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Learning from Mistakes

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No news is said to be good news. For Scot Silverstein, M.D., however, lack of information is a symptom of a major industry problem. In 1998, Silverstein launched a Web site devoted to shining light on healthcare IT failures. Hospital leaders, IT vendors and the media have swept the topic under the rug, he says. "IT failure is a serious problem, but people are reluctant to study it," says Silverstein, the director of the Philadelphia-based Institute for Healthcare Informatics at Drexel University College of Information Science and Technology. "We like to talk about success, not failure."According to Silverstein, the healthcare industry is plagued by projects that do not live up their potential-or in some cases, are scrapped altogether. His observations are drawn from several years of experience working at large health systems, where clinical documentation projects involving IT stalled due to mismanagement. In 1998, Silverstein launched the site, hoping to gather case studies from others in the field.The site has grown slowly. It now includes more than 15 case studies, which Silverstein wrote, that are based on first-hand reports from medical informatics colleagues. The reports detail information systems, such as computerized order entry and electronic medical records, that were scrapped or never accepted by the clinical users. The stories offer a litany of projects that were understaffed, improperly budgeted or failed to consider user workflow. Case study sources remain anonymous to avoid litigation, Silverstein says. Many failed efforts reflect what he calls "bull in the china shop implementations." In these, technology staffs undertake system design without understanding what clinicians need. Vendors are part of the problem as well, he asserts. Too often they create software packages in a vacuum, marketing products that are difficult for clinicians to use. In a territorial hospital environment, the weaknesses converge. "There are huge disconnects in expertise and culture among clinicians, hospital executives, and IT people," he says. "Executives are risk-adverse and have a paternalistic attitude about clinicians. Clinicians are focused on improving the quality of care and their own lifestyle. IT people view themselves as the guardians of information. The discord leads to bad decisions."Silverstein says that failures can be avoided with more sophisticated management expertise. Involving medical informatics professionals whose background spans IT, computer and medical science is crucial, he says. The site is: www.ischool.Drexel.edu/faculty/ssilverstein/medinfo.htm.-Gary Baldwin