The Impact of Technology Insertion on Organisations

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HFIDTC/2/12.2.1/1 Version 3 / 21 November 2007 • Export control issues and supply line issues were not anticipated or well understood. • <strong>The</strong> need to design a flexible system allowing for component upgrades was not considered sufficiently. • <strong>The</strong>re was an insufficient consideration <strong>of</strong> technology issues from a range <strong>of</strong> perspectives (knowledge management). 9.1.1.2 Focus on ITAR ITAR relates to Section 38 <strong>of</strong> the USA’s Arms Export Control Act (22 USC 2778), which authorises the President to control the export and import <strong>of</strong> defence articles and defence services. According to the ‘Defense Industry Daily’ website [205] ‘<strong>The</strong> problem is that complex ITAR rules force the UK and Australia to wade through a weeks-long process to get military export approvals, sometimes on mundane weapons parts and components. <strong>The</strong> restrictions are wide-ranging and extend to “defense services”, which can include “furnishing <strong>of</strong> assistance, including training, to foreign persons in the design, engineering, development, production, processing, manufacture, use, operation, overhaul, repair, maintenance, modification, or reconstruction <strong>of</strong> defense articles, whether in the United States or abroad” or furnishing <strong>of</strong> technical data. Unsurprisingly, therefore, this process also plays a role in joint defense projects’. 9.1.2 Armed Forces Health Longitudinal <strong>Technology</strong> Application <strong>The</strong> US Military Health System (MHS) lost records <strong>of</strong> almost 5,000 patient encounters because <strong>of</strong> hardware and s<strong>of</strong>tware problems with portions <strong>of</strong> the Defense Department’s Armed Forces Health Longitudinal <strong>Technology</strong> Application (AHLTA) electronic health record system [206]. <strong>The</strong> system experienced backup problems with data stored locally at military treatment facilities (MTFs). <strong>The</strong> s<strong>of</strong>tware problems occurred after local cache servers (LCS) were installed at 101 facilities and Northrop Grumman provided a new AHLTA s<strong>of</strong>tware patch. <strong>The</strong> patch, designed to improve LCS performance, was successfully installed at 99 MTFs, but did not work at Fort Stewart, Ga., and Fort Drum, NY, when it was installed. A database flag or trigger was incorrectly set at those two locations. Consequently, clinical encounters between doctors and patients were not captured and stored because the system viewed each as an inactive patient. As a result, 2,608 encounters were not captured at Fort Drum and another 978 at Fort Stewart. MHS later resolved the patch problems at those two locations. A hardware problem at Fort Hood, Texas, in September resulted in the loss <strong>of</strong> information from 1,400 clinical encounters. That loss was because <strong>of</strong> a hardware failure in a Redundant Array <strong>of</strong> Independent Disks when a Hewlett-Packard technician installed a new piece <strong>of</strong> equipment and inadvertently erased all the data on the disk by setting it to factory default. No backup was in place. 49
HFIDTC/2/12.2.1/1 Version 3 / 21 November 2007 9.1.2.1 Findings 9.2 Civil • <strong>The</strong>re was a lack <strong>of</strong> redundancy in the system. <strong>The</strong>re was no backup system in place and paper records were not kept; • <strong>The</strong>re was a lack <strong>of</strong> user feedback in the system. Errors were not apparent to the user until the entire system failed. 9.2.1 <strong>The</strong> Regional Information Systems Plan <strong>The</strong> Wessex Regional Health Authority’s (WHRA) Regional Information Systems Plan (RISP), aimed to achieve integration across the health region, and began in the mid 1980’s. <strong>The</strong> plan envisaged the development <strong>of</strong> five core computer systems covering hospital information, manpower estates, community care and accountancy, operating to common standards in every district region. Development was to be completed within five years at an estimated cost <strong>of</strong> £25.8 million (at 1984/1985 prices), with associated revenue costs over the five-year period <strong>of</strong> £17.5 million. In April 1990, when the project was <strong>of</strong>ficially abandoned at least £43 million had been spent. Jeffcott and Johnson [58] analysed the organisational issues involved in the RISP case and identified the following factors that led to the system’s failure. 9.2.1.1 Findings: • <strong>The</strong> NHS risk management strategy underestimated the risks involved in the adoption and implementation <strong>of</strong> new technologies. <strong>The</strong> risk management strategy was developed in response to increasing financial pressures from litigation for clinical negligence, but did not consider the risks involved in the introduction <strong>of</strong> new technologies; • <strong>The</strong> focus on risk assessment and avoidance <strong>of</strong> litigation can be understood in historical and organisational terms. In 1975, the cost <strong>of</strong> clinical litigation in the NHS in England alone was around £1 million; by 1990, survey data suggests the cost had risen to around £50 million; in 1996 the costs were about £200 million [207], [208]; • Risk assessment is a task that is not well understood in the NHS. <strong>The</strong> NHS Executive report that it is only carried out ‘because we have to include it in the business case’ rather than because it is recognised as a central task <strong>of</strong> successful project planning and management; • In terms <strong>of</strong> prior experience, the RISP was the first project <strong>of</strong> its kind in the WRHA; • At the time that RISP was conceived in 1982, there was no clear and agreed national framework for information management. Until 1986 the Department <strong>of</strong> Health’s (DoH) IT policy allowed each regional health authority to develop its own IT services and decide what hardware and s<strong>of</strong>tware to buy, within the framework <strong>of</strong> broad national guidelines and international rules; 50
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The Impact of Technology Insertion on Organisations

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