Disastrously conceived, managed, and applied U.S. Coast Guard EHR leaves our Coast Guard heroes safer … after reversion to paper information



Generally, the everyday EHR mismanagement debacles that I’ve been writing about since a minimum of 1999 depart sufferers safer.  That is one such instance.

I be aware that the contents of this weblog, in addition to my still-extant Drexel web site “Modern Points in Medical Informatics: Good Well being IT, Unhealthy Well being IT, and Frequent Examples of Healthcare IT Difficulties” (http://cci.drexel.edu/school/ssilverstein/instances/) and plenty of different assets about healthcare IT mismanagement and failure, can be found freed from price.  They might have saved the Coast Guard many hundreds of thousands of if their contents had been reviewed and brought severely.

(I take no pleasure in making these observations.)

As a consequence of simply the newest instance of gross well being IT mismanagement, a compelled reversion again to paper will probably be far safer than this catastrophically unhealthy well being IT would have been, had it been turned on:

After failure of EHR program, Coast Guard wants to seek out new answer ASAP, watchdog says
Zaid Shorbajee

Fedscoop Information
January 31, 2018
https://www.fedscoop.com/failure-ehr-program-coast-guard-needs-find-new-solution-asap-watchdog-says/

The U.S. Coast Guard should urgently discover and implement a brand new digital well being information system, the Authorities Accountability Workplace says in a report, after a previous challenge that took half a decade failed and left the group utilizing a paper course of.

The Coast Guard started working with Wisconsin-based Epic Methods in 2010 to implement a brand new EHR system, dubbed Built-in Well being Info System (IHiS). Over the next 5 years, the challenge confronted a number of setbacks and delays, in response to the GAO. IHiS was in the end scrapped in 2015, with almost $60 million spent as of August 2017 and a few funds nonetheless to be made.

The Coast Guard got here away with no software program or gear from the challenge for use for the long run. To make issues worse, within the two years since IHiS’s cancellation, the Coast Guard needed to additionally decommission its two legacy EHR methods as a result of they didn’t adjust to worldwide requirements.

Put extra merely, $60 million and counting went down just like the Titanic in a five-year challenge.  Why?

The GAO report says the challenge failed due to “monetary, technical, schedule, and personnel dangers.” At a Home Transportation and Infrastructure Committee listening to on Tuesday, Coast Guard representatives admitted fault.
“What started as a challenge to develop a easy digital well being file elevated in scope and expanded right into a a lot bigger idea which added work life and security companies,” stated Rear Adm. Erica Schwartz, the Coast Guard’s director of well being, security and work-life. “This challenge lacked applicable oversight and governance and resulted in a challenge that had important mission creep, premature delays and elevated price.”

First, I’m impressed that Coast Guard representatives took some accountability. 

Nonetheless, well being IT initiatives with poor oversight, governance, monetary, technical and different defects have been the fixed subject of my writings, and that of some others in Medical Informatics, courting again 20 years.  It appears the teachings realized from previous failures comparable to at http://cci.drexel.edu/school/ssilverstein/instances/?loc=instances and at this weblog by way of question hyperlink http://hcrenewal.blogspot.com/search/label/Healthcare%20IT%20failure could also be past the comprehension of what could be known as “the standard IT suspects.”

With no system to fall again on, the Coast Guard has been working with a largely paper-based course of to handle well being information for about 50,000 service members.

I discover that, actually, comforting.  The Coast Guard service members are safer in comparison with what would have transpired if this Frankenstein system (as with the fictional Golem by that title) had really turn out to be “stay.”

The report doesn’t establish the names of any of the distributors. Epic Methods didn’t reply to request for remark, however the firm’s web site says it fulfilled the phrases of the settlement and that its software program was able to stay when IHiS was cancelled.

The Coast Guard didn’t reply to request for touch upon whether or not the software program was certainly prepared.

I imagine the distributors to be the standard Beltway Bandit suspects, and I’m not sanguine about EPIC’s experiences.  That is simply my private opinion, after all.  Nonetheless, simply previous to embarking on this put up I’ve begun to evaluate an EPIC chart of a deceased affected person, and discover a pile of legible gibberish that, had I documented that method as a medical scholar, would have earned me the “Professor Kingsfield” therapy relating to a U.S. ten-cent piece and a telephone name to my mom (https://www.youtube.com/watch?v=_wOUMd3bMRI).

Testifying on the identical listening to, David Powner, who directs IT administration points on the GAO, listed a number of indicators of IHiS’s poor administration. Among the many issues that slowed it down had been questions on whether or not the Coast Guard was utilizing applicable funding sources, restricted safety features within the system, failure of the Coast Guard to correctly observe its personal acquisition course of, and the non-involvement of executives who ought to have been concerned.

The GAO report notes whereas the Coast Guard created a number of governance boards to supervise the planning of IHiS, the Chief Info Officer was not included on any of them.

That omission is, in a phrase, an excessive instance of IT mismanagement.

“You can have the perfect challenge administration on these expertise initiatives, however if you happen to don’t have executives which are accountable and respiratory down the neck of challenge managers – that’s what makes this stuff work,” Powner stated on the listening to.

He additionally expressed concern concerning the paper course of at present in place, calling it “inefficient and harmful.”

It’s a disgrace that the IT world appears to lack altruism, teamwork, cooperation, and so forth. and as a substitute must be brow-beaten into producing affordable merchandise.   (In what subject is altruism, cooperation, shared accountability and teamwork comparatively frequent?  Reply – medication.)

So far as paper being “inefficient and harmful”, I ask: in comparison with what?  Unhealthy well being IT?  See my Jan. 31, 2018 essay “The inevitable downgrading of burdensome, damaging EHRs again to paper & doc imaging” at http://hcrenewal.blogspot.com/2018/01/the-inevitable-downgrading-of.html for extra on that situation.

In truth, I hope the Coast Guard is utilizing a environment friendly doc imaging administration system at current with their paper.  If not, that’s one more blunder.

The GAO report says that the Coast Guard didn’t formally establish any classes realized from the failed IHiS challenge.

Maybe as a result of bureaucracies and their IT personnel are unteachable?  That’s maybe not a wholly unreasonable conclusion after all of the writing I’ve executed or learn since my entry into Medical Informatics at Yale College of Drugs in 1992.

Lastly, if the Coast Guard wants a brand new chief for this initiative, I provide my companies. 

I might demand, nonetheless, unfettered rent/hearth authority, in addition to a Sherman tank as my workplace, comparable to my father (decrease proper) used to move round Europe in WW2.

My father, decrease proper, someplace in Europe ca. 1944-5.

— SS



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