IT And The Government 101 - National Health Care and IT

I am not averse to national health care – I am averse to poor planning, minimal oversight, and wasted expenditures for a system which will so greatly impact all Americans (and non-Americans we are told). I would also like to be told where nationalized health care has ever worked before.
Experience has shown me quite clearly that non-trivial computer systems cannot be installed and be expected to work properly without proper planning and testing.

When Clinton was governor in Arkansas I was working on a statewide performance appraisal system. We needed to computerize the results, but the state was switching over to an IBM mainframe computer at that time. They prepared the IBM and completely disconnected the previous computer. And it was several weeks before the state’s employees were able to receive their paychecks!

Now, Let us jump to 2009. Earlier this year I was speaking to a college president in the Georgia system of colleges and universities. Initially all colleges in the University of Georgia System ran largely by themselves, except for small software programs (i.e., elearning software, etc.). Then the Chancellor of the system decided to standardize on Banner, an Oracle-based software package which would handle virtually all of the data needs of a college or university.

The shortcoming to this decision lay in the complexity of Banner. A printout of the data dictionary (a roadmap, if you will, of the data configuration within the large program) is 18 inches high! The learning curve was not a short one, and because the Chancellor required all the colleges to install it immediately, the same mistakes were repeated – probably in every college.

Instead of installing it at one college and documenting problems faithfully, all colleges dove in separately. One of Banner’s strengths touted by the vendor is the ease a non technical user has in producing required reports. In a discussion with the president of one Georgia college I was told, “I received several reports for a meeting, and the same report from two different sources had different figures!” One report writer used was Crystal Reports, a well known third party report writer which works with the Oracle data base. The other report came from a Banner report writer.

You see the problem.

The last example I want to tell you about I call An “Excellent” Failure. A Fortune 500 company for whom I had consulted hired an IT firm to write a new software program for the accounting department.

I had an opportunity to see the software before delivery – and it was really Neat! In addition it was written brilliantly, if I may say so, from a programmer’s standpoint. Clients could be accessed with a minimal number of keystrokes – meaning fewer misspellings and greater possible worker productivity. The software was delivered and a quiet revolution among the workers grew to the point that they refused to use it. Management could not understand why.

I prefer to use one of my favorite sayings, “You can do a professionally competent, even a brilliant job, and you can still fail.”

The major reason for success in any project is the result of meeting the expectations of the project stakeholders – management, the end-users, the consultants, etc. In this case it is easy to see something was missing for the end-users. I asked some questions of the end-users and received several common responses:
“There was nothing wrong with the old program.”
“No one bothered to ask me what I thought.”
“This program was rammed down our throats.”
“Management does not care about the workers.”
“The old program was easier to use, and there was nothing wrong with it.”
“Who is responsible for this garbage?” (referring to the new software)
And so on.

So, Figure the odds that the proposed Health System software will be even be close to useful?
I recently spoke to a doctor whose practice was spread across several counties and three offices. “I spent more than $100K for a paperless system, and it costs me half that each year to keep it running. Now the federal government says I have to trash the system and do it their way when their system comes online. I will sell out and retire before I let the government tell me how to run my business!”

Apparently the government will not assess the impact on professionals and patients. I believe this to be so – their track record on national projects is shoddy at best. The odds that the proposed computerized system will work sufficiently is slim – according to the administration implementation will be as soon as possible – the computer system will not be that flexible – Buyer Beware!
Dr LGG