How well will hospitals adapt to their new $100 million IT systems?

by philg

On Friday evening I visited a friend at Howard University Medical Center, near Capitol Hill in Washington, D.C. The neighborhood isn’t the best so I brought my Canon EOS 5D Mark II into the hospital rather than leave it in the car. This set off a three-alarm security emergency involving multiple guards and a senior hospital administrator. “We can’t have cameras in the hospital because of patient privacy.” Could I leave the camera with them? “We can’t be responsible for your camera and won’t accept it.” How about mobile phones? Were they allowed in the hospital? “Of course,” the senior administrator responded. Don’t all mobile phones these days also have cameras and oftentimes video? “Yes.”

Here we have a business apparently determined to prevent anyone from coming in and photographing patients. Yet they haven’t figured out which of their rules they need to change in response to the phenomenon of camera phones, devices that appeared nearly 10 years ago. They’ve stuck with their paper records in filing cabinets, writing with magic markers on whiteboards in patient rooms, and other manual procedures. The U.S. government is now telling this hospital that they need to adopt some of the world’s most complex software. A university hospital in the Boston area, considered one of the most sophisticated in the world, recently spent $60 million on a new IT system from Cerner, a market leader in the field. So far the results have been disastrous, despite the fact that all of the personnel were accustomed to using an electronic medical record system (home-grown starting around 1990).

The enterprises that have been the most successful users of IT have been the best-managed enterprises, such as Walmart. Hospitals don’t have the same competitive pressures as Walmart and historically have not worried as much about management or efficiency. If they have resisted computerization, perhaps it is because they had a good idea of what their organization could handle.

This March 17, 2009 Washington Post op-ed makes the same point: “Bad Bet on Medical Records”. What do folks think? Will this be a waste of $50 billion?

8 thoughts on “How well will hospitals adapt to their new $100 million IT systems?”

  1. I worked for a crack team, and I do mean it, of an EDMS and imaging vendor consortium. We delivered often early and under budget. We had opportunity to pitch just about the entire Longwood medical area – Brigham and Womens, the whole 9 yards and MGH as well.

    Oy! The prebid process was an exercise in vatching these IT people up to state if the art….10 years behind us! Forget the RFP’s, they were so out of the industry ballpark…I was speechless. They have staff IT analysts that were plain simple unaware of the vendors and workflow research that was truly in vogue and working in the best run global IT systems.

    Got out of that sector before I bit my arm off.

  2. Sounds like depending on hospitals to develop and deploy new systems is a bad idea. Then again, given the prevalence of fast Internet access, why not put the majority of the “system” into the “cloud”? Allow competition among vendors to offer services on top of the shared database of records.

    For many uses, classic web applications are all a hospital needs. For some specialized uses, we might need to deploy client-server applications. All the hospital IT staff needs is the ability to support generic Internet-connected PCs.

    Google, Sun, and Amazon are all working on technology and infrastructure for “cloud” support. As long as there is some allowance for market-competition, $50 billion should go a long way.

    Even better – what if the “cloud” knows about hospital performance levels? If in a strange city and needing medical help, you might choose a hospital with the best-reviewed performance. For those hospitals that adapt slowly, would this be enough to force change?

  3. I’m going to Portsmouth Naval Hospital for residency in part because one of the other residents has started working on a new electronic medical record interface, to replace the crapware called AHLTA that DoD has paid ~ $16 billion for. Billion.

    Did I say billion?

    Having used several medical records systems now, I’m quite confident in saying AHLTA is the worst interface I’ve ever used. It makes the command line intuitive and friendly. I know because people at military hospitals are now reteaching themselves the commandline access for the old system, which is based on the VA’s VISTA system (not to be confused with MSFT’s famously successfully OS).

    So this one resident has started working on his own. From my experience with tmedweb (tmedweb.tulane.edu), I’m pretty sure the users of highly unique systems can make a better system than the Comp Sci BS code monkeys I meet cowering in their grey cubicles behind locked doors and retinal scanners.

    For context: at Bethesda Naval, with the most expensive medical records system ever, my team got there at 5 am and left at 7. Never had more than 4 or 5 people on our list. At University Hospital in New Orleans, we use paper charts. We never have less than 10 patients on the list, we do twice as much surgery (less surgery per patient, and yet more penetrating trauma), and the only nights we’ve been there past 7 were on call nights.

    You tell me which method is more efficient.

    Programmers can write great blogging software, web servers, and email clients because thats what they deal with every day. They haven’t got the slightest idea of what docs and nurses and social workers deal with every day. I don’t care how many user tests they do. They will never, ever, get it.

    Necessity is the mother of invention. I’ve never seen a programmer in a hospital. I’ve seen a couple of marketeers at Bethesda 5 years ago, but that’s about it. No programmer is going to understand the hospital efficiency problem until they spend years writing the code from inside the hospital ward rooms. They should be kicked from empty room to empty room, show up every day at 5 am, forced to write the code on the fly, amid the screams and body fluids.

    I would *love* for any programmer to contact me if they are really interested in solving this problem.

  4. Niels, I’ve got a friend who wrote a maintenance management system that saw moderate use in hospitals back in the early ’90s. He abandoned it for greener (ie: Internet) pastures.

    Even in a space where we weren’t worried about patient privacy, back before the HIPAA rules and all, we had huge resistance from the entrenched IT departments in implementing this stuff; I built several bits that patched into printer cables and terminals that were invisible to the IT guys, but moved stuff back and forth from their systems into the one that the facilities guys actually used.

    I think the way to implement the system you want is to give some nurses purchasing authority and get a self-taught PHP coder in there to build the system the nurses want, one several thousand dollar invoice at a time. This would never actually succeed, the politics of the situation would kill off the system just as it started to actually get useful, but quick response to genuine user needs on the fly is the only way such a system will actually get built.

    And there are enough more profitable less political gigs around that I wouldn’t get back anywhere near that field.

  5. “Hospitals don’t have the same competitive pressures as Walmart and historically have not worried as much about management or efficiency.”

    If you look at the success of 2-year and technical colleges who teach medical billing and record keeping you get a hint at just how inefficient the health care industry is.

    Another part of the problem is that nobody knows how much procedures cost. The same treatment costs different things to different people according to what and how much insurance they have. You cannot measure efficiency without some kind of yardstick, and price is the simplest and most reliable.

    What I’d like to know is why I can’t keep my own medical records. After all, I’m the one interested in them. How come I can’t download everything onto a USB flash drive and bring it to whatever doctor I need to go to? How come I have to fill out the same forms every time I visit which asks me questions I’m not 100% sure to remember the full answers to?

  6. I couldn’t stop laughing during the campaign when we were repeatedly told doctors and hospitals would be forced to upgrade to more efficient record-keeping systems — as if doctors and hospitals love doing things inefficiently.

    A lot of work has gone into the systems currently available, and frankly it’s not like they have to do much more than provide a reasonable interface into a database. If these aren’t catching on we may be simply fighting an uphill battle. It may make sense to look for other low hanging fruit in the medical field instead, like inventory management at the pharmacy.

  7. I work for a hospital that has taken IT as a serious priority, long before I started working here. And in the process we have had to fight the environment that has been fostered where doctors find something new and shiny and have to have it _now_. As well as fighting with manufacturers and vendors claiming FUD with HIPPA or FDA regulations in order to sell proprietary solutions at exorbitant prices. What has emerged out of these two cultures are application islands of patient information, typically managed by the vendors, that don’t lend themselves to sharing information across a hospital.

    I empathize with hospitals that are in this situation, and know they may have a steep road ahead. The issues are complex and definitely not solved by self-taught PHP coder. But they have to start at the top, with CxO involvement and vision which understands that the hospital is larger than one doctor’s wishes and the needs to share information is more critical than one vendor’s proprietary application. Then IT can start to have the authority to exercise policy that complies with what one would expect out of a typical fortune 500 company.

    Money is not the answer; it is simply a tool. If a tool is implemented poorly then the tool is pointless. AIG is testament to that fact. But if there is structure in place to support proper use of a tool, then the money could be put to good use.

    In all instances of the money being handed out by the government, research on the effectiveness of giving that money should be sought. It appears that this is the case w/ the automobile industry; lets hope that carries over into some of the other areas of the stimulus packages.

    If you are truly interested in some of the advances in IT around the Healthcare Industry, here are some good places to start.

    http://www.healthcareitnews.com/
    http://www.himss.org/ASP/index.asp
    http://healthcare-informatics.com/ME2/Default.asp

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