HIMSS: Health IT community needs to share failure stories

LAS VEGAS—Almost 70 percent of health IT projects fail. As a result, Jonathan A. Leviss, MD, vice president of physician solutions at Dearborn Advisors and Larry Ozeran, MD, president of Clinical Informatics, urged their colleagues to share IT failure stories for their educational value and to shed the stigma during a Feb. 22 presentation at the annual Healthcare Information and Management Systems Society (HIMSS) conference. 

“While we all make mistakes, failures in the health IT space still have stigma attached, and they rarely get openly discussed because they are emotionally charged issues,” said Ozeran. "This is exactly the reason why we need to open the discussion up further.”

He described several kinds of errors, including process errors, design errors, stakeholder errors and implementation errors—the latter of which increases the chance for a stakeholder error. “If some process has been successful on numerous occasions, then the error can likely be directed at the user or implementation,” Ozeran said. 

In order to avoid errors or have a quick recovery after failure, the presenters recommended pursuing objectives with clear goals and guidelines to minimize loss, avoid using knowledge that is not tried and true and use standard processes to monitor closely and identify failure early to recover at a low cost. “You have to clock failure based on the value of what could be lost,” Ozeran said. “The value is dependent on how novel it is.”

For health IT leaders, he suggested providers foster a culture wherein people are encouraged to come forward with concerns about potential failures. “If you shoot the messenger, they’ll stop giving you messages. If you stop getting messages, you won’t know what’s going on until it’s too late,” Ozeran said. 

These experiences can serve not only to teach people within an organization, but also teach vendors and medical professionals outside the organization, explained Leviss.

One example of a real-life failure that was presented related to ambulatory EHR downtime after the EHR becomes a critical resource. In this case, when the EHR went down, providers were told to continue seeing patients, while the administration said they “were working on the issue.” This situation resulted in everyone, including patients, becoming angry.

Prior to such a disaster, Leviss said that providers need to question: How do you manage downtime? And how do you prepare for downtime? Is prevention a sufficient strategy?

Ozeran suggested a few options for assessing failure management:

• Prevention: What steps might have been taken to anticipate and prevent the problem and at what cost (people, time and money)?
• Early intervention: Were there points where earlier identification would have minimized cost or shortened the time to resolution? How should those points have been identified and who should have the authority to implement the solution?
• Post-failure remediation: What now?

Part of the reason to share these examples of failure is to learn from each other’s mistakes, concluded Ozeran and Leviss, but also to shed the culture of silence with regards to health IT mistakes.