Saturday, October 09, 2010

Guess What? Another Example Where Big Has Blown Up Badly At Vast Expense!

The following appeared a day or so ago.

DOD's EHR Failure Due to Poor Planning, Says GAO

John Commins, for HealthLeaders Media , October 8, 2010

Shortcomings in the Department of Defense's failed 13-year, $2 billion transition to electronic medical records were largely due to poor planning and execution, and a failure to appreciate the "significant complexity" of the program, the Government Accountability Office said.

DOD's EHR project—the Armed Forces Health Longitudinal Technology Application (AHLTA)—was expected to give the military's healthcare providers realtime access to health information for the 9.6 million active duty service members, their dependents, and other beneficiaries worldwide. However, the system hasn't met expectations.

GAO was asked by DOD to examine AHLTA's shortcomings as the military prepares to acquire a replacement system called EHR Way Ahead, for which the federal government has budgeted $302 million in fiscal 2011.

GAO found that AHLTA had met some benchmarks for outpatient care and dental care documentation, but that DOD had been forced to scale back other capabilities. "In addition, users continued to experience significant problems with the performance (speed, usability, and availability) of the portions of the system that have been deployed," GAO reported.

DOD has begun to improve system performance and enhance functionality and plans to continue to stabilize the AHLTA system through 2015, as a "bridge" to EHR Way Ahead. "However, it has not carried out a planned independent evaluation to ensure it has made these improvements. Until it ensures that these weaknesses are addressed, DOD risks undermining the success of further efforts to acquire EHR capabilities," GAO reported.

Details here:

http://www.healthleadersmedia.com/content/LED-257477/DODs-EHR-Failure-Due-to-Poor-Planning-Says-GAO

Here we have another example of a huge, long project that has failed to deliver on all sorts of major objectives despite lots of time, money and effort.

I hope this is another report that the anonymous people at NEHTA and DoHA who seem to be planning to implement all sorts of large national projects look at very closely.

It is really hard to identify very large scale Health IT projects - with the exception of the clinician led Kaiser Permanente Project which has a second bite after billions had been wasted on the initial effort - that have really gone well.

Let me know if you think there are others that are worth a look!

David.

5 comments:

Anonymous said...

So what is the other option...work on small scale projects forever !! They fail too!!

The issue is the planning not the size of the project. No argument there, better methodology, constant review and improvement and accountability.

If people never tackle big projects, then we would be destined to never seeing the outcome in our lifetime. Why aim for the moon when you can aim for the clouds 'eh.... a sad way to move forward.

Dr David More MB, PhD, FACHI said...

I agree that you can reduce the risk with quality planning and project management. Sadly large scale government IT projects often seem not to have those essential basics!

David.

Anonymous said...

All too often large projects go off-the-rails and crumble in a heap; whilst small projects seem to crawl along for ever, gasping for oxygen, occasionally growing steadily - all the while successfully dealing with problems encountered along the way - to eventually become large, mature, successful projects underpinned by solid foundations.

That said, the essence of why the large so very often crumble and fail after vast sums of money have been spent, versus why the small occasionally succeed has to do with a very complex mix of factors. Factors which are poorly understood by the proponents of the large projects, but intuitively understood by the entrepreneurial risk takers whose small projects succeed to the envy of those who failed.

Ian Colclough
Integrated eHealth Strategies & Market Development

Anonymous said...

And given the embarrassment of small projects succeeding its not surprising that the proponents of the large projects try and squash/deny the success of the small projects. Sadly NEHTA are in this phase currently. They are a roadblock to progress. The shining light of NEHTA is its PR team, without which they would have been killed years ago. But is that healthy??

Anonymous said...

And the depth of expertise in the small companies referred to is unique. Regrettably, because most of us work in small companies we are rarely heard above all the noise generated by the large companies that have political leverage,deep pockets, and plenty of sales and marketing resources to divert attention away from where the real expertise can so often be found. It has always been so and it probably always will be without some new enlightened leadership.