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Lessons Learned Lessons Learned from Two IT from Two IT Failures Failures Farrokh Alemi Ph.D. Farrokh Alemi Ph.D. Lee Baliton Lee Baliton

Lessons Learned from Two IT Failures Farrokh Alemi Ph.D. Lee Baliton

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Lessons Learned from Lessons Learned from Two IT FailuresTwo IT Failures

Lessons Learned from Lessons Learned from Two IT FailuresTwo IT Failures

Farrokh Alemi Ph.D.Farrokh Alemi Ph.D.Lee BalitonLee Baliton

Case Study• Interpractice Inc.

($15 million and 7 years wasted)– Web-based services to patients of an

HMO• Telepractice Inc.

($6 million & 3 years wasted)– Computer services via telephone to

patients of an HMO

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Description of the Online Services

• Health education• Email contact with clinicians• Online counseling• Pre-visit testing• Support groups• Personalized medicine

Technology is Seductive

• A fix: efficient production

Technology is Seductive

• A fix: efficient production• Changes what we do, re-defines us

Technology is Seductive

• A fix: efficient production• Changes what we do

– InterPractice Inc– TelePractice Inc.

Randomized Clinical Studies

• Improve patient outcomes• Reduce cost of care

– 28% total health care cost savings– 33% lower cost for AIDS care

Randomized Clinical Studies

• Improve patient outcomes• Reduce cost of care• Failed as a business

Business Process Change Needed

• New technology is not enough• Process change is needed

You cannot take a car for a walk

What do we mean What do we mean by new business by new business

processes?processes?

What do we mean What do we mean by new business by new business

processes?processes?

Case of an Online Patient Case of an Online Patient Service CompanyService Company

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Focus on economies of scale not Focus on economies of scale not scopescope

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Small is BeautifulSmall is Beautiful

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Conflicting DemandsConflicting Demands

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Examples: Salic Clinic; CABG Examples: Salic Clinic; CABG operationsoperations

Organization's Organization's policies on scope policies on scope of services must of services must

change change

Organization's Organization's policies on scope policies on scope of services must of services must

change change

FocusFocus

Recruitment and Recruitment and training policies training policies

must change must change

Recruitment and Recruitment and training policies training policies

must change must change

Recruitment and Recruitment and training policies training policies

must change must change

Recruitment and Recruitment and training policies training policies

must change must change

Physicians resist remote Physicians resist remote managementmanagement

Recruitment and Recruitment and training policies training policies

must change must change

Recruitment and Recruitment and training policies training policies

must change must change

Initiating ContactInitiating Contact

Recruitment and Recruitment and training policies training policies

must change must change

Recruitment and Recruitment and training policies training policies

must change must change

Changes the relationshipChanges the relationship

Policies on capital Policies on capital purchases must purchases must

change change

Policies on capital Policies on capital purchases must purchases must

change change

Shrink the physical overheadShrink the physical overhead

Policies on capital Policies on capital purchases must purchases must

change change

Policies on capital Policies on capital purchases must purchases must

change change

Example in bankingExample in banking

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Health educators making triage Health educators making triage decisionsdecisions

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Drop in Value of Drop in Value of Primary Care ClinicsPrimary Care Clinics

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Managed by SpecialistsManaged by Specialists

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Policies on the Policies on the gatekeeper must gatekeeper must

change change

Example among Example among AIDS patientsAIDS patients

Policies on medical Policies on medical records must records must

change change

Policies on medical Policies on medical records must records must

change change Electronic recordsElectronic records

are neededare needed

Policies on medical Policies on medical records must records must

change change

Policies on medical Policies on medical records must records must

change change

Decision aids Decision aids are neededare needed

Patients' Attitudes Patients' Attitudes Will Change Will Change

Patients' Attitudes Patients' Attitudes Will Change Will Change Definition of illness Definition of illness

will changewill change

Patients' Attitudes Patients' Attitudes Will Change Will Change

Patients' Attitudes Patients' Attitudes Will Change Will Change

Informed Informed consumerconsumer

Patients' Attitudes Patients' Attitudes Will Change Will Change

Patients' Attitudes Patients' Attitudes Will Change Will Change

Patients may know Patients may know more than their cliniciansmore than their clinicians

Patients' Attitudes Patients' Attitudes Will Change Will Change

Patients' Attitudes Patients' Attitudes Will Change Will Change

““You have been mothering us, You have been mothering us, how dare you stop?”how dare you stop?”

Technology Technology Demands Process Demands Process

ChangeChange

Technology Technology Demands Process Demands Process

ChangeChange

So much needs to changeSo much needs to change

Technology Technology Demands Process Demands Process

ChangeChange

Technology Technology Demands Process Demands Process

ChangeChange

You may disagreeYou may disagree

Take Home Lesson Take Home Lesson Take Home Lesson Take Home Lesson

Management MattersManagement Matters