DMC tried CPOE in 2003 and said it would regroup and try it again. What lessons were learned from that first attempt?
In 2003 we did try at one hospital — a more community-based hospital — on two units. We did it on our rehab unit, the psych unit. I think the first lesson we learned there was that it was really just designed as, or worked out as, an IT project. I mean, it was really IT-led and there wasn’t clinical involvement from the get-go.
There wasn’t really a leadership pattern that had physician and nursing components to it. There wasn’t a design phase that included a lot of clinicians. There wasn’t leadership buy-in from the hospital. We took the product from the vendor and implemented what they gave us. It was really doomed to fail from the start. [Doomed, that is, due to inexcusable ignorance for the year 2003 - ed.]
This is striking for a number of reasons, least of which is the tone in which the failure is presented, a tone that suggests this failure and its 'lessons' were banal in character and something that 'just happens.' It's as if by 2003 there was no other way to have done due diligence and learned these lessons, other than by actual experimentation on hospital floors with live patients and busy clinicians.
If this story had appeared about a health IT project in, say, 1983 or 1993, it would have been less remarkable. By 2003, however, the literature on how do do health IT 'right' (and on how not to do it, including all the faults mentioned about DMC's efforts), was quite voluminous.
The medical informatics literature from AMIA and IMIA, textbooks such as Lorenzi and Riley's 'Organizational Aspects of Health Informatics: Managing Technological Change' (ed. 1 - 1995), sites such as my own on HIT failures (freely available and one of the first hits one received via google on searches on 'Healthcare IT difficulties' and similar concepts even then), and other resources could have prevented the CPOE failure - if someone at DMC or their consultants had had the meta-knowledge to know of their existence or the managerial savvy to ask, and the initiative to actually read the materials and heed the advice of experts.
Instead, this sounds like a classic example of hospital mismanagement, via not knowing what you don't know, and not caring.
What is described is a failure that characteristic of HIT naivete and HIT incompetence that should not have existed in hospitals in an American city in 2003.
The story is also remarkable in terms of risk presented by this experiment on live patients. It is well known that poorly done CPOE is associated with medication errors, not a happy event on a psychiatry unit or PM&R/rehab unit (where elderly frail patients often abound).
The story is also remarkable due to the waste of money it represents in a city not exactly rolling in money, looking somewhat like Dresden after the WW2 firebombing and with wide sections of former residential land designated for demolition and 'return to nature.'
Instead of spending money on 'let's try to figure out CPOE today, all by ourselves!' health IT experiments, perhaps the money could have been used for better care of Detroit's poor.
The 'lessons learned' in 2003 could and should have been learned for free and without risk to patients - in a public library.
I ask:
- Did patients get injured in this debacle? If they did, are the records sealed? We may never know.
- Has DMC truly learned the lessons of 2003 fully, or do similar problems continue?
- Were the executives responsible for this failure held accountable in any meaningful fashion?
Finally - and this is my major point - how many organizations in 2010 and beyond are similarly stuck in the stone age regarding how to 'do health IT well'?
I believe the answer is 'far too many.'
