What 3 leaders at SIIM18 learned from their informatics failures

What do you do after receiving an email from your CIO that reads: “AND YES I’M YELLING AT YOU”?

If you’re Peter Sachs, MD now vice chair of informatics at the University of Colorado Anschutz Medical Center in Aurora, Colorado, you share the experience and hope others can learn from it.

Sachs, along with seven colleagues, took to the stage during a session at the Society for Imaging informatics in Medicine (SIIM) 2018 annual meeting to share memorable hardships related to imaging informatics and what they learned.

In the case of Sachs, his institution was deploying a clinical decision-support tool and decided not to include the cost information providers wanted after a discussion with radiologists.  

However, six months later, Sachs found that providers had gone straight to the hospital to ask for its inclusion, which led him to send a “very angry” email to many in the system, including his CIO who and wasn’t thrilled.

Although unnerving at the time, the email taught Sachs a few lessons. Wait 24 hours before sending an angry email, he said—and don’t assume you have more influence than you actually do.

“If you’re going to send an angry email your CIO is going to read, you better ask him about it,” he joked.

Where’s the backup?

Some situations have stronger consequences than an angry email.

More than a decade ago, James Whitfill, MD, then CIO of a private practice outpatient imaging center, found its PACS system had growing problems rooted in a poorly functioning database index.

But Whitfill and his colleagues didn’t know their remote support team decided to re-index the database in the middle of the night. When the center opened the following morning, the process was far from complete and the PACS system was unavailable. Practitioners were left with its standalone backup viewer on all workstations and hooked up to DICOM routers.

Those backup systems were never tested and would have taken too long to get running. Ultimately, the practice was down for nearly 12 hours, completed a mere 30 percent of its work and required several days of catch-up.

“We actually learned a lot of things,” said Whitfill, now CMO of Innovation Care Partners and chair of the board of directors at SIIM. “I had a lot more engagement, and when I went to ask for things after that I usually got them.”

They implemented a new backup system and instituted a practice drill every quarter. Physicians usually don’t welcome the change, he said, but they didn’t mind in this case, because they had gone through the painful experience.

When a systems upgrade feels like a downgrade

Tessa Cook, MD, PhD, assistant professor of radiology at the Perelman School of Medicine at the University of Pennsylvania, recalled numerous times a supposed system upgrade felt more like a downgrade for some.

In Cook’s department, innovation projects often require access to various report data. In more than one situation, she said, an upgrade or update to a production level system changed the database schema, resulting in catastrophe for downstream systems.

“I had an entire section of radiologists very upset with me for many months at one point because one of these systems changed and it had downstream consequences for the systems we had built in-house,” Cook said.

Improved communication between corporate IT and the development team better prepared individuals for updates.

Similarly, Cook has found when upgrading systems, many direct users receive training, but those who come in contact with it further down the line may receive little to no training—making the upgrade seem questionable.

“Sometimes things go really well, and all the moving parts move as they’re supposed to and you end up with a lot of great success,” Cook said. “There are other times, despite all the planning, and all your best efforts you end up wondering how on earth you got to where you are.”