Abstract
Management is surprised when big investments in hospital information technology fail to produce expected results. Although failure appears to be sudden, it is actually the cumulative result of many subtle acts of omission by multiple parties over an extended period. Unfortunately, many senior managers recognize, but few confront the early warning signals of impending disaster. This article outlines 10 common predictors of hospital information system failure plus effective antidotes in each case. A carefully defined project outcome, appropriate project governance structure, and rigorous adherence to a structured systems development methodology are particularly critical management tools for assuring return on investment.