The VA and the military continue to have problems managing large IT projects and particularly those relating to EHRs (see, for example: Why the Military and the VA Healthcare Systems Are Not Amenable to Change; Epic Partners with IBM for Military EHR Proposal; This May Be a Problem; VA-Cerner EHR Deal Paused Over Interoperability Concerns). The U.S. Coast Guard turns out to be no exception to this rule based on a recent story about the travails of this branch with an attempted Epic EHR install (see: U.S. Coast Guard’s $67 Million EHR Fiasco). Below is an excerpt from the article:
In late January, the U.S. House of Representatives’ Subcommittee on Coast Guard and Maritime Transportation held a hearing to review the United States Coast Guard’s $14 million, five-year electronic health record (EHR) system project. The project, which began in September 2010, ballooned into a $67 million fiasco that the USCG [U.S. Coast Guard] finally ended in September 2015. But the Coast Guard didn’t officially confirm its termination until April 2016. At the time, the USCG public affairs office vaguely explained that there were concerns about whether the project could be completed in a reasonable time and at a reasonable cost....Finally, at the House subcommittee meeting, the reason for the agency’s uncommunicativeness became crystal clear: sheer embarrassment....[T]he project was originally envisioned and sold as an EHR modernization effort based on Epic’s EHR software that would begin deployment to the Coast Guard’s 41 clinics and 125 sick bays sometime in late 2011. It soon morphed into a “whole new Coast Guard Integrated Health Information System.”....Soon, 25 different vendors were working on the IHiS, at a total cost of $56 million, without active USCG management oversight. The GAO’s report...revealed a cringe-worthy litany of poor or non-existent system development, management, and governance practices over the duration of the IHiS project.... A memo from last May by Epic also details myriad operational blunders that explain why the project tanked....According to the GAO, the $67 million reported cost is probably a huge understatement of the actual cost. The Coast Guard, in computing its cost of failure, “did not include labor costs for the agency’s personnel (civilian or military) who spent approximately 5 years managing, overseeing, and providing subject matter expertise on the project.
There is a large literature about why large IT projects fail. A 2016 Forbes article summarized the major reasons for such failures (see: Are These The 7 Real Reasons Why Tech Projects Fail?). Here are the main reasons listed in this article:
- Poorly defined (or no defined) outcome.
- Lack of leadership.
- Lack of accountability.
- Insufficient communication.
- No plan or timeline.
- A lack of real-world user testing before launch.
- Solving the wrong problem.
It's useful to compare this list with the Coast Guard project problems enumerated in the excerpt above. The Coast Guard project seems to have failed primarily because of (1) scope creep; (2) incompetent project management with multiple vendors; and (3) leadership failure. Although the perhaps understated cost of the aborted EHR project was $67M, its important to keep in mind that it only encompassed clinics and "sick bays" without any hospital involvement.
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