INPHO

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INPHO

• Information Network for Public Health Officials

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INPHO Goal

• Build statewide public health infrastructure for
• Linkage
• Information Access
• Electronic Information Exchange

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INPHO State Projects

• 1993-7, 15 states GA, CA, FL, IL, IN, KS, MI,
  MO, NJ, NY, NC, OR, RI, WA, WV
• 1998- , 9 states
• Implementation GA, FL, NY, MO
• Demonstration IA, MD, MT, NV, TX

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INPHO Results

• Approximately 16 million spent
• Developed critical infrastructure
• supports immunization registries
• Awards
• 1994 Federal Technology Leadership Award
• 1995 National Information Infrastructure Award
  (Health)

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INPHO Results - 2

• Key lessons learned
• leadership
• political and organizational obstacles
• incremental steps
• Model state integrated data systems NY, MO, GA,
  FL

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Health Alert Network (HAN)

• Part of CDC bioterrorism preparedness initiative
• Provide local health departments
• Internet connectivity
• Distance learning connectivity
• Training
• FY99 funding 19 million

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INPHO HAN Future

• Continued close collaboration with National
  Immunization Program All Kids Count
• Expand INPHO and HAN nationwide

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How to Avoid Information Technology Disasters

• William A. Yasnoff, MD, PhD
• Public Health Practice Program Office
• Centers for Disease Control and Prevention

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How to Cause Information Technology Disasters

• William A. Yasnoff, MD, PhD
• Public Health Practice Program Office
• Centers for Disease Control and Prevention

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Causing IT Disasters

• Risks of Information Technology
• Disaster Strategies Management
• Disaster Strategies Technical
• Avoiding Disasters

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Rates of IT Failure are High

• 16.2 were project successful (software
  projects that are completed on-time and on-budget
  among American companies and governments)
• 52.7 were project challenged (they were
  completed and operational but over-budget, over
  the time estimate, and offer fewer features and
  functions than originally scheduled)
• 31.1 were project impaired (canceled)

Source Charting the Seas of Information
Technology The Standish Group 1994
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... except in Lake Wobegon

• 100 were project successful (software projects
  that are completed on-time and on-budget among
  Lake Wobegon companies and governmental units)

Source A Prairie Home Companion, Garrison
Keillor, National Public Radio, 1995
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Risks of IT How Projects Fail

• Functional system does not perform needed tasks
  (correctly)
• Users resist new system
• Management resists new system
• Cost overrun
• Delays
• Technical problems system does not work

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Sources of IT Risk

• Mismatched expectations
• Lack of knowledge by management
• Lack of accurate forecasting
• Lack of adequate communication
• Inadequate planning
• Changing specifications
• Resistance to change
• Technology

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Nolan Norton Benefit/Risk Grid
HI
BlockBuster
High Wire Acts
B e n e f i t s
Bread Butter
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D O A B I L I T Y
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Key Elements in IT Projects
Time
Features
Budget
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Strategies for IT Failure

• Management
• Technical

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1. Trust the Vendor

• Buy system without clear problem specification
• Rely on single source of advice
• Ignore standards and open systems
• Select the lowest cost option
• Use only one vendor for all purchases
• Only allow use of standard, centrally approved
  software

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2. Delegate

• Implement and manage IT systems with different
  group from purchaser
• Separate strategic and operational management
• Impose cosmetic quality control standards
• Delegate operations, retain financial control
• Develop rigid job descriptions

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3. Impose Rigid Controls

• Eliminate exploratory work
• Enforce conformity with current in-house
  standards
• Require justification for every computer system
  expenditure (savings or competitive advantage)
• Eliminate operational managers who take an
  organization-wide view

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4. Divide and Rule

• Separate business and IT functions and personnel
  separate career tracks and reporting lines
• Encourage competition within the organization
  discourage collaboration
• Maintain management ignorance of IT do not fund
  IT continuing education
• Underpay all IT staff

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5. Use IT as Tool for Finance

• Place IT under Director of Finance
• Use IT primarily for financial control
• Focus IT efforts on executive information systems
• Move corporate staff to remote site
• Move IT staff and operations to (different)
  remote site

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6. Use Consultants

• Rely solely on external consultants for IT
• Use the same external consultants for management
  advice
• Eliminate any in-house staff that address the
  areas of IT covered by the consultants

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7. Set Rigid Objectives

• Impose rigid quarterly financial performance
  objectives with required cost-benefit analyses of
  all IT expenditures
• Use IT to support and reinforce vertical patterns
  of management reporting
• Do not support general objectives with detailed
  IT project planning

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8. Control Information

• Restrict contacts between departments
• Penalize criticism of IT systems
• Avoid discussions of failures or conflicting
  views
• Minimize communication between management and
  staff
• Centralize all IT operations and development

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9. Avoid User Input

• Do not consult with staff who will use or be
  affected by new systems
• Provide minimal training in new IT systems
• Automate all possible functions with the goal of
  eliminating the maximum number of staff

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Strategies for IT Failure

• Management
• Technical

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1. Technical Leadership

• Appoint a technical project leader with complete
  authority do not involve users
• Ensure that team consists only of programmers
• Give technical team complete financial and
  decision-making autonomy

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2. Resources

• Provide whatever resources are requested at
  outset and as project continues
• Do not involve managers or users in resource
  allocation
• Provide latest state-of-the-art equipment,
  software, and tools without regard to other IT
  systems

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3. Planning

• Insist on complete specification of system in
  advance, including all deliverables, tasks, and
  sub-tasks allow no revisions
• Require strict adherence to a timetable
  completely defined in advance
• Allow continuous modification of requirements
  throughout the project

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4. Feedback

• Avoid discussing technical issues with users
• Avoid user testing of system operational concepts
• Develop complete working systems without user
  involvement
• Insist on user cooperation in use of new systems
  even if they do not benefit

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5. Technology

• Encourage development of custom software and
  tools rather than use of commercial packages
• Encourage use of latest technology, especially if
  unproven in operational systems
• Avoid purchases of any capability that can be
  developed in-house

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Avoiding Disasters

• Reasons for success and failure
• Warning signs of projects in trouble
• Paradigm for IT project implementation

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Reasons Projects Fail

• Expectation Mismatch
• Poor communication
• Bad idea
• Forcing project delivery dates
• Assigning under-skilled managers
• No high-level business sponsorship
• No comprehensive plan

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Reasons Projects Succeed

• User involvement
• Senior management support
• Skilled, experienced project managers
• Clear requirements statement
• Comprehensive work plan
• Sound development methodology
• Prototyping
• Extensive Testing

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Project Failure Warning Signs

• Lack of agreement on goals
• Continuously changing requirements
• No written project implementation plan
• Rapidly growing budget
• Repeated contract modifications
• Major deliverables are late
• Project managed solely by contractor

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Paradigm for Success

• Behavior Modification
• Management
• Users
• Minimize increments of change
• Use intermittent positive reinforcement
• Provide real benefits to users
• What they want, NOT what you want

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Disaster Avoidance Pearls

• Clear goals supported by management
• Adequate budget and time
• Continuous user involvement
• Education and planning
• Use proven methods and technology
• Prototyping
• Minimize increments of change
• Behavior modification

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References

• Ennals R Executive Guide to Preventing
  Information Technology Disasters (Berlin
  Springer-Verlag, 1995)
• Clemons EK Evaluation of Strategic Investments
  in Information Technology. Communications of the
  ACM 34,1 22-36, 1991.
• Tapscott D Caston A Paradigm Shift The New
  Promise of Information Technology (New York
  McGraw-Hill, 1993)

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For Further Information

• http//weber.u.washington.edu/ ocarroll/infrmatc/
  home.htm
• William A. Yasnoff, MD, PhD 770/488-2503 way2_at_c
  dc.gov

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Nancy Hoffman, MSN

• Deputy Director, Center for Health Information
  Management Epidemiology, Missouri Deparment of
  Health
• Active in MOHSAIC project since its inception in
  1992
• 20 years experience in public health nursing
• MSN, U of MO-Columbia

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Amy Zimmerman, MPH

• Chief, Childrens Preventive Services, Division
  of Family Health, RI Department of Health
  (Childhood Immunization, Childhood Lead
  Screening, Universal Newborn Development Risk
  Assessment, Family Outreach, KIDSNET)
• 11 years in Dept. of Health with KIDSNET since
  inception in 1993
• MPH, UNC Chapel Hill

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Debra Sottolano

• Senior Project Coordinator, Integrated Child
  Health Information System (ICHIS), Bureau of
  Healthcom Network Systems Management, NY State
  DOH
• Formerly Director, Institute for the Advancement
  of Health Care Management, SUNY-Albany
• PhD candidate, Organizational Studies,
  SUNY-Albany
• MBA, Athabasca U, Edmonton

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