Why is healthcare IT so bad?

Even after $19B infusion, conversion to digital records looks like a disaster

You know you're in trouble when all the success factors for your most recent IT project involve wetware instead of software and hardware.

In the healthcare industry the wetware the bits of wetware that make the decisions tend to be specialists in wetware, not in business or technology.

That can be good or bad, according to hospital CIOs I've interviewed.

On one hand docs are generally smart(ish) and those who have been practicing for the last five to ten years are generally pretty technical as well. A decade or two ago it wasn't unusual to see copiers, computers and other gear marked with a "No M.D.'s" sign because people used to poking at soft tissue often didn't do well with software.

Now there are plenty of doctors who specialize in both clinical systems used to treat patients and administrative systems used to run the hospitals.

The best known of them even has a sense of humor. John D. Halamka, CIO and many other things at Boston's Harvard Medical School-affiliated Beth Israel-Deaconness Medical Center blogs at geekdoctor.blogspot.com.

So with all those heavily degreed IT specialists running the IT and the hospital (no matter what it says on the organizational chart, the doctors always run the hospital), it shouldn't be that difficult to walk even a big healthcare organization through the conversion to electronic health records (EHR) that has to be completed by the federally mandated deadline of October, 2013, right?

So why are the first five success factors listed in a new report from CSC's Health Delivery Group all the kind of "soft" issues usually associated with IT projects with more political obstacles than technical ones, and shelfware or outright failure rates much higher than projects that are only technologically impossible?

Nope. HealthcareIT always seems just five to 10 years away from radically transforming healthcare, but the deadline moves ahead at the same speed as the calendar, according to one guy who's obviously spent a lot of time watching the healthcare industry chase itself in circles.

According to CSC's list of success factors, EHR projects need to have the right leadership, right culture, right governance, doctors, nurses and stakeholders engaged and accountable for the transformation?

Isn't all that pretty basic for a massive, company-wide conversion to which you're not only committed, but are required by law (and subsidized by $19 billion in 2009) to complete?

The rest of the success factors aren't that surprising -- every project needs enough money, accepted standards, matched timeline and expectations, training/communications and vendor partnerships.

It's just the first five (usually the most important, but I hope they were counting backward) that sound like the more remedial portions of "Baby's First Technology Project."

Healthcare IT projects are really complicated and they're starting much farther back than companies in other industries, most of which also got excited about computers sometime in the Disco era, but actually kept using and sometimes updating them right through the 80s and 90s.

Hospitals have traditionally been run as a collection of fiefdoms in which department heads made all the decisions about when to use computers and what kind -- which usually boiled down to "no" and "cheap ones."

No matter what anyone says about ObamaCare (double-check their facts; chances are they haven't), the IT requirements in the American Recovery and Reinvestment Act can only make the whole convoluted, inefficient process of delivering and paying for healthcare more efficient.

And no one's saying the healthcare industry has an easy nut to crack plugging paper-based, rigidly independently minded, often luddite-leaning doctors and large physician practices into a smoothly interoperable, secure network.

When one of the leading consulting companies helping the industry do that leads its success list with such lowered expectations and assumptions of obstruction and failure, it does nothing to make me feel more confident that healthcare is moving fast enough to hit its own deadlines.

That's not true of individual hospitals. Some are shining towers of tech. Some are moss-covered castles still rooted in the bronze age.

It's not just the castles that are the problem; it's a culture that allows luddites to overrule or seriously retard updates to process and technology that are well proven to make the process more efficient and improve patient care at the same time.

When the conversions and training to allow users to deal with them are rushed, however, as they are when a whole industry approaches a hard deadline, efficiency and patient care crash at the same time.

Two years isn't a lot of time for a big project. Those of us on the consumption side of the healthcare industry can only hope the parts of the industry that still need to work through their personnel issues to move to digital recordkeeping get the hell on with it.

Kevin Fogarty writes about enterprise IT for ITworld. Follow him on Twitter @KevinFogarty.

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