A Conundrum called “Business requirement Document” alias “BRD” by Dr. Chandrika Kambam. @ckambam

#Healthcare IT, #Gap in Healthcare IT, #failed IT projects, #Cost of failed IT projects

Over the last couple of years, I had an opportunity to work closely with information technology (IT) team on various initiatives that we undertook to improve and support our business processes. I was the bridge between the team that executed the services on the ground and the technology team that put these systems in place. What I have observed is that very few systems meet 100% customer expectations in one go. There are always reiterations, innumerable versions of the systems that are released, before it meets even 90% of the end user needs.
  

As I reflect on the various reasons for this, I was surprised to read few of the statistics world over. The worldwide cost of the failed IT projects is around $6.2 trillion [1]. As I looked at the various statistics on the failure of these projects, it was indeed an eye opener.

1. 70% of projects fail
2. Just 40% of projects at IBM meet the company’s three key goals (Schedule, budget and quality)

3. Three-quarter of the projects fail as senior management do not get involved

And the list goes on and on…[2]

IT industry has been one of the fastest growing and largest sources of employment in the world. While we started with simple tools like word, XL, PDF, internet, we now talk about artificial intelligence, machine learning, predictive analytics etc.  Then why is there, such a gap and cause for failure. Since I come from healthcare background, let me dwell a bit more on this. 

The hospital information system has come a long way from simple electronic medical records, to picture archiving and communication systems, Lab software, clinical decision support system, telemedicine, IOT and finally to artificial intelligence, machine learning and predictive analytics. Most of the projects involve either improving the existing system or migrating from one system to another, establishing interoperability and standardization. In my opinion the reasons for a gap in the expectations of the end user on what systems need to deliver and what it delivers are:

End User:
Though we all like to blame others and blame the system for failure of process and outcomes. The main reason for this gap is the end user themselves. We must understand our business process better, should be able to articulate it to the IT team in the form of # BRD. The word BRD send chills to most of the end users and looked at like a taboo. Lack of defining the scope is the major contributor for the failure of the projects [Source:  Causes of failure in Healthcare IT projects: 2011 3rd International Conference on Advanced Management ScienceIPEDR vol.19 (2011) © (2011) IACSIT Press, Singapore]. Followed by lack of communication, understanding of the system and lack of training.

What can we do better?
1. Have an in-depth knowledge about our existing system and process.
2. The devil is in the details. We have to deep dive into the nitty gritty of the system requirements keeping all the possible scenarios in mind. Identify stake holders and get them involved from the beginning. Take inputs from the end users. Think through the process, end to end. Keep the end point (outcome) in mind
3. Differentiate between system requirements, process related issues and lack of discipline in the team, to follow certain process which leads to system failure. 
4. Involvement of the leadership is as important as end user. 
5. Schedule periodic meetings to review the progress and to mitigate any issues faced by the technical team
6. Get involved in the testing of the system before it is released into live environment. 
7. Spend enough time to ensure the end users are trained and aware of the functionality of the system.
8. Engage with the technology team to keep them abreast with changing business need and the system requirement for the same.
9. Have team leader who bridges the gap between the end user and the technology team

Technology team:
The technology team should understand the need of the industry that they are working in. Especially so in healthcare as we are dealing with people’s lives, when they are at their most vulnerable period. The pursuit of growth should not place patients as secondary. It takes a long time to develop products for healthcare due to nature of the human body and variations we deal with. It takes even longer to prove the clinical validity of these products. Not every product can be looked at for ROI. Containing costs and helping hospitals to deliver care in a cost-effective manner is as much a responsibility of the technology team as it is of the healthcare provider. 

What can we do better?
1. Get on the floor! How many of you, have visited hospitals to understand the process and system requirements from the end user? 
2. Understand the industry- From Care giver and Consumer point of view. 
3. Have a clinical person in your team, to guide and give inputs from time to time.
4. Keep yourself abreast of new technologies that are coming up, suggest development of systems keeping future requirements in mind. 
5. Schedule periodic meetings with the end user, keep communication channels open. 
6. Involve end user in testing and training. 

The industry has recognised this gap, and many have moved from watershed-based management of projects to agile methodology. Though both have their pros and cons, agile methodology is becoming more popular as it is more collaborative and flexible in nature. Recent survey shows 81% of the companies have started adopting agile method. Having teams spend enough time with each other helps them to understand both sides of the coin, which in turn helps to ensure success of the projects.

Let us build systems that are agile, sustainable, replicable, scalable and makes our process safe and effective so that we improve patient safety and clinical outcomes. 

Author
 Dr. Chandrika Kambam
PRESENT DESIGNATION: VICE PRESIDENT – CLINICAL SERVICES

PRESENT AFFILIATIONS: COLUMBIA ASIA HOSPITALS- INDIA

MAJOR ACHIEVEMENTS: ESTABLISHING CLINICAL GOVERNANCE AND QUALITY MONITORING SYSTEM FOR COLUMBIA ASIA GROUP. MANAGING DOCTOR RECRUITMENT AND DOCTOR COST. STARTED HOSPITALIST PROGRAM. WORKED WITH THE TEAM ON VARIOUS DISEASE SPECIFIC PROGRAMS E.G. COLUMBIA DIABETES CARE. INVOLVED IN CONTINUOUS REVIEW AND UPGRADE ON INFORMATION TECHNOLOGY FOR THE GROUP. ACTIVELY INVOLVED IN OPENING NEW HOSPITALS.

PURSUED ACADEMIC QUALIFICATIONS, BY COMPLETING MBA, ABMQ, PGDMLE .

I HOLD VOLUNTEER POSITIONS IN KRUPANIDHI GROUP OF INSTITUTES AS MEMBER OF BOARD OF STUDIES.

I WORK WITH NASSCOM ON CENTRE OF EXCELLENCE FOR IOT IN HEALTH CARE SPACE.

I am founder and chairman for Yeshshomaheswari trust through which I help economically weaker section for education and health care needs.

Free time, I enjoy gardening and I work out to keep fit. I write blogs on topics close to my heart. drchandrikakambam.com

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