December 31, 2010, 10:05 AM — When businesses started deploying large ERP and CRM systems in the 1990s, it didn't take long to learn that deriving a significant return on investment would take far longer than vendors promised and customers hoped. Indeed, many early deployments were failures.
Now there's a push to digitize health care records and automate data collection and billing by doctors and other medical personnel. It's early days, but there are indications that these deployments will also be far more difficult than vendors -- not to mention some politicians -- would have us believe.
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Like ERP, the deployment of electronic health records and systems depends on more than the software itself. Good applications may perform poorly if not carefully customized and integrated.
Consider the well-publicized debacle suffered by San Francisco when it deployed an electronic medical records system called Avatar, designed to streamline billing for state-supported behavioral health programs. As recounted by the New York Times, "providers struggled to use the new software, causing health officials to lose track of millions of dollars of services." Although some officials thought they had gotten through the worst of a shakedown period, others simply saw Avatar as a failure. In any case, the deployment has been extremely difficult and expensive.
However, as the Times story missed, Avatar has also been deployed in Monterey County, a few hours south of San Francisco, and the project "came in on time and under budget," says Amie Miller, supervisor of quality improvement for the county's Department of Behavioral Services. She says that the county IT department, the software vendor, and the clinicians worked closely to customize the program before it went live.
Miller, herself a therapist who worked directly with the IT department, said a key step in the deployment was a careful audit of functions needed by clinicians, followed by intensive training of users. It appears that San Francisco opted for a top-down approach with little input from users.