Spectacular Imaging IT Failures—and the Lessons They Impart: Part I

It’s not terribly deep, but it is really hard to remember where your loyalties lie in our world. ...I have a lot of bosses or no bosses; it is hard to tell on any given day on any given project.

Peter Sachs, MD
University of Colorado Hospital
January 29, 2020

Delivering a talk on a successful initiative or research project at the annual RSNA is an act of generosity but getting up and sharing one’s failures takes courage.

Six courageous—and generous—physician imaging informaticists shared lessons learned in a valuable and unique session that was by turns hilarious and painful, “Radiology Informatics Mistakes and War Stories from the Front Lines,” moderated by Peter Sachs, MD, a diagnostic radiologist and imaging informaticist at the University of Colorado Hospital, Aurora, CO. 

This is the first in a 4-part series that shares four of those stories.

Yes, I AM Yelling at You: Peter Sachs, MD

Sachs confessed that he was surprised he had not yet learned to refrain from sending email when angry. Nonetheless, when he heard that providers wanted the system’s CDS application to display the prices of imaging exams after everyone agreed to withhold the information, he fired off an angry note to the CIO.

“As a physician informaticist, I depend heavily on my CIO and vice versa,” he shared. “The CIO is a bit younger than I am, but I consider him one of my great mentors in IT as well as management processes and behavior in general. He does not raise his voice in public, and I had never seen him raise his voice electronically—until this time.” Ergo, the title of Sachs’ presentation.

While radiology understood the potential benefits of displaying cost, the department had come down against the practice due to the difficulty of determining exactly which cost information to display.

“We had a long internal conversation in radiology reflecting that it is really difficult to know whether you are displaying cost, charges, how you take into account different insurance plans,” noted Sachs. Ultimately, radiology determined that it did not have a way to display costs that would not confuse patients and ordering providers or compromise their competitive position in a crowded medical imaging marketplace.

With the support of the CIO and CMIO, radiology’s wish prevailed—cost information would not be displayed in the CDS system.

It turned out that the case was not closed—a group of providers went to the administration and asked again, and Dr. Sachs received an email stating that this had occurred, prompting an angry email to a lot of the involved parties asking how they could do this after considering the question and resolving that cost information would be withheld. While Sachs appeared momentarily heroic within the radiology department, providers elsewhere were not happy.

Lessons Learned

“It’s not terribly deep, but it is really hard to remember where your loyalties lie in our world,” explained Sachs, citing a community of stakeholders that includes all users of radiology IT systems as well as the CIO, the CMIO, analysts, builders, and support people. “Life in general is complex but life as a physician informaticist and an imaging informaticist can be incredibly complex. I have a lot of bosses or no bosses; it is hard to tell on any given day on any given project. A lot of times, I am reporting to all of these people simultaneously.”

Sachs noted that the pain could have been avoided if he had, a) calmed down, b) not sent an email, c) entered into direct conversations with the CIO and other folks involved, and then d) engaged back with the providers in intelligent conversation.

“Many times, in our world, battles that you think are over are far from over or they resurface,” he said.  “I also forgot that it really isn’t about me—it is about the patients, the providers, and the health care process in general.”

Yes I AM Yelling at You is the first in a series of four articles.  Next issue: I Almost Got Fired as the Enterprise IT Doc: Christopher J. Roth, MD, MMCI

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