healthy4u: HIT failure

"We are unable to share documents relating to problematic EHR's as our contract with Cerner includes a confidentiality clause ..."

In my post "<a href="http://hcrenewal.blogspot.com/2009/11/academic-freedom-and-ed-ehrs-down-under_10.html">Academic Freedom and ED EHR's Down Under: Another Update and a Welcome Development</a>" I reported on the Univ. of Sydney's somewhat belated support for academic freedom, and the reappearance of an essay on ED electronic health records problems in NSW by one of its informatics faculty, Prof. Jon Patrick, after an apparently government-initiated attempt at censorship. A new update of the paper "A Critical Essay on the Deployment of an ED Clinical Information System - Systemic Failure or Bad Luck" version 6, has now been posted by Dr. Patrick <a href="http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146">at this link</a> on his department's web pages (a direct link at this time to the PDF is <a href="http://www.it.usyd.edu.au/~hitru/essays/The%20Story%20of%20the%20Deployment%20of%20an%20ED%20Clinical%20Information%20System6.0.pdf">here</a>). The press has started to take notice. A piece in the Sydney Morning Herald entitled "Health department accused of censorship" appeared on Nov. 28 <a href="http://www.smh.com.au/national/health-department-accused-of-censorship-20091127-jwwm.html">here</a>. That piece was noted by Computer Weekly in the U.K. in a piece entitled "Claim of censorship over Cerner system" <a href="http://www.computerweekly.com/blogs/tony_collins/2009/11/claim-of-censorship-over-cerne.html">here</a>. The U.K. suffers a severe EHR epidemic (the UK Public Accounts Committee report on disastrous problems in their £12.7 billion national EMR program is <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">here</a>.) [12/3/09 update: the piece has disappeared, then reappeared, at Computer Weekly. In case it disappears again, a copy of the article from Google's cache is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/claim_of_censorship_cerner.doc">here</a>.] From the U.K. Computer Weekly article: <blockquote> The Sydney Morning Herald and ZDNet in Australia report that the University of Sydney removed from its website - temporarily - a negative essay about a Cerner system which had been installed at hospitals in New South Wales. The author of the essay is a medical IT professor, Jon Patrick, who is reported to have claimed that NSW Health, which is part of the government of New South Wales, put pressure on the university to take down the paper. If true, it would tie in with what's been happening in England where mentions of Cerner in a negative context are being officially discouraged. Cerner is due to be installed at hospitals across London as part of the National Programme for IT [NPfIT] but several trusts that have already gone live - including the Royal Free and Hampstead, Barnet and Chase Farm, and Barts and The London - have run into serious problems, including the losing of patient appointments and patients not being treated. A showcase Cerner site at Homerton ceased mentioning Cerner in its public board papers after doing a deal with NHS Connecting for Health and the Department of Health. Homerton also rejects FOI requests related to its discussions on Cerner. Homerton told me: "We are unable to share documents relating to these meetings as our contract with Cerner includes a confidentiality clause and as such disclosure of the information could give rise to an actionable breach of confidence."</blockquote> I am repeating that last sentence for effect: <blockquote> We are unable to share documents relating to these meetings as our contract with Cerner includes a confidentiality clause and as such disclosure of the information could give rise to an actionable breach of confidence.</blockquote> This is solid evidence of such confidentiality clauses in HIT contracts and the chilling effect they have, along with dangers of "hold harmless" clauses. This style of EHR contracting is a practice now under investigation by the U.S. Senate Committee on Finance, as in their Oct. 16, 2009 letter to major healthcare IT vendors and management consultants from Senator Charles E. Grassley (ranking member). A copy of that letter is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/grassley_erecords102409.pdf">here</a> (PDF). I have written on the dangers of such clauses before as in my July 22, 2009 letter in the Journal of the American Medical Association "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards" (<a href="http://jama.ama-assn.org/cgi/content/extract/302/4/382" rel="nofollow">http://jama.ama-assn.org/cgi/content/extract/302/4/382</a>), as well as my much more thorough posting on these issues in the essay at my Drexel University website <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=koppel_kreda">here</a>. In that essay I observed: <blockquote>Regarding healthcare IT "Hold Harmless" and Defects Gag Clauses, I also question whether hospital executives violated their fiduciary responsibilities by signing such contracts, and violated Joint Commission standards of hospital leadership conduct as well ... Let's look at the Joint Commission Hospital Accreditation Program <a href="http://www.jointcommission.org/Standards/SII/sii_hap_ld.htm">Leadership Chapter</a>, and its standards for hospital leadership (<a href="http://www.jointcommission.org/NR/rdonlyres/D53206E8-D42B-416B-B887-491B6D5AA163/0/HAP_LD.pdf">link</a>, PDF): <o:p></o:p>Leadership LD.01.03.01 Standard LD.01.03.01 The governing body is ultimately accountable for the safety and quality of care, treatment, and services. Rationale for LD.01.03.01 The governing body’s ultimate responsibility for safety and quality derives from their legal responsibility and operational authority for [organization] performance. In this context, the governing body provides for internal structures and resources, including staff, that support safety and quality. <o:p></o:p> The governing body has a legal responsibility for safety and quality, not just a moral obligation. One of the "internal structures" is healthcare IT that is safe and effective and that does not expose patients or staff to undue risks. How does signing "hold harmless" and "defects gag order" clauses with an HIT vendor serve such a purpose, exactly? Hospital executives know, should know, or should have known that such provisions would remove incentives for health IT vendors to produce the best products and to correct deficiencies rapidly, thus increasing risk to patients and clinicians.<o:p></o:p>Elements of Performance for LD.01.03.01 5. The governing body provides for the resources needed to maintain safe, quality care, treatment, and services. <o:p></o:p> One of those resources is health IT.<o:p></o:p>Standard LD.02.01.01 The mission, vision, and goals of the [organization] support the safety and quality of care, treatment, and services. Rationale for LD.02.01.01 The primary responsibility of leaders is to provide for the safety and quality of care, treatment, and services. The purpose of the [organization]’s mission, vision, and goals, is to define how the [organization] will achieve safety and quality. The leaders are more likely to be aligned with the mission, vision, and goals when they create them together. The common purpose of the [organization] is most likely achieved when it is understood by all who work in or are served by the [organization]. <o:p></o:p> How is a contract with an HIT vendor that calls for hiding defects in health IT and exposing staff to liability for defects in same serving the above purposes?<o:p></o:p> Standard LD.02.03.01 The governing body, senior managers and leaders of the organized medical staff regularly communicate with each other on issues of safety and quality. <o:p></o:p> Does that include communication on health IT defects? Can a medical staff member ask to see a database of such defects when the hospital has signed a nondisclosure of defects agreement with an HIT vendor?<o:p></o:p>Rationale for LD.02.03.01 Leaders, who provide for safety and quality, must communicate with each other on matters affecting the [organization] and those it serves. <o:p></o:p> I ask the same question as above.<o:p></o:p> Standard LD.03.01.01 Leaders create and maintain a culture of safety and quality throughout the [organization]. <o:p></o:p> Safety for whom, exactly? Patients, or patients and staff? How is exposing professional staff to undeserved liability from defective health IT serving the creation of a culture of safety and quality for them? How is suppressing information on health IT defects and problems helping patient safety and care quality? How is lack of seeking informed consent on health IT use from patients whose care is mediated by health IT devices with known but undisclosable defects creating a culture of quality? How is hiding such defects creating a culture of quality in the community's other hospitals, that may be considering purchase of the very same health IT?<o:p></o:p>Standard LD.03.04.01 The [organization] communicates information related to safety and quality to those who need it, including staff, licensed independent practitioners, [patient]s, families, and external interested parties. Rationale for LD.03.04.01 Effective communication is essential among individuals and groups within the [organization], and between the [organization] and external parties. Poor communication often contributes to adverse events and can compromise safety and quality of care, treatment, and services. Effective communication is timely, accurate, and usable by the audience. <o:p></o:p> Are physicians and nurses explicitly informed by administration that clinicians are liable for bad outcomes due to software problems? Are they informed of the gag clause? Are patients informed of unremediated health IT defects existing at time of service? This standard seems a veritable smoking gun regarding breach of fiduciary responsibility and Joint Commission obligations when hospital leadership signs agreements specifically excluding the sharing information about health IT defects and complaints. It is already known that hospitals maintain lists of health IT defects, some in the thousands of items. A number of the defects rise to the level of creating considerable risk to patients, and nobody is in a hurry to remediate them. (See my proposed although somewhat tongue in cheek "HIT Informed Consent" that describes some of these known defect categories <a href="http://hcrenewal.blogspot.com/2009/03/draft-patient-rights-statement-and.html">here</a>).<o:p></o:p>Standard LD.04.04.03 New or modified services or processes are well-designed. ... 3. The hospital's design of new or modified services or processes incorporates: Information about potential risks to patients. 4. The hospital's design of new or modified services or processes incorporates: Evidence-based information in the decision-making process. Note: For example, evidence-based information could include practice guidelines, successful practices, information from current literature, and clinical standards.<o:p></o:p> How does the contractual inability to communicate about health IT defects, which its executives willingly sign, serve this purpose?<o:p></o:p>Standard LD.04.04.05 The [organization] has an organization-wide, integrated [patient] safety program. ... 12. The hospital disseminates lessons learned from root cause analyses, system or process failures, and the results of proactive risk assessments to all staff who provide services for the specific situation.<o:p></o:p> Disseminates lessons learned, except when the HIT contract they've signed with a vendor forbids it, that is. The practices of the health IT industry, and the dealings of the hospital leadership with that industry, may in fact be a scandal of national (or international) proportions.<o:p></o:p><a href="http://www.infoplease.com/ce6/society/A0818616.html"></a></blockquote> International scandal, indeed. I predict these EHR confidentiality clauses will end up causing great loss of money in failed systems, and/or harming patients, due to the chilling effect they have on revelation of defects and problems by clinicians and executives alike. Those who signed them will very likely be held liable, at least in the U.S., as the clauses breach the safety standards of the accrediting agency for hospitals here, the Joint Commission. I wish the signers of such contracts good luck in the courtroom. In Australia and the U.K., I cannot comment, but also wish good luck to those who signed these clauses when lawyers go full court press on EHR-mediated debacles. -- SS

"We are unable to share documents relating to problematic EHR's as our contract with Cerner includes a confidentiality clause ..."

In my post "Academic Freedom and ED EHR's Down Under: Another Update and a Welcome Development" I reported on the Univ. of Sydney's somewhat belated support for academic freedom, and the reappearance …

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01 Dec 2009

Academic Freedom and ED EHR's Down Under: Another Update and a Welcome Development

In "<a href="http://hcrenewal.blogspot.com/2009/11/academic-freedom-and-ed-ehrs-down-under.html">Academic Freedom and ED EHR's Down Under: An Update</a>" I wrote about the disputed essay on electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney. The essay was entitled "A Critical Essay on the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck?" I am happy to report that an updated version of the essay, version 5, is now available from Dr. Patrick's university web site at <a href="http://www.it.usyd.edu.au/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146</a> . It can be downloaded from the icon at Item 6. This is a welcome development. The essay is now labeled as an Op-Ed (Opinion Editorial). -- SS

Academic Freedom and ED EHR's Down Under: Another Update and a Welcome Development

In "Academic Freedom and ED EHR's Down Under: An Update" I wrote about the disputed essay on electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical inform…

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10 Nov 2009

Fuzzy Math Indeed: Rising Costs in Government's Digital Health Stimulus

Seen in the blog of the Huffington Post Investigative Fund: <blockquote><a href="http://huffpostfund.org/stories/2009/10/fuzzy-math-rising-costs-governments-digital-health-stimulus">Fuzzy Math? Rising Costs in Government's Digital Health Stimulus</a>  <div id="node-880" class="node odd full-node node-type-article"> <div class="subtitle">Spending Could Be Double The Obama Administration's Public Estimate of $19 Billion </div></div> <div class="author">By <a href="http://huffpostfund.org/users/fred-schulte" title="View user profile.">Fred Schulte</a> Huffington Post Investigative Fund </div> <div class="post-date">15 Oct 2009</div> Creating digital medical records for every American within the next five years – a key provision of President Obama’s stimulus package -- could cost more than twice the $19.5 billion figure that has been cited by federal officials. Federal budget documents show that actual spending for the plan, which will use stimulus money to help doctors and hospitals defray the cost of installing high-tech records systems, could hit nearly $47 billion. The discrepancy between the Obama administration’s <a href="http://huffpostfund.org/stories/2009/10/fuzzy-math-rising-costs-governments-digital-health-stimulus#cost">$19.5 billion public estimate</a> and the entry in the budget of the U.S. Department of Health and Human Services mostly arises from the government’s calculation that it will recoup some of the cost of subsidizing digital systems through billions of dollars in reduced federal health spending. But many health analysts are highly skeptical that such savings can be accurately predicted.</blockquote><div id="TixyyLink" style="border: medium none ; overflow: hidden; color: rgb(0, 0, 0); background-color: transparent; text-align: left; text-decoration: none;"> </div>It's worse. Far worse. I believe the government is underestimating EHR costs by a factor of 5 to 10, due to implementation failure and remediation costs. I'm a long term optimist on health IT, but a short term realist. I believe we will be having an avalanche of failed/stalled projects such as this one in years to come: "<a href="http://hcrenewal.blogspot.com/2009/10/another-major-hit-project-setback.html">Another Major HIT Project Setback at UCSF</a>". The incompetence in this industry is worse than I imagined when I started writing about HIT dysfunction a decade ago. Worse are the coverups of problems that occur in implementation and in use. At least in the U.S. military, there is transparency about health IT problems (e.g., see <a href="http://hcrenewal.blogspot.com/2009/06/if-military-cant-get-electronic-health.html">here</a>). In the private sector, forget about publicity of what actually goes on in the U.S. (The U.K. has increased its own transparency to <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=UK">some extent</a>.) <blockquote>A spokesman for the department [U.S. Department of Health and Human Services], Nicholas Papas, said that the $47 billion figure is “undergoing revision and we anticipate it will decrease.” He said the agency expects to generate a “firmer figure” by the end of the year, but declined to say how much it would be. Papas said there was no attempt to lowball the number for public consumption. Calculating both cost and benefits in the government’s estimate is a sound way to explain the price of the plan, he said.</blockquote> Unfortunately, these calculations do not factor in the cost of dyscompetence, incompetence and failures created by lack of essential cross disciplinary expertise and talent in the HIT industry. <blockquote>Many health policy experts agree that electronic health records can cut costs by reducing harmful medical errors and wasteful spending.</blockquote> I would bet these "policy experts" have never tried to implement clinical IT. <blockquote>The $19 billion figure has appeared in numerous news articles and been widely picked up and repeated by many bloggers covering the fast-growing health information technology industry. Earlier this month President Obama’s chief technology officer, Aneesh Chopra, mentioned the $19 billion figure twice in a live video cast from the White House. But it’s “totally hypothetical,” said Sharona Hoffman, a professor of law and ethic at Case Western Reserve University School of Law. She said it counts on savings “with no concrete evidence they will occur.”</blockquote><div id="TixyyLink" style="border: medium none ; overflow: hidden; color: rgb(0, 0, 0); background-color: transparent; text-align: left; text-decoration: none;"> </div>It's worse than "totally hypothetical." A major confounding variable is simply missing - the cost of HIT failures, false starts, delays, and remediation. More can be read about those risks <a href="http://www.tinyurl.com/hit-misadventure">here</a>. That site has been online for a decade now, and ironically is nearly the only relevant "hit" on a search engine query on "<a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&q=healthcare+IT+failure&btnG=Google+Search">healthcare IT failure</a>" or similar concept. Has anyone in government been paying attention? A slide deck I recently presented entitled "Health IT Promises and Threats" provides a dose of reality on supposed cybernetic miracles. It is at <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/EHR_benefit_peril_final.ppt">this link</a> (PPT). -- SS

Fuzzy Math Indeed: Rising Costs in Government's Digital Health Stimulus

Seen in the blog of the Huffington Post Investigative Fund:Fuzzy Math? Rising Costs in Government's Digital Health Stimulus Spending Could Be Double The Obama Administration's Public Estim…

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16 Oct 2009

Another Major HIT Project Setback at UCSF: Vendor, Client or Both at Fault?

In yet another example of a major health IT project setback, in August I wrote about UCSF's apparent problems with health IT implementation that I learned about through anonymous comments at the <a href="http://www.histalk.com/">HisTALK</a> blog. At "<a href="http://hcrenewal.blogspot.com/2009/08/lessons-unlearned-health-it-failure-act.html">Lessons Unlearned: Health IT Failure, Act 2</a>" I wrote: <blockquote>I find it remarkable that this resource-wasting scenario (with possible adverse patient care repercussions) can occur: <ul><li>In a state that's in a severe economic crisis, </li><li>At an organization that failed severely in a HIT and administrative IT merger ten years ago (in the failed, late 1990's attempted merger between UCSF and Stanford's medical centers, see the 2000 stories "UCSF/Stanford: Marriage was rough; divorce is expensive" <a href="http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2000/04/24/focus4.html">here</a> and "A thousand MIS personnel cannot merge two healthcare systems"<a name="thousand"> </a><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=A%20thousand%20MIS%20personnel%20cannot%20merge%20two%20healthcare%20systems">here</a>),</li><li>With an EHR product, Centricity, that is the descendant of Logician that others have implemented successfully (including myself, speaking from experience), </li><li>With GE, a major global high technology vendor, presiding over this new failure at a major academic medical center,</li><li>With ample preventive material available in books, journals on the web about such failures (e.g., at the many pages and links <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/">here</a> and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=other">here</a>, as just a few examples). </li></ul></blockquote> I asked if vendor and hospital executives bother to read such materials. Here is an update in this poorly-covered mystery: <blockquote>Friday, October 9, 2009 <a href="http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2009/10/12/newscolumn3.html">UCSF halts clinical IT installation</a> San Francisco Business Times - by <a id="byline" href="http://www.bizjournals.com/search/results.html?Ntt=%22Chris%20Rauber%22&Ntk=All&Ntx=mode%20matchallpartial">Chris Rauber</a> <div id="storycontent"> Dr. Sam Hawgood, newly appointed dean of the University of California, San Francisco's<a class="story_clink" href="http://www.bizjournals.com/sanfrancisco/gen/University_of_California,_San_Francisco_10AE04B6F6FD4994A2DE25245732FFE4.html"></a> School of Medicine, confirmed that UCSF has put the brakes on installation of a $50 million clinical IT system from General Electric [which had acquired Medicalogic's "Logician" EHR some years ago - ed.] In late August/early September, the Business Times was unable to reach high-ranking UCSF officials to comment on anonymous reports on the respected HISTalk blog and by sources that UCSF was unhappy with early results of the electronic medical records system installation. An informed insider says GE was “way behind schedule” in writing code, and “UCSF got fed up with the endless GE delays,” and is looking to identify other vendors for a drug order entry system. “We are taking a pause to evaluate our best options moving forward, and we will be making a decision in the next two to three months, and then moving forward aggressively,” Hawgood said. The delay will not put the IT project behind schedule, he said, because “once we make a decision regarding the vendor, we’ll be back on track for an aggressive installation.” [Unfortunately, that sounds like wishful thinking or spin to me - ed.] UCSF has brought in consultant Kurt Salmon Associates to help it evaluate the IT project’s woes, which were said to be creating considerable frustration within <a class="story_clink" href="http://www.bizjournals.com/sanfrancisco/related_content.html?topic=UCSF%20Medical%20Center">UCSF Medical Center</a>, and obviously the School of Medicine as well. </div>  </blockquote> This setback is of great concern to me. I believe such scenarios could become commonplace in coming years as healthcare organizations bow to the ARRA-created pressure to computerize "or else" by 2014 - that is, suffer reimbursement penalties for not being "meaningful users" of HIT. (Whatever that somewhat presumptuous term describing a largely experimental technology will ultimately come to mean.) I have frequently written about the HIT vendors being dominated by those with an MIS (management information systems or "business computing") background, and unshakably and arrogantly deficient in talent management where Medical Informatics expertise is concerned. GE may also suffer from domination by engineers whose primary experience is at the level of capital equipment, PACS etc., much as I wrote about competitor Philips Medical <a href="http://hcrenewal.blogspot.com/2009/08/in-nov.html">here</a> and <a href="http://hcrenewal.blogspot.com/2008/11/who-leads-in-intellectually-challenged.html">here</a>. Having once worked for a GE competitor myself, Comdisco Healthcare Group, and having asked GE representatives about what a phrase on a banner at an RSNA show stating "GE: Leader in Radiology Informatics" meant -- and getting blank stares and comments that "it has something to do with the computers connected to our xray devices" back in return-- my concern was that the problems are not just UCSF centric but vendor centric as well. UCSF is a big, complex organization, with a lot of very smart clinicians and lots of politics, and I conjecture that GE bit off more than it could chew regarding development, customization and deployment of major health IT at such an organization. It requires far more than technical excellence. My concern is that GE, along with many if not most of the other major health IT vendors, lack the Medical Informatics and <a href="http://rkcsi.indiana.edu/archive/SI/Arts/SI_report_Aug_14.doc">Social Informatics</a> talent and depth to make our ambitious national EHR plans a reality. The overselling of vaporware and "yes, we can do that, no problem" promises by sales and marketing are also a concern, as I find common in HIT where salespeople promise the world to close a deal. Then, the technical people need to play catch up to the grandiose promises made by their creative sales colleagues. I fear in a few years we will be in the situation that the UK's National Programme for IT (NPfIT) in the NHS <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">is in now</a>. If we want to avoid that fate, we as a country must: <ul><li>Increase transparency and information diffusion about HIT difficulties and failures greatly. That my <a href="http://www.tinyurl.com/hit-misadventure">website on HIT failures</a> is still nearly unique on the Web after ten years is symptomatic of a true lack of information sharing on real world HIT problems. My monitoring of access patterns to the site as reported in <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/content/documents/FINAL_Healthcare%20IT%20Failure_Oct_19_2006.ppt">this 2006 AMIA poste</a>r (PDF) strongly suggests the demand for such material far exceeds the supply. The AMIA/AHIMA book of which I am an associate editor entitled "<a href="https://imis.ahima.org/orders/productDetail.cfm?pc=AB102209&bURL=%2Forders%2Findex.cfm%3F">H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations</a>" and the new journal "<a href="http://www.schattauer.de/index.php?id=558&L=1">Applied Clinical Informatics</a>" whose Editor-in-Chief is Dr. Chris Lehmann, informaticist at Johns Hopkins, are a start -- but just a start on candid information diffusion about applied HIT realities.</li></ul><ul><li>Health IT vendors need to understand that those in MIS and engineering are, in the context of complex clinical settings where clinician-supportive HIT is to be developed and deployed, often dyscompetent (they fail to maintain acceptable standards in one or more areas of professional practice) or even incompetent (lacking the requisite cognitive and non-cognitive abilities and qualities to perform effectively in the scope of professional practice). Lacking an understanding of medical culture and the <a href="http://www.ctlab.org/documents/Hiding%20in%20plain%20sight.pdf">nature of medical settings</a> is a highly compromising deficit. It leads to mission hostile HIT devices such as shown <a href="http://tinyurl.com/hostileuserexper">here</a>. There needs to be much better talent management in that regard.</li></ul><ul><li>Suboptimal HIT vendor performance, and defective HIT devices, should not be tolerated. Repeat purveyors of such technology should be materially sanctioned for wasting precious healthcare resources. Whether this happens primarily in the courtroom, or in the court of "consumer opinion" by HIT buyers -- based on transparent consumer reports on HIT - remains to be seen.</li></ul> -- SS Addendum: a reader familiar with the UCSF situation largely confirms my suspicions as above regarding vendor capabilities and the vendor's biting off more than it could chew, greatly delaying deliverables. They did say, however, that I was not correct (in this case) about the issue of salesperson "promise the moon" behavior, and that this was not a factor in the project stoppage.

Another Major HIT Project Setback at UCSF: Vendor, Client or Both at Fault?

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13 Oct 2009

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