Editor—As one of the “special advisory group of experts” in the Limpopo project, I would like to comment on the article by Littlejohns et al.1 There are several misleading inaccuracies, some self evident: pharmacy management was not part of the IBM contract (correctly reflected in box 2).
Paradoxically, investments in information technology continue despite the lack of impact on the productivity of health professionals. Unless all the relevant decision makers are crazy, they would not be spending large sums on projects with no benefits whatsoever.
Neither client nor contractor was insensible to the “lessons” at the initiation of the project. Contractual and “real life” reasons prevented their application. The Limpopo project was high risk, dependent on expected developments (unrealised) of our parlous rural infrastructure, and organisational change (imperceptible). Ideal circumstances will remain elusive for years.
Evaluation, yes—but how and when? The usual yardsticks are inadequate, including the return on investment that is the industry standard. The timing is even more critical. The huge culture shift involved in transitioning from paper based to online, real time operations, requires years, not months. Experience gained elsewhere may not be helpful.
Premature measurement may lead to premature termination. Under similar circumstances in Gauteng province, South Africa, the participating hospitals in another large information systems project showed few objective benefits after the third year. Yet in the current (fifth) year, there is a notable difference—hardly a paragon of success, but indubitably a palpable hit.
Even the bedevilled Limpopo project was starting to deliver—it was declared a failure by a new decision maker, with different priorities and indifferent grasp.
Perhaps the money could have been spent on aspirin, but there is a necessary (expensive) first step in moving into the information age. It is instructive to compare the amount wasted here, with the amount quoted by the authors for one large hospital. Perhaps some lessons have been learnt, after all.
Competing interests: BL was an employee of IBM South Africa from February 1996 to February 2002. He has a collaborative relationship with IBM and is an expert on the Medicom healthcare information system.
References
- 1.Littlejohns P, Wyatt JC, Garvican L. Evaluating computerised health information systems: hard lessons still to be learnt. BMJ 2003;326: 860-3. (19 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]