The Risks of Information Technology

Dear Reader,

Unfortunately, missing from all this discussion is an appreciation of the dark side of health IT. Unless the problems with American health IT are as openly discussed, understood, and dealt with, as the problems with American healthcare, mixing IT with healthcare could deepen our national healthcare crisis.

The problems with health IT begin with IT itself. According to The Standish Group’s CHAOS 2004 survey results, only 29% of software projects come in on time, on budget, and with all the features originally planned. 53% of software projects fail at least partially, and 18% fail completely. Although people not familiar with the sorry state of the software industry find these numbers shocking, the reality is even worse.

The Standish Group’s numbers are oriented toward tracking the effectiveness of the project management, not the effectiveness of the resulting software. Any experienced IT user can tell you that many “successful” projects are actually failures from a usefulness perspective, bad ideas successfully imposed upon the organization. Similarly, these numbers do not factor in whether the budget was an effective use of the organization’s resources. Many, many projects are vastly more expensive than they should be for the value delivered. Once these crucial but omitted criteria are imposed on the CHAOS numbers, the numbers fall in line with the reality of an industry in crisis, The Software Crisis.

Since 1968, the software industry has understood itself to be immired in a crisis that defies solution. Forty years of innovation have still not managed to fix the kinds of problems measured by The Standish Group. Indeed, they have only clarified that at the root of the problem is a basic but paradoxical principle of complexity: Success breeds failure. Success with software development invariably increases the amount of software to be managed and taken into account in the next round of development. There is no limit to the potential complexity of software, but human capacity for managing complexity begins to fall apart at surprisingly low levels of complexity.

Successful software lifecycles become less successful over time. No wonder so many software adopters cyclically opt to replace what they have with something new! The temptation to blame the current software and start over with something else helps to fuel a major portion of the healthcare IT industry’s annual revenues. This wheel spinning may be successfully executed as projects and reported as such in the CHAOS reports, but it constitutes ongoing waste and failure disguised as success.

The consequences of our limitations are starkly illustrated by two parallel trends. First, at the same time that the hardware revolution has made computer hardware orders of magnitude smaller, faster, and cheaper, the software crisis has made software orders of magnitude larger, slower and more expensive. Second, the ability to succeed with software projects goes down dramatically as the scale of those projects increases, a factor noted in the CHAOS reports.

Yours truly,
Rick