Why bad things happen to big health IT projects

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Waste and mistake are functions of size not sector -- private or public. Health IT is rife with the potential for both. Here's how to tell when things are going very wrong.

In late July the Pentagon awarded a $4.3 billion contract that its CIO described to the press as “not really an IT project (but) a business transformation project.” Good luck with that.

In the 1980s, when I worked for a Beltway Bandit -- the colloquialism for a government contractor located in the suburbs along the highway that circles Washington, D.C. -- there was a going joke. Contracting was supposed to bring the efficiencies of the private sector to the nobility of public service. The opposite was closer to the truth. There is no reason to believe anything has changed.

If so, the 7-year, multibillion-dollar award announced July 30 will be a long hard slog. It calls for the contracting team of Leidos Holdings and Cerner to streamline and digitalize, as needed, records in the Pentagon’s Military Health System, according to the Wall Street Journal. Success will be defined by military specifications -- MilSpecs. These serve as the backbone of all defense contracts. That, in itself, speaks volumes.

I’ve learned, however, over the last couple decades that waste and mistake are functions of size not sector. And health IT is rife with the potential for both. Each year mistakes and missteps cost American IT dearly. Security breaches, data losses, and system crashes cost $1.6 billion annually, according to MeriTalk, a public-private partnership focused on improving the outcomes of health and government IT.

A 2014 report, entitled “Rx: ITaaS + Trust,” states that health IT is particularly vulnerable. Sixty-one percent of global healthcare organizations surveyed by MeriTalk had experienced a security breach, data loss, or unplanned downtime in the previous 12 months.

Interestingly, many of these losses are due to outside attack. More distressing are the mistakes that come from poor planning and execution.

The largest public sector IT program ever attempted, the UK’s National Programme for IT in the NHS, was dead less than a decade after its birth in 2002. Its mission had been fairly straightforward: create an integrated electronic patient records system for the UK’s National Health Service. The goal was to increase efficiency. The result didn't come even close.

Much can be learned from this debacle, just as the Pentagon’s new contract award bears watching. What has been learned from the Brits. Will past mistakes be repeated on this side of the pond? Here are a few things to keep an eye on.

Buy-in is paramount to success. Anyone expected to take part in an IT project needs to be involved in its planning and implementation, if for no other reason than to know what to expect and how they might reap the rewards.

“Haste makes waste,” this idiom is made to order for health IT. Speed should not be mistaken for efficiency in the planning phase. Glossing over the details of how a project will work in the hope that issues will resolve themselves is a formula for disaster.

Good communications is essential. The difficulty of doing so is directly proportional to the number of groups involved. The more partners, the more difficult keeping track of what the others are doing. Just as too many cooks spoil the soup, too many partners can tangle up an IT project.

Accountability and responsibility are important. But so is flexibility. When clearly the project is going south, there are few surer ways to scuttle a project than to doggedly defend the initial approach. Circling the wagons does little more than stave off the inevitable.

Bottom line: Start with a competent strategy and plan, but be ready to adapt to changing conditions. This hinges on having a clear understanding of the commercial drivers from the outset and good communications among everyone involved. Government agencies typically are pretty awful at this. To its credit, the Pentagon is framing its newly announced project as more a business transformation than IT project. So far, so good.

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