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Major B.C. government IT projects go over budget or end up missing key features

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] BY LORI CULBERT AND ROB SHAW @vancouversun.com -

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] READ THE FULL ARTICLE

] http://www.vancouversun.com/technology/major+government+projects+over+budget+missing+features/11583978/story.html?__lsa=81d1-1025

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] 2015-12-14

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] When the province’s new social-welfare computer system crashed in May 2014, it left B.C.’s most vulnerable citizens struggling to get money for food and rent. Today, the Integrated Case Management system, designed to link the children’s ministry and the social development ministry into one database, has been fully online since November 2014. Despite overshooting its original $108 million budget by $74 million, it is performing only a third of the tasks the government had initially hoped it would do.
] It is one of eight high-profile IT projects recently launched by the province — with a total price tag of $2.5 billion — that The Sun has investigated for this series of stories. Several have taken much longer than originally planned; many have defects or are underperforming; and five of them have shot over budget, so far by a combined $350 million, including $72 million spent on an electronic health records system that had to be reset after the contractor was fired.
] The findings, support the call for a new approach to tackling these large information technology projects, which will become more common as technology continues to advance.
] The two ministries using Integrated Case Management say the system has been available 99 per cent of the time over the past year, and don’t anticipate another system-wide crash like the devastating one in 2014.
] While most social workers acknowledge it is an improvement over the child protection software it replaced, they insist problems continue and its complicated design occasionally causes information to get lost. “This system is slow, it’s clunky, it goes down, it isn’t stable yet. It is hard to find information,” said Doug Kinna, the social worker spokesman for the B.C. Government Employees Union.
] B.C.’s information technology woes are not unique, said Ellen Balka, a Simon Fraser University professor. She cited two academic studies that reveal universal failure rates of 65 per cent — or two out of every three projects — for complex systems. “Large scale computing infrastructures frequently fall far short of articulated goals and expectations, and a new approach to understanding IT projects is warranted,” said Balka, an expert in information technology systems. “It is astonishing to me that as a culture we think (this failure rate) is OK. We really haven’t, as a culture, said, ‘We have to do this better. We can’t accept this.’” Over the last decade, success rates for large-scale IT programs have been only 35 per cent, according to The Standish Group, which researches software projects around the world. A mere two per cent are outright successes.
] It is not uncommon, Balka said, for managers in charge of these projects to focus on the hardware and software, without spending enough time considering the complex work the technology is supposed to support or the needs of the staff who do that work. “We live in a culture that believes in the infallibility of technology,” she said.
] B.C. spends approximately $500 million a year on IT infrastructure and systems, according to the auditor general. The auditor’s office has issued a series of scathing reports about some IT projects, and has recently started a government wide look at technology problems.
] NDP critic Adrian Dix, who has closely monitored many of these projects, argues government needs expertise to work with the companies that build the systems, and to understand what they do.
] Bette-Jo Hughes, the government’s chief information officer, said it is frustrating that the public only hears about the IT projects that go poorly. She said the government has 51 small IT projects on the go right now — collectively worth $200 million — and all are running effectively, on scope and on budget. She pointed to a $150,000 emergency lab database that helped coordinate the 2014 avian flu outbreak, and a $335,000 wildfire tracking system used to help fight forest fires. “There’s a huge number of projects that occur on an annual basis that do go very well. … There is a lot of good stuff going on, unfortunately nobody ever hears about those,” said Hughes, whose office provides oversight to government on information technology.
] “(And) when we do have issues on some of the larger projects, we absolutely do learn from that.”
] With the case of the maligned Integrated Case Management system, financial pressures and critical problems processing child welfare cases led the government to quietly abandon two-thirds of what the project was initially promised to do, an auditor general’s report concluded. The software is used for income assistance, disability payments, and child welfare, but social workers say they still have to rely on an old computer system to do part of their jobs.
] A recent BCGEU report found B.C. was the only Canadian province to choose this type of software, while five other provinces rejected it as either too costly or not suitable for the job. The government of New South Wales in Australia purchased Integrated Case Management, but eventually abandoned plans for costly upgrades after backlash from staff and the public.
] The B.C. government announced the Integrated Case Management project nearly a decade ago, and said then it would cost $107.3 million. Victoria “refined” its plans in 2010 and increased the budget to $182 million for the capital costs of designing and building the system. The ministries did not include implementation costs in this final price tag, which they say follows accounting rules.

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[2015-03] BC AG - Integrated Case Management Audit

vandudey

There is a great paper written years ago about how many large health IT projects fail:

https://www.researchgate.net/publication/39066200_Tensions_and_Paradoxes_in_Electronic_Patient_Record_Research_A_Systematic_Literature_Review_Using_the_Meta-narrative_Method

Their conclusion? Large projects almost always fail. The successful ones are those that are not too ambitious and that reduce their size & scope. In their words: "small is beautiful." This paper became the founding document for a successful health IT project that I joined.

Main finding:

"Our review found no evidence that large-scale commercial IT systems in health care produce the benefits anticipated by their architects, and a few high quality studies suggest that they do not."

Other notable excerpts:

If patient record systems are developed organically and in-house, (co-design) is more likely to be successful. The dramatic differences in success between “off the shelf ” (commercially developed) and “homegrown” EPR systems, as well as the question of whether & in what circumstances “small is beautiful” in EPR systems, all demand further critical exploration. (p754- 755)

Clinical knowledge is often tacit, context bound, and ephemeral rather than codifiable, transferable, and enduring. In “failed” EPR projects, technical designers typically missed these subtleties and produced artifacts that fitted poorly with the situated nature of knowledge and the microdetail of clinical work practices. (p 762) The tension here might be expressed as “clinical work as decision making” versus “clinical work as situated practice,” and between “knowledge as transferable facts” versus “knowledge as information in- Context

The idea that meaning is transmitted unproblematically along with data underpins many of the large-scale EPR programs currently under way (notably the National Programme for IT in England) (Department of Health 2008) and the plans for an extensive expansion of the IT infrastructure in the United States (Institute of Medicine 2009), but critics of this type of program claim that this is a flawed assumption (Berg 2000). . . and offer evidence that clinical data must be interpreted in context and “framed” before they become meaningful.

I work on a health IT project that operates with a tenth of the budget of these failed health IT projects, and I can tell you that the source of our success was by staying small, staying agile, staying lean, and getting right early with our core users (doctors) at a small scale, what our application needed to look like before moving on to scaling out our services to a wider area. It is hubris to think you can design a healthcare application without doing this work.

tl;dr: In health technology projects, bigger is almost never better.

EDITed OUT

Our project was originally a pariah with the provincial government, a rebel project against the original project being funded. The BC government spent $24 million on that project before finally canning it and admitting that ours was what doctors really wanted. To this day our entire project still operates on less than a $1 million dollars of funding per year, and we're expanding our scope to be province-wide this year. That's inclusive of literally the entire team both technical and non-technical, and is quite literally an order of magnitude cheaper than any of these death march projects that try to do the same thing.

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