Generically, IT implementations across verticals have a failure rate of 35%. This article explores a few amongst a plethora of reasons as to why health IT projects have a high failure rate and is an attempt to learn as to how to mitigate them.
At the outset, it is important to define what constitutes a project failure. Project failure primarily involves missing project deadlines which in turn results in cost overruns and results in under delivery of value. Do note that when projects are sanctioned some of them do subject to calculations of Net Present Value based on the Discounted Cash Flow and IRR (Internal Rate of Return) and so time is of the essence in defining project success.
With regards to EMR Software Implementations, US data reveals that 73% fail and only 27% of the healthcare providers use the EMR as was intended. This is in spite of the meaningful usage standards being out in the open and the penalties in place for not achieving stage 1 of meaningful usage by 2015.
Before listing top reasons each of them can be categorized into a group as a risk dimension such as Project, Technological, Human, Usability, Strategic, Organizational/Environmental etc.
1) The Big Bang Approach – Going for the Full Monty! (Risk Dimension – Project)
This is a sure shot success to failure made famous by the big ERP vendors whether it be the Supply Chain, Finance or CRM implementations. Shocking the entire organizational structure to align itself to the new system is like training the elephant to move with the efficiency and swiftness of a deer. In fact studies in the US reveal that most of the 73% of EMR projects which failed had undertaken the big bang approach.
The solution would be to chew bit size portions one at a time – called the Incremental Approach. The incremental approach has a 95% success rate in EMR implementations and the idea is to identify areas for change and taking assured progress onward. The partnership approach with the vendor also works in being a win-win situation. Learning as you move ahead brings about agility in the process.
2) Lack of a Project Champion (Risk Dimension – Project)
Many healthcare providers feel that they aren’t competent enough to handle a technological project and so ask the vendor to take complete control. This leads to a lack of buy-in from the internal stakeholders and can lead to a greater resistance to change. So having a steering committee along-with 1 named leader for the project is important. What could be recommended is to additionally identify departmental or role level project champions. Champions in each small group can help improve the turn-around times during user level training.
3) Lack of commitment – Top-Down or Bottom-Up. (Risk Dimension – Organizational)
Top-Down commitment is absolutely critical for organizational acceptance of a system wide change but the bottom-up involvement during the selection of the vendor is also vital. A mix of both top down decision making and bottom up acceptance makes a revolutionary change during change management. Do keep in mind that grudging acceptance can lead to non-acceptance especially amongst the clinician group. So it is important to highlight the value add within the change process and some providers do creatively incentivize employees during this period.
4) Project Ambiguity (Risk Dimension – Project)
It is of absolute importance for all stakeholders within the project to understand the need for undertaking the project and the key timeline bound goals and objectives to achieve. The scope of the project needs clear definition at the outset both at a high level and at a low level. The high level may involve the steering committee members and at the low level the end users at a departmental/role level.
5) Poor Vendor Selection (Risk Dimension – Organizational)
Vendor Selection of prime importance and awarding contracts hastily can lead to irreparable damage in the future. Careful deliberation needs to be undertaken to ensure that the system is aligned to local practices and processes or it could lead to poor perceived system usefulness.
Other technological risks are incompatible hardware or software, poor software performance, complex/unreliable technical infrastructure in the network.
On brain storming with experienced project managers several more points can be identified such as – Changes to the membership in the project team, insufficient resources, organizational stability, lack of required knowledge/skills, large and complex project, introduction of new technology, political games and conflict etc.
But the bottom-line is that it is important to understand that EMR implementations are not just a technical change but also an organization wide cultural change which modifies processes and workflows affecting even individual work habits. In fact a Delphi study conducted by HEC Montreal, Pole Sante revealed that the Technological risk dimensions are ranked much below Project, Organizational/Environmental, Strategic and Human risks.