Wheel Of Fortune . . . Or MisfortuneRolling a Successful Wheel Takes a Committed CEOI recently visited a hospital that has published “before and after” performance measures on what ARRA and the HIMSS EHR Adoption Model would consider a very modern system (at least relative to the lower 97% of systems). The data therein describe a performance initiative that went live in 2007.This hospital had both 100 percent CPOE use and 100 percent electronic documentation. Both are, of course, necessities to report perfect or near perfect care under existing performance measures.The results were inspirational, reflecting what an early adopter of technology can accomplish. Though uncommon when compared to all hospitals at this point in time, such results are not necessarily unique for teaching facilities that have been pushing the HCIT envelop for more than a decade.While on-site, the chief medical officer shared with me easily a dozen critical success factors. The one that struck me as most profound, and I paraphrase here, was,“ Our hospital CEO was completely behind this project and everyone knew it. I didn't need to point that out to anyone. I cannot stress how powerful that was. Without it, we would have failed."When I reflect upon the dozens of HCIT projects I've been directly involved with, and the hundreds I've read about, this critical factor is consistent. Successful projects always have the explicit, visible support of the CEO. So is the opposite true. When the CEO abandons a project, or never bonds with it, that spells death. It may be quick, usually concurrent with a general system-level budget shortfall, or a slow death, as if the project were put on minimal life support. I would suspect that you seasoned readers of HCI have experienced both types of “pre-destined to fail” projects, too.The political and technical chemistry, and physics of the universe will not change with creation of Meaningful Use criteria. Which hospitals will be awarded millions of stimulus dollars and which will enter the fray without hope of success will likely come down to two or three essential factors, CEO support being chief among them.
