1. Lessons Learned from Two IT Failures Farrokh Alemi Ph.D. Lee Baliton

2. Case Study Interpractice Inc. ($15 million and 7 years wasted) –Web-based services to patients of an HMO Telepractice Inc. ($6 million & 3 years wasted) – Computer services via telephone to patients of an HMO

3. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

4. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

5. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

6. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

7. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

8. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

9. Description of the Online Services Health education Email contact with clinicians Online counseling Pre-visit testing Support groups Personalized medicine

10. Technology is Seductive A fix: efficient production

11. Technology is Seductive A fix: efficient production Changes what we do, re-defines us

12. Technology is Seductive A fix: efficient production Changes what we do –InterPractice Inc –TelePractice Inc.

13. Randomized Clinical Studies Improve patient outcomes Reduce cost of care –28% total health care cost savings –33% lower cost for AIDS care

14. Randomized Clinical Studies Improve patient outcomes Reduce cost of care Failed as a business

15. Business Process Change Needed New technology is not enough Process change is needed You cannot take a car for a walk

16. What do we mean by new business processes? Case of an Online Patient Service Company

17. Organization's policies on scope of services must change Focus on economies of scale not scope

18. Organization's policies on scope of services must change Small is Beautiful

19. Organization's policies on scope of services must change Conflicting Demands

20. Organization's policies on scope of services must change Examples: Salic Clinic; CABG operations

21. Organization's policies on scope of services must change Focus

22. Recruitment and training policies must change

23. Physicians resist remote management

24. Recruitment and training policies must change Initiating Contact

25. Recruitment and training policies must change Changes the relationship

26. Policies on capital purchases must change Shrink the physical overhead

27. Policies on capital purchases must change Example in banking

28. Policies on the gatekeeper must change Health educators making triage decisions

29. Policies on the gatekeeper must change Drop in Value of Primary Care Clinics

30. Policies on the gatekeeper must change Managed by Specialists

31. Policies on the gatekeeper must change Example among AIDS patients

32. Policies on medical records must change Electronic records are needed

33. Policies on medical records must change Decision aids are needed

34. Patients' Attitudes Will Change Definition of illness will change

35. Patients' Attitudes Will Change Informed consumer

36. Patients' Attitudes Will Change Patients may know more than their clinicians

37. Patients' Attitudes Will Change “You have been mothering us, how dare you stop?”

38. Technology Demands Process Change So much needs to change

39. Technology Demands Process Change You may disagree

40. Take Home Lesson Management Matters