How not to implement new IT systems in hospitals...
An entirely non-Covid post
A few years ago, I did a project in the US, interviewing staff across different hospitals which had all implemented the same intensive care IT system. I used the interviews to develop a simple cartoon guide on the common pitfalls of IT implementation within health care and how to avoid (some of) them.
In any sector, new IT systems are often hailed as a magic bullet which then turn out to be a dead duck. The issues highlighted in this guide apply more generally to any tech implementation in any sector. Below is a thread I wrote on it back in 2020 and a link to the full guide at the end. I’ve lightly edited it for readability. I think it is still, unfortunately, as relevant as ever!
NOTE: I’ve separated my substack into different sections - subscribers can choose to subscribe only to specific ones and unsubscribe from others. Current sections are: All about Covid; NHS by numbers (including NHS performance metrics); Misc posts; and Legacy Covid Twitter Threads.
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THREAD: many of us in healthcare have seen new IT systems hailed as gamechangers. Many don't live up to their promise. Often failure is at the final step of implementation - I interviewed people at 4 hospitals who all implemented the same IT system & developed these cartoons...
The hope is that they capture typical stories of what pitfalls happen in real life - and give tips for how to avoid them! The full cartoons (and a downloadable booklet) are available from NEJM Catalyst, but here are some excerpts. Quotes are from real people!
Getting to contract signing and purchase
"Because it involved IT, even tho the CMO had signed off & we had his blessing & the promised resources & the contract, then we had to go through what we call the IT gov committee. Which is not a quick process, so we had to formally present this…and that took another 6 mnths"
Key tips for avoiding these barriers!
Technical issues and practicalities
"Our [hospital] rooms are kind of small - they're small from the standpoint of where we could put the monitors - they're not in a good spot to be able to utilize them on rounds... I would say that that's part of the frustration - the location of some of the monitors is not the best place"
Involve intended users from the beginning!
"Often it's like "ta-da, we got this new thing" and it's like "oh that's [MD’s] toy…versus "okay, we're going to implement this, we're all going to own it, it's going to meaningful to everyone so what do you think about it?"
What’s the point of the system?
"I kept pressing for something I could give the nurses to say these are guidelines for using this…. [docs] didn't have a whole lot of input as to what they expected bedside nurses to use it for. And it's not that we want to ignore it ... but we also want to know how is it useful.."
The full booklet is available on my google drive, and includes more quotes, a brief explanation of how I developed it and a handy checklist. If you use it, please do acknowledge the source!
Many thanks for compiling the booklet which should be a must read before anyone embarks on an "IT" project for their healthcare department and the checklist should prompt any amount of head scratching. However I genuinely believe these shouldn't be IT projects.
IT is just another tool to help us do our stuff more efficiently and effectively and projects such as these should preferably be led by someone in the department which also has the benefit of conferring ownership. It helps avoid the usual cries of what "IT have done to us" (again).
The department might want to enlist a project manager from the IT department, after all it's what they do in managing change. Perhaps there's one thing which was touched on in the comments and could be added to your checklist which is "understand the project requirements and scope" (ok two things).
All projects suffer from some lack of understanding of these two vital aspects and thus expectations of what a project will deliver. Nailing these two and managing them ongoing will pay huge dividends in the end.
As someone who experienced a full EPR install that was touted as the bees-knees, the ludicrous amount of paper document record keeping we needed to keep tabs on the fudged work-arounds and massive holes we found, just for ultrasound work loads was outrageous.
I cannot imagine just how insane it must have been for other departments. The frayed tempers were palpable.