The chronicles of the last few weeks on the problems associated with the start-up of the new information system of the Hospital of Verona lead me to some reflections on major projects and how they are carried out.
The idea of resolving the fragmentation and heterogeneity of health information systems by choosing a single supplier at the regional level is widespread and has found a further boost from funding from the PNRR. In a previous post (which you can read here) I highlighted the risks and limitations of regional electronic health record projects.
The first region that tried to replace the hospital information system for all healthcare companies was Veneto, which in 2018 launched a tender for 123 million euros, divided into five lots (groupings of companies), for the supply of SaaS a HIS. In 2019, two groups won the tender, winning two and three lots.
The expected times, also thanks to the Covid-19 pandemic, have expanded considerably and finally this summer the first HIS was put into operation at the Verona hospital. The project, of considerable complexity, was managed by Azienda Zero and by the suppliers who configured the integrated system that had been chosen.
Apparently the doctors and nurses of the healthcare company were not sufficiently involved in the process of configuring, verifying and testing the system which, once put into operation, presented various problems and complications such as to slow down and make the activity difficult clinic. This dissatisfaction has been taken up and disclosed by some national newspapers which have collected the testimonies of users and the actions that their trade union representatives are considering undertaking, including the possibility of calling a strike.
I don’t know in detail what happened and, for this reason, I don’t express judgments on the work of those who have the great responsibility of replacing a hospital information system in a reality that is certainly complex. However, it is possible to make some reflections, perhaps to learn from the mistakes of others.
In many existing regional projects that I know of, I notice the low involvement of users and the idea of ”impose from above” choices and working methods by those who do not have experience in the field or, if they do, are not significant and cannot be taken as a model for all healthcare companies. When I point this out I am told that time is limited, that it is difficult and complicated”listen to the doctors“, that often “they don’t know what they want” and that it is impossible “get them to agree”. To be quicker and respect the times, therefore, a confrontation with the users is avoided, who will have to use what has been decided for them, only to then try to remedy the problems that are reported when the system is used.
Instead of creating value, projects conducted in this way create dis-value, discontent, frustration and, what is more serious, undermine the efficiency and effectiveness of clinical practice.
The incredible thing, from my point of view, is that all this is nothing new. There are many examples abroad of large projects that fail, despite being able to count on much more economic and professional resources.
To return to the present day, what will become of the large regional electronic health record projects, entrusted moreover to a single group of companies? Whose times are really tight? Unfortunately, it is not difficult to guess the outcome …
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