Over the last few weeks we have read media reports that New York City’s Health and Hospitals Corporation, with about $5 billion (USD) in revenues and with over 30,000 employees, covering 11 hospitals, is having problems implementing a new health information system.
I take zero pleasure in reporting this as I have been there on a more micro scale, and I expect to be there again. This “epic” issue is of note. Some of the facts, as I think I have them, are that this is a huge project. We know from the audit [page 10] that $22 million (USD) was expended directly in FY 2014. We know that the implementation was budgeted between $300 million and $764 million [as reported by NY Post].
The lead New York Post (NYP) story reported that:
Three top officials with the city’s Health and Hospitals Corp. have been forced out amid a probe of improper billing for a $764 million revamp of its records system. Chief Information Officer [name deleted] was forced to resign from his $296,000-a-year job in February while investigators were looking into allegations, including claims that his domestic partner received taxpayer-funded training on the new electronic medical record.
Work on the system began in early 2013, but its launch date at the first two of the 11 hospitals in the city network was pushed from November 2014 to April 2016, [NYP] sources said. The actual price tag for the project was set in internal documents as high as $1.4 billion, nearly double the stated cost, [NY Post] sources said.
The reports go on to say that there were as many as 14 project managers, but there was “no leadership.” There we reports of major changes and dismissal of both employees and consultants. Some reports say that the project is 18 months behind schedule and others say it is on schedule and will be completed by December of 2018.
Complex systems are called complex systems for a reason. It is not the first time that a hospital or a system began to break under the width and scope of an EHR implementation. We have seen systems ranging from $200 million to $1 billion abandoned or severely scaled back once implementation starts.
I think the biggest issue has been prompted by severe government controls and penalties imposed, and have required speedy implementation. This has caused a lot of change, a lot of cost overrun and a lot of delay. It is impossible, as history is now showing us, to take an industry that is $3.3 trillion (annual expenditures), and nearly 20% of the U.S.economy, and move it from antique analog technology to modern, interconnected digital technology in 10 years, while simultaneously taking care of over 300 million people. You can’t shut down a hospital and retrofit it. Think of how it would look to change the engine on an airplane while it was still in flight. Might be interesting but…you get the point. It must be done, it should be done, but it requires more time. The digitization of wellness is a very worthy mission.
– Noel J. Guillama, President