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1. GEMINI: The Life and Times of a Clinical Information System 13tend to recall the most recent and extreme data. Databases on the other hand can recallall data.” Dr. Hill indeed realized that many did not accept GEMINI in the UH ICUs.“People’s impression was that it was inaccessible.” He noted many other commoncomplaints, including the inconvenience of only one terminal per ICU and infrequentupdating of the database.While the database required updates every 8 hours to providereliable information about patients, it was in fact updated only every 24 hours. This ledmany physicians to question the validity of the GEMINI database and the system’susefulness, because a patient’s status can change by the hour in an ICU.Physicians were not the only staff group to have issues with GEMINI. Nursesand technical staff felt an additional burden regarding data collection and system maintenance.They had become disinterested and unexcited about using the GEMINIsystem. Physicians as well as house staff felt their concerns were not taken intoconsideration.Farewell to GEMINIIn light of these events, Dr. Billings decided to terminate the implementation. Tocontinue pouring resources into the project at such a late stage, without the neededinfrastructure and support, would be foolish, he thought. The project was beyondrestoration, and he would have to live with the failed attempt at implementing thesystem. The aftermath of unmet expectations and the prohibitive logistics of organizationalchange justified abandonment; it was as simple as that. Billings stood up andwalked out of his office. The sun was beginning to creep out of the clouds, and birdswere singing under the partly overcast sky. “Well, at least now UH is free from worryingabout the right choice,” Billings mulled, more at ease with himself. “Deimplementationwas clearly the right decision. I’ve done my part.”EPILOGUESeveral months after GEMINI was completely removed, a meeting was held to discussits failure. Dr. David Billings, director of medical affairs, found himself amid an angrygroup of key people involved in the GEMINI implementation, including ICU directors,service center directors, and project personnel.As Billings sat in the meeting, he noted that those who had invested many hourstrying to make GEMINI work were venting their frustrations, trying to find someoneto blame for the failed project. Edward Morgan rose from his seat and spoke. Morganhad been outspoken about GEMINI’s potential and had played a key role in convincingthe hospital administration to lay out funds for the system. “We didn’t even try touse the system—how can we say it wouldn’t be beneficial ...”Morgan’s voice trailedoff as he angrily sat down in his chair.Questions1. What problem was GEMINI intended to solve? In other words, what clinical oradministrative need was the system intended to address?2. Who at UH perceived this to be a problem? In particular, what did Billings, Cleary,and Morgan think? What about the clinical staff (doctors, nurses, respiratory therapists,etc.)?