Computational Health Informatics Program, 25th anniversary

It is sobering to think that I sat down and began writing a web interface to an electronic medical record system (the Oracle database at Boston Children’s Hospital) more than 25 years ago (see “Building national electronic medical record systems via the World Wide Web,” a paper from 1996).

Today is a celebration (agenda) of the 25th anniversary of the Boston Children’s Hospital Computational Health Informatics Program (CHIP). I’ll try to take some notes and write a blog post later about what I learned.

For at least 25 years we’ve had all of the tech building blocks that we’ve needed to implement almost any kind of IT support for health care. Yet in the US we have ended up with a unified database of every ad that we’ve ever clicked on and are discussing the possibility of a unified medical record.

8 thoughts on “Computational Health Informatics Program, 25th anniversary

  1. Nearly every single aspect of US hospitals’ operations is inefficient, grotesquely expensive and providing sub-par service. Why would their IT be any exception?

    • As someone who worked with phone companies and health IT – communication companies IT is way less efficient than health IT. Phone/mobile IT are the most inefficient information systems departments, save for rare outrageous cases in other industries. Usually phone companies IT have no idea what they do.

  2. 25 years later, and its still a mess (maybe a bigger mess it you talk to clinicians who hate the kludgy systems they are forced to use).

    Andy Grove (multi-billionaire, founder of Intel) made several investments in health care IT that all failed. He said in retrospect, that health care IT systems ”need to start with something embarrassingly simple, but nobody wants to build that”.

  3. Congratulations on your accomplishment from 25 years ago. That must have been an exciting time working with early web tech to satisfy an important user need.

    I wonder how we can solve the problem of replacing systems that are “too big to replace?” There probably aren’t too many of them (I hope), but the problem isn’t isolated to health care systems.

    The ad database is circa recent history, while a few important EHR systems have been around since the 70’s I believe. The VA is on it’s third attempt (at least) to replace VistA. The amount of work required to replace a system like that is almost beyond imagining.

  4. In 1997, I went to work for UT Southwestern Medical Center in Dallas, TX on a clinical medical records system written in Sybase and Visual Basic. We had the Cloverleaf medical records gateway and another product to do HL7, which I can’t remember the name. The medical records system was called OACIS, the system was brilliant but bankrupt by 2000. The hospital system continued to run it as open source into the late 2000s. I moved on after a year needing to earn more than a hospital system pays. The health informatics world is terribly corrupt, heavily regulated and fraught with lots of risks. The primary problems are the oligopolies that the regulation has created, and the egos of the people who own and regulate the systems. It is a good ole boy network designed to stifle innovation and pay off those who are close friends of the regulators. No one will ever be happy with it, except those who make money off of it. The current process even for new innovations like automating the ACA healthcare marketplace involves 3 rounds of audits designed to deny all but the richest and best connected the ability to create ALIs to the marketplace. The rest of IT is rapidly becoming oligopolistic, as consumers simultaneously sign up to get discounts, giving away their personal info, then lobby government to keep their records private, inviting the government into what previously had been an innovative and vibrant industry. Innovation in IT is hitting a wall, as the realities of the complexity of what we are building hits us.

    • Hitler, Stalin ad Mao would agree – people and something called “ego” (we call it individuals) is a problem. Happy Shiny Way ! No need to learn SDLC and agile methodologies.

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