Less than two weeks after the implementation of a Cerner electronic health record system at Athens (Ga.) Regional Medical Center, physicians began expressing patient safety concerns. According to a May 15 letter from medical staff leaders, the EHR had led to "medication errors ... orders being lost or overlooked ... (emergency department) patients leaving after long waits; and of an inpatient who wasn't seen by a physician for (five) days."
In the wake of the embattled rollout, both the health system's CEO and CIO have resigned. Although their resignations have not been officially linked to the physicians' complaints about the EHR in any publicly released material, the timing of the resignation (and a vote of no confidence the hospitals' medical staff issued against CEO James Thaw at a May 22 board meeting) strongly suggests both Mr. Thaw and CIO Gretchen Tegetoff took the fall for the failings the medical staff saw in the new EHR.
Their resignations beg the question — who is ultimately responsible for any IT project failures? Below, two IT leaders reflect on this question, and decide the responsibility extends beyond the CEO and CIO.
Heather May, RN. Director of Clinical Informatics at Yavapai Regional Medical Center (Prescott, Ariz.).
I believe IT failures are the responsibility of the entire organization. Yes, the CIO is ultimately driving the project, however, in today's changing healthcare landscape, organizational change and organizational acceptance needs to accompany technology change. It simply cannot be blamed on IT alone.
The IT solutions that are available are good, maybe not great, but they can lead to transformation. However, the organization must be willing to accept the changes, determine how to deal with the change and stay strong in the face of adversity. Technology in healthcare isn't easy, but neither is patient care.
Spencer Hamons, CHCIO. CIO and COO of Taos (N.M.) Health System.
In most cases, errors don't just occur by themselves, but are allowed to happen by a failure to anticipate the potential errors and engineer strategies to overcome those errors… When it comes to EHR implementations, this ability to analyze and predict potential errors is both an art and a science that extends to every aspect of the organization.
The failure [to analyze and predict potential errors] is a compilation of failures of the entire executive team. A technology as all-encompassing as an EHR spans every facet of the organization, and therefore the system impacts areas of responsibility overseen by all members of senior leadership.
While certain members of the team may want to place the blame on one or two members of the organization, the failure is based in a culmination of weak skills across the entire executive team: The CIO for not having the strength and straightforwardness to make the senior leadership team aware of the scope of the project. The CMO for not taking enough responsibility during implementation, the COO for failing to recognize the responsibilities necessary for the variety of nursing and ancillary involvement required, and the CEO for failing to bring the entire team together for a true multidisciplinary approach to the implementation.
For the better part of a decade, my personal approach to an EHR installation is that these are not "IT projects," but rather "clinical projects with an excessive amount of IT resources." The moment the EHR installation is viewed as an "IT project," the project is destined to fail because those most responsible for the overall success are insulated from the repercussions of poor planning and processes.
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