malingerer, and when it does, the work is only part time, but I hear the benefits may be improving as I think I heard somebody mention healthcare is being reformed.
I don’t know if you are aware of it, but there are actually people who have taken an Alfred E. Newman, “What, me worry” attitude towards EHR. For the youngsters in the crowd, Alfred was the poster child for Mad Magazine, not Mad Men.
Just to be contrarian for a moment–as though that’s out of character for me–most providers have no need to fear–does this happen to you? You are writing aloud, trying to make a point, and the one thing that pops into your mind after, ‘there’s no need to fear’ is “Underdog is here.”
Anyway, since many providers haven’t begun the process, or even begun to understand the process, there is still time for them to lessen the risk of failure from an EHR perspective. Many don’t want to talk about it, the risk of failure.
Here’s another data set worth a look (The Chaos Report). They went a little PC on us calling them ‘Impaired” factors. EHR impairment. Step away from the computer if you are impaired, and take away your friend’s logon if they are. These are failure factors.
| Project Impaired Factors | % of the Responses | |
| 1. | Incomplete Requirements | 13.1% |
| 2. | Lack of User Involvement | 12.4% |
| 3. | Lack of Resources | 10.6% |
| 4. | Unrealistic Expectations | 9.9% |
| 5. | Lack of Executive Support | 9.3% |
| 6. | Changing Requirements & Specifications | 8.7% |
| 7. | Lack of Planning | 8.1% |
| 8. | Didn’t Need It Any Longer | 7.5% |
| 9. | Lack of IT Management | 6.2% |
| 10. | Technology Illiteracy | 4.3% |
| 11. | Other | 9.9% |
My take on this is with overall “failures” so high, several respondents could have replied to “all of the above.” Also of note is that these failure reasons differ from the ones listed previously.
Who knows, maybe if we multiply them by minus one we can call them success factors.
Pale Rhino Consulting 
Hi there Paul,
Agree with your advice. We need people to step back and use some practical common sense thinking.
We should also do a post mortem on past failed projects with the honest objective of trying to learn and improve.
I worked for 5 years on the NPfIT programme in the UK (later it was called Connecting for Health CfH). It was officially canned last week and officially recognised as a failure.
We tried to take on too much too fast. We accepted unrealistic deadlines. The budget pricing was around 6 billion pounds when everyone knew from the start it would be over 30 billion pounds to do the job properly. We expected the hospitals and NHS Trusts to pick up the bill for “implementation” (i.e. the 24 billion+ that was underfunded). We suffered from lack of user involvement; lack of trust; lack of executive support; constantly changing requirements and speciifications; last minute changes away from the tendered software to “vapourware”; lack of planning; and practically all the other factors you listed.
Much has to do with the appointment of a senior Programme Director who didn’t have any previous experience in healthcare.Yet everyone learned a lot. Quite a number of value-added benefits were delivered to the NHS’ staff. Electronic booking of appointments between primary care and acute care are now happening routinely.
The Identity Management engine that is part of the NHS Spine is working successfully. Summary Care Records are being captured. Electronic Prescriptions are working. The majority of GPs are using electronic health records, though perhaps not exchanging them outside their own Primary Trusts. The N3 backbone network is plugging away delivering connectivity and bandwidth capacity.
And as a Learning Organisation (in the sense Peter Senge talks about) the NHS has come a long way.
If we were to embark on a new programme now much of this learning could be brought to bear. However, that is unlikely because credibility is shot to pieces.
[Just as an asside, 6 billion pounds (or 30 billion pounds if we are being honest) seems like a lot of money until you realise that the NHS is the 3rd biggest organisation per capita in the world (after the Chinese Army, and Indian Railways.) And the NHS has a burn-rate for cash of over 1 billion pounds/day. If an EHR programme could deliver better than 8.2% dividend in improving patient care and reducing medical error, then a 30 billion price tag would be re-couped in 1 year.]
[As another aside: We also suffered from the British media (in particular the Daily Telegraph) runing bad publicity stories every day of the week. As an Australia who used medical services when I lived in the UK I came away astounded. The average Brit feels the NHS is hopelessly sub-standard when I felt it was an excellent healthcare service.]
My question (to those who are interested in genuinely improving healthcare) is, “How can we improve the way we initiate these kinds of huge programmes to truly deliver benefits to healthcare workers, patients and citizens?”
– Bruce
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Well said Bruce. We will see in a few years how closely we mimic the UK
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