Failed Medical Information System

 

 

 

 

 

 

 

 

 

 

 

Kun Yuan

kun_yuan@msn.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Department of Computer

and Information Science

Brooklyn College,

City University of New York

 

 

Outline

 

 

Ø    Introduction

 

Ø    The causes and solutions of the failed medical information system

 

Ø    Case study

 

Ø    Conclusion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction

 

·        The area of medical information systems have long been explored and studied since 1960’s in almost all aspects of medical care. From integrated, continuing patient medical record to software-aided medical devices, from computerized medical imaging and pattern recognition to automated medical diagnosis, etc.

 

·        Medicine’s dirty software secret is that it has wasted untold millions on failed software projects.

 

·        Some health care information systems (HCIS) do succeed, but the majority are likely to fail in some way.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Three major reasons leading to Medical System Failure

 

1.    Software related failure in medical device activated by software faults

 

2.    Failure caused by the large design ---- reality gaps

 

 

3.    Caused by one of the human natures ---- Pride

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.   Software related failure in medical device activated by software faults

 

a.     The associated failures caused no death or injury and recalled by their manufacturers from 1983 to 1997

 

b.      Failure Analysis

 

 

                      

    

 

 

 

 

 

 

 

 

 

 

 

c.     Prevention and detection of faults

Include inspection as both a prevention and detection technique and use a variety of other techniques to detect the problems and prevent them from happening again.

 

·        No Verification against original design specification

 

         Prevention

        Detection

Traceability analysis. Change impact analysis

Inspection of proposed changes. Regression test

 

 

·        Use of wrong master program for the software revision

   

        Prevention

         Detection

     Use of CM tools

Verification of appropriate master program. CM manager inspects the versions

d.     lessons learned

 

d. Lessons learned

 

·      Development & maintenance

 

Complete specification of requirements, Traceability of the development artifacts, software config. Management,etc.

 

·      Assurance Practices

 

     Formal inspection meetings, Mental execution of potentially troublesome locations (e.g.,an algorithm, a loop, an interface), use of simulation in complex situations,etc.

 

·      Testing

 

Stress testing, regression testing, integration test, system test, etc.

 

 

 

 

 

2. Failure caused by large design --- reality gaps

 

“The critical issues in the implementation of these (HCIS) systems are social and organizational, not solely technical”(Anderson 1997:89)

 

1)  Dimensions of the Conception --- Reality Gap (design conceptions vs. contextual realities)

 

‘ ITPOSMO’ model to study conception --- reality gaps

·                         Information

·                        Technology

·                        Process

·                        Objectives and values

·                        Staffing and skills

·                        Management and structures

·                        Other resourses: money and time

 

    

     

 

 

2)            Archetypes of Health Care Information System Failure

 

·      Rationality --- reality gaps

“Hard rational model” vs. “Soft behavioral model”

ü  Technical rationality

ü  Managerial rationality

ü  Medical rationality

 

·      Private --- public sector gaps

 

·      Country gaps

 

 

 

 

 

 

 

3)        Lessons learned

 

·      Assess the mismatch along the seven main dimensions (ITPOSMO model)

 

·      Use gap closure techniques for greater HCIS success

 

Ø   Legitimizing and mapping organizational reality

 

Ø  Reality-supporting not rationality-imposing applications

 

Ø   Customization to match realities

 

 

 

 

3. Caused by one of the human natures ---- Pride

(Case Study)

 

Wessex Regional Health Authority tried to computerize hundreds of hospitals at a time when other health authorities were struggling to computerize a single outpatient department       --- £ 43 – 63 million failure

 

Here pride refers to a belief among some computer managers that they should know it all – and cannot easily admit when they don’t

 

 

Nobody questioned the technology visionaries because the uninitiated felt unqualified to challenge those who were assumed to know what they were doing

 

So when something goes wrong, it was hidden to the public or even to the inside till long after the failure was exposed

 

 

 

Conclusion

 

·      Technically, use of many generally accepted quality practices, rather than use of a “silver bullet” is significant towards reduction of system failures

 

·      Use effective techniques to reduce conception-reality gap and other gaps

 

·      Computers rely for their functioning on reason, but computer projects defy logic because of human caprice

 

·      A successful HCIS will be one that tends to match its environment in relation to technical, social and organizational factors

 

 

 

 

 

 

 

 

References:

 

1.        Collins T., Bicknell D. (1998) Crash – learning from the world’s worst computer disasters, Simon & Schuster UK Ltd, 55-97.

 

2.        Anderson, J.G. (1997) ‘Clearing the way for physician’ use of clinical information system’,

Communications of the ACM, 40, 8: 83-90.

 

3. Heeks R., Mundy D., Salazar A. (1999) ‘Why Health Care Information Systems Succeed or fail’ in Information Systems for Public Sector management-Working Paper Series (Paper No. 9), Institute for Development Policy and management: University of Manchester, UK.

 http://www.man.ac.uk/idpm/idpm_dp.htm#isps_wp

 

4.   Dolores R. Wallace, D.Richard Kuhn, Lessons from 342 Medical Device failures, information technology laboratory, National Institue of Standards and Technology, Gaithersburge, MD USA.

       hissa.nist.gov/effProject/handbook

 

 

 

 

 

 

   

 

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