Update: The authors opinions on the JAMA CPOE article at the Hospital of the University of Pennsylvania in Philadelphia made it into Health-IT World: The article is here (second story down). Editor’s note: Dr. Silverstein is responding to a research article in the Journal of the American Medical Association JAMA which concluded that a Computerized Patient Order Entry (CPOE) system called TDS, now obsolete, made some medication prescribing errors more frequent. A reasonable assessment of the recent CPOE controversy was made by Don Detmer, MD, the President and CEO of the American Medical Informatics Association. He writes that healthcare IT is of great value, is moving forward, and that those in clinical IT need to rigorously assess issues and problems and correct them iteratively, as in any evolving field. He is confident that AMIA and its researchers, clinicians, and educators are committed to these objectives and will continue to raise the performance bar for clinical IT. I heartily agree. However, other topics such as IT project leadership need to be addressed as well. I’ve put my commentary on this topic here.

As reported in Houston, We Have A Problem Part I in December 2002 about the Harris County Hospital District blowing $75 million on a Health IT ‘upgrade’ that was behind schedule and error-prone. Now the head of HCHD is resigning in part because of it: ‘…His resignation comes amid increasing tension between the CEO and the board the last several months, much of it surrounding questions over the district’s purchasing and information technology efforts… When will medicine come to its senses about proprietary Health IT software?

The latest in the decades old and continuing saga of multi-million dollar Health IT bombs: ‘Scottish health bosses have pulled the plug on the launch of a �30 million computer system from McKessonHBOC after staff at the Edinburgh Royal Infirmary complained that they couldn�t access vital information on it…’ Read the rest of the article here. Thanks to A. Midgley for this link.

Glenn Kuczer is actively soliciting open source solutions after having enough difficulties with Medical Manager to begin a website called “www.medicalmanagersucks.com”: ‘…Thinking about buying anything from Medical Manager a WebMD company? Think Twice! Can you say Class action? webmd is a hastily assembled juggernaut which emerged from 1990s dot-com venture capital cash. it grew by acquisition of very different business units, which remain poorly integrated today. The division I deal with is medical manager. this is a proprietary software vendor with high staff turnover and a poor record on timely project delivery. their software runs on all the systems that i manage. we are currently looking for a appointment and billing system because the product and the company are both flaky and we’re looking at open source software as a solution to both problems. Any Practice that would like to discuss the problems with Medical Manager and their software System feel free to email me, I am the Information Systems Administrator for a large medical facility. The intention of this website is to gather information from other medical practices that also use the Medical Manager software systems. There will be articles that pertain to specific situations that will be discussed, so Thank you for visiting this buyer beware information on Medical Manager. ***All those who wish to shutdown this site need only to read the first amendment in the US Constitution…’

Updated 12/2/03: link now works. Announcing a new blog on Healthcare IT management and leadership issues called the Clinical IT Mismanagement Survival Guide. This blog is a successor to my old website “Medical Informatics and Leadership of Healthcare Computing.” Contributions of material are welcome.

The British Medical Journal has an article about an all-too-common medical software failure: ‘…A major new information and communication technology initiative in South Africa5 gave us the opportunity to evaluate the introduction of computerisation into a new environment. We describe how the project and its evaluation were set up and examine where the project went wrong. The lessons learnt are applicable to the installation of all hospital information systems…’ Again, thanks to Adrian Midgley for this link.

From: “Deb”
To: “Ignacio Valdes”
Subject: Re: cyberren software
Date: Thursday, January 16, 2003 3:37 AM

Dear IV,

First of all I’m a nurse, and pretty much computer illiterate. What I’m trying to do is find some answers to why some of my documentation is missing especially medications. We have a real problem at work with sharing passwords, screens left open etc… I am also wondering if some of my documentation might have been deleted intentionally, or unintentionally. Tell me a little bit about why close source, vendor lock in, non-standard interface, and Windows 95 is bad. Cybernius said that they could find no record on the Cyberren program of the specific deletions, however I didn’t expect them to come right out and tell me any problems they have had with their software. Another concern I have is potential loss of information, this program crashes weekly, and becomes very slow to respond freezing screens for 10-20 mins a time

Deb

The Mercury News has this story about MedUnite: ‘…An attempt by seven big health insurers to take control of electronic services that link them with patients and doctors has run into financial trouble, industry officials said, and most of the companies have written off all or most of their investment. Insurance companies expect to reap enormous savings if they can persuade hundreds of thousands of doctors to use computers and the Internet instead of telephones and paper to submit claims…’ Which also begs the question how is Healtheon/WebMD doing?

The British Medical Journal has a piece about how the National Health Service: ‘…has completely missed last month�s target to introduce electronic patient records across a third of acute hospitals�much as the medical profession had predicted. Department of Health officials admitted this month that only 3% of acute hospitals had introduced level 3 electronic patient records by 31 March, compared with the target of 35% set in its 1998 information technology (IT) strategy, Information for Health…”GPs have always been more computerised than secondary care. The fact that we can�t exchange results is a continuing source of frustration for us,” said Dr Cundy. “They�ve spent millions of pounds on new systems, which�by the time they are delivered�are obsolete and don�t work.” ‘