Clarification on VA Hospital System IT initiatives

In response to my postings on the Penn CPOE controversy such as here, where I included a reference to the Bay Pines VA Hospital IT system failure, a VA official involved in IT pointed out that this system, known as CoreFLS, was a financial IT system, not a CPOE or clinical IT system.

I should clarify that the VA’s VistA system and its EMR module (CPRS) are exceptionally well-regarded in the healthcare IT community and are actively promoted by the open-source community especially, and are distinct from the CoreFLS initiative.

I should also point out that my critiques are not of CPOE or EMR or clinical IT in general, but of the leadership model of healthcare IT.

(Note: I define clinical IT as IT utilized in actual clinical interactions between a provider and patient such as EMR, CPOE, decision support, enduser clinical data repository, concurrent-care knowledge management apps, etc. Healthcare IT is a broader domain that subsumes clinical IT but also includes Management Information Systems or MIS applications in hospitals, such as financial, registration, master patient index and other administrative systems. Others' precise definitions may vary.)

My opinion on healthcare IT leadership is summarized by a major point I raise in my web site on Healthcare IT failure :

"The belief that mastery of IT process and repetition for management information systems implementation entitles IT personnel to lead and control implementation and operationalization of essential tools in complex domains such as medicine (for example, electronic medical records systems) is presumptuous and creates an environment strongly misaligned with the business of healthcare delivery."

I consider an enterprise hospital financial system to be an essential tool for healthcare delivery. In my website on Healthcare IT Failure, I presented another example of a situation where mismanagment of a healthcare financial system by those without clinical knowledge led to dire consequences: "Insufficient IT management depth results in Justice Department investigation."

I included the CoreFLS failure in my critiques of healthcare IT leadership based partly on the fact that the failure of that financial system had a major impact on clinical operations at Bay Pines due to resulting inventory ordering problems (preventing surgery from being performed, for example), and partly on an article in The Tampa Tribune, "VA Faults Training At Bay Pines" (Richard Lardner, Mar 24, 2004) that states, among other factors:

… the VA inspector general released an interim report of an investigation into Bay Pines and CoreFLS. The report criticized weak hospital leadership, poor staff training and ``serious deficiencies'' in the sterile surgical supply process. Before joining the department, Campbell [VA assistant secretary for management] was chief financial officer for the Coast Guard, where he oversaw the implementation of a system similar to CoreFLS. ``It is a failure on my part, having done this [implemented a financial IT system] at another agency [Coast Guard]. I did not anticipate the complexity [of the system] and the difficulty of training,'' he said.

My point is that one might not anticipate the complexity of healthcare environments when one is not a healthcare professional. The admission of a project leader of a major IT initiative not understanding the complexity of a healthcare environment is an illustration of what I've been teaching in medical informatics for a number of years, that multidisciplinary training that includes a healthcare background helps a person better understand the complexities of healthcare.

Hence my view is that high-level leadership roles in healthcare IT initiatives (and especially clinical IT initiatives) should be very carefully defined with regards to experience and skill sets.

Organizations that ignore this do so at their peril, in my opinion, and sooner or later I predict provider-side and R&D sector (e.g., pharma) litigation that will be based on patient harm and/or financial losses that result from inadequacies in healthcare IT leadership.

-- SS

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