In my last Insight I asked “Are we MAD”, by which I mean Making a Difference. In this Insight I started to look into the ‘All or Nothing’ model.
This model is offered by vendors, when responding to an eMR tender, after I attended a (National) State Health Chief Information Officer (CIO) ‘Square Table’ two years ago. Executives from the eMR, PAS and GP software vendors were seated on one side of the table, participating in a Q&A on how to collaborate and integrate to enable the PCeHR (Personally Controlled electronic Health Record) across Australia. It was a question from a CIO… ”Why can’t you vendors integrate with each other, so we don’t have to buy everything from one supplier and be locked in?”
This isn’t how other industries work, are hospitals dealing with massive in-house IT incompetence or some other factor? I think there are two reasons.
We know there is a poor record of complex, large system installs across the world, particularly in large hospitals. Too many moving pieces and too many affected users, resulting in unnecessary technical complexity.
Analysts have tried to quantify the number of failed IT projects, usually reporting statistics that discuss failures as a percentage of the overall number of IT projects. These failure statistics are primarily useful to the extent that they illustrate that IT failure is a common and serious problem. Roger Sessions CTO of ObjectWatch defined a model that quantifies the dollar cost of IT failure worldwide (1). Roger concluded that global IT failure costs the world economy a staggering $6.2 USD trillion per year, or $500 billion each month.
The second force at work is that hospital executives have been conditioned into thinking that the only solution to support clinical computing is the deployment of a single, large system. The fallacy was pointed out by Dr. Paul Chang in a lecture at Pathology Informatics Summit 2012 (see: The Internet as the New Industrial Revolution: Implications for Healthcare).
Bruce Friedman wrote :
We have hospitals today spending hundreds of millions of dollars installing EHRs running on local servers that are the rough equivalent of "mainframe computers" in a former era. Dr. Paul Chang commented in his lecture at PI-2012 that healthcare is the only industry in the U.S. that "solves" its computer problems by using a single, monolithic, inflexible EHR system rather than a set of specialized servers connected on a network. With this more advanced computer architecture, the user submits a query to the network and the response is assembled using information from the most appropriate, specialized systems.
The irony of these systems is that these companies provide the most widely accepted EHR solution for hospital executives and they then evolve into the hospital's worst nightmare. They sell a monolithic product that only the company can install in 'some' settings, though this isn't always transparent from the start. We all have stories of this situation, across the globe.
So, I will choose the Best of Breed and integrate it with what I need, nothing more. Also saving dollars.