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IT and Health Care

samzenpus posted more than 5 years ago | from the broken-by-design dept.

Databases 294

Punk CPA writes "Technology Review has some thoughts about why the health care industry has been so slow to adopt IT, while quick to embrace high technology in care and diagnosis. Hypothesis: making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model. My take is that it might also make it much easier to gather and evaluate quality of care information. That would be chum in the water for malpractice suits."

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Anus Transplant (-1, Troll)

Anonymous Coward | more than 5 years ago | (#28463439)

Goatse [goatse.fr] has had an anus transplant!

Slashcode writers (-1, Flamebait)

Anonymous Coward | more than 5 years ago | (#28464135)

Fix this fucking problem already:

by Anonymous Cowardon Wednesday June 24, @11:38PM

Hanlon's Razor (3, Insightful)

gmuslera (3436) | more than 5 years ago | (#28463455)

Is not very surgical, but probably will be the right tool to diagnose this problem.

Electronic Health Records is very hard (5, Informative)

dreadlord76 (562584) | more than 5 years ago | (#28463467)

Having worked in development of EMRs, it was an extremely challenging area to work in. Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way. In a particular area, such as diabetic care, it was possible to templatize the intake notes. But when dealing with general care, it became a very difficult data input issue, and meaningful data extraction was messy.
A very large HMO has spent Billions on an EMR, with major IT consulting involved, and little to show for it. The benefits were very clear over 15 years ago. The medical community wants it to save money, and also to document against malpractice suits. The OP's take on why it has not been adopted was definitely not the view at the VP levels of the HMOs...

Re:Electronic Health Records is very hard (2, Insightful)

rtb61 (674572) | more than 5 years ago | (#28463591)

The biggest danger, manually you might make one mistake, electronically you can repeat that same mistake thousands of times before you catch it. Next up of course are software warranties, typical M$ warranties categorically states the software is "unfit" for any purpose, so if using it results in an error occurring it immediately leaves the hospital liable for criminal negligence as the software EULA stated it was unfit for the use to which is was put and the hospital "choose" to ignore that warning and use that software at the patients risk.

Strange things can really happen with computers, as stray neutrino can strike a transistor and change it's state and either cause a system to crash or the wrong prescription to be issued. In the medical field, it is life or death and manual system continually checked, and immediately reviewable by any concerned parties do have a considerable safety advantage, this can certainly be augmented by electronics but replacing it requires extremely reliablly hardware and of course software with warranties that actually warrant the quality and reliability of the code in the software.

Re:Electronic Health Records is very hard (4, Informative)

Z00L00K (682162) | more than 5 years ago | (#28463881)

Not all medical systems are equally sensitive, and if there is a one in ten million risk of a technical error causing incorrect data for a patient the risk of prescribing the wrong medication is a lot higher if the doctor can't get the whole picture because information is locked away in an inaccessible system or only exists on paper.

There is the Unified Medical Language System [nih.gov] that is supposed to address some of the issues regarding interoperability, but I'm sure that there are a lot of problems left to take care of.

Another problem with medical records is the privacy issue. Some data may be embarrassing like sexually transferable diseases. Others like broken bones are rather harmless for the privacy.

And the issue of keeping medical records accessible is an international problem.

Re:Electronic Health Records is very hard (5, Informative)

ILongForDarkness (1134931) | more than 5 years ago | (#28463901)

I worked at a cancer centre and controlled the treatment planning, delivery and records. In my experience if something was going to get screwed up across the board it would have to be me that does it. Individual doctors and therapists just had access to one patients "file" at a time. Technology also makes it much easier to fix problems. For example, we had to report the time that a patient had to wait for treatment. The definition of the start date changed (can't remember something like it used to be when the treatment plan was approved by the oncologist, but became the date that the oncologist consult happened), anyways with a half hour of thinking and a couple lines of SQL I was able to change this value to the new definition on 10k+ patient files. With a paper chart they probably would have had an intern sitting around for weeks updating charts rather than practicing medicine. Manual practices are just that, manual, lots of health care provider time is wasted waiting for a chart that someone else has. With an electronic chart everyone can view the same chart at the same time (they usually lock the chart so only one person has write permission at a time though).

As for hardware reliablity: I had 5 servers, 60 workstations, a CT, and 5 radiation therapy machines (which themselves have 3 computers running in a voting redundant system), in the two years I was there we had 1 day that we were down because our database came back with an inconsistancy after its backup. Patients were then treated with the paper method and it was much much slower, treatments easily took twice as long because of waiting for charts etc. It actually turned out not to be bad, it probably was your stray neutrino scenario, anyways we left it in the state we found it in so that the vendor and database supplier could find the problem so it wouldn't happen again. We could of been back up in an hour because we had tape backups of the system. What happens if someone spills their lunch on a paper chart? Also, for another 50k or so you can get a hot standby server to failover to.

Also reporting is much easier from electronic systems. I got questions all the time like "what percentile of breast cancer patients getting 20 or more sessions waited for more than one week to start treatment?", I was able to have the answer over a 5 year period in less than an hour. It was much harder for a physician to bullshit his way into justifying his performance when any claim he made could be verified that quickly. In a paper system it would take days of someone's time to verify that stuff and so it probably wouldn't happen until someone had a bad outcome or a malpractice suit was filed.

Re:Electronic Health Records is very hard (1, Interesting)

Anonymous Coward | more than 5 years ago | (#28464633)

Computerised medical records can be great fun. I once visited a certain type of clinic and gave my name, and was asked if i had lived in a certain city, which i had. and a certain road, which i hadn't, but I knew who had!

Re:Electronic Health Records is very hard (5, Insightful)

Yoozer (1055188) | more than 5 years ago | (#28463913)

Strange things can really happen with computers, as stray neutrino can strike a transistor and change it's state and either cause a system to crash or the wrong prescription to be issued.

Why blame computers (and why go the lengths to blame stray neutrons) when humans themselves can screw up far more often and far better [smh.com.au] ?

Re:Electronic Health Records is very hard (4, Informative)

greenbird (859670) | more than 5 years ago | (#28463931)

Strange things can really happen with computers, as stray neutrino can strike a transistor and change it's state and either cause a system to crash or the wrong prescription to be issued.

It's idiotic statements like that which make the non-experts in the technology field shy away from technology. The odds of a human error is many orders of magnitude greater than the odds of a stray neutrino causing a wrong Rx.

Re:Electronic Health Records is very hard (5, Informative)

adavies42 (746183) | more than 5 years ago | (#28464145)

neutrino? i think the odds of a neutrino hitting a transistor are about the same as the odds of a 1000-bed hospital's patients all going into spontaneous remission from everything simultaneously, then living to 120. photons or cosmic rays or something maybe, but neutrinos have a 50-50 chance of getting from here to alpha centauri through solid lead.

Re:Electronic Health Records is very hard (4, Funny)

dkf (304284) | more than 5 years ago | (#28464371)

neutrino? i think the odds of a neutrino hitting a transistor are about the same as the odds of a 1000-bed hospital's patients all going into spontaneous remission from everything simultaneously, then living to 120. photons or cosmic rays or something maybe, but neutrinos have a 50-50 chance of getting from here to alpha centauri through solid lead.

Indeed, there's a higher chance of the neutrino changing the state of the doctor's own neurons and making him flip out and start turning patients into mutant zombies in a plan to take over the world...

Re:Electronic Health Records is very hard (0)

Anonymous Coward | more than 5 years ago | (#28463611)

Yep, people outside the field grossly underestimate its complexity. There are tens of thousands possible tests one can subject a patient to, tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes, states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient. No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo.

Re:Electronic Health Records is very hard (1)

MrMarket (983874) | more than 5 years ago | (#28463633)

So, instead, we should treat every physician encounter as a first encounter? How is that any better?

Re:Electronic Health Records is very hard (3, Interesting)

Antique Geekmeister (740220) | more than 5 years ago | (#28464009)

It means you don't get to see the physician twice, and learn about each other so they can tell when you're lying and you can tell when they're full of horse pucks. And it means that you can't organize your visits to arrange for expensive, long-term treatments for those chronic conditions like sleeplessness, work-related stress and RSI, diet and lifestyle changes. It's also a way to avoid providing mental care, which is very dependent on generating trust and non-verbal communication between a therapist and a patient.

NHS IT: last year's hardware at next year's prices (2, Interesting)

AGMW (594303) | more than 5 years ago | (#28464535)

There are tens of thousands possible tests one can subject a patient to, tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes, states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient. No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo.

So why not have the ability to "skin" the interface to keep the primadonna clinicians happy? Provide a 'reasonable' default interface and a tool kit that enterprising folk can use to charge the clinicians for making a bespoke interface for that clinician. The clinician then owns his own interface that he can carry around with him (on a thumbdrive maybe).

The system should obviously provide an interface that attempts to provide standard information in a standard way, but should also have the ability to step 'over' the standard way when the clinicians feel it is preventing them from correctly/accurately/fully writing up the patient notes. These occasions should automatically flag themselves up to someone in the "office" who can manaully glean the correct info to fill in the "standard info". It could also notify the writers of the software, providing a feedback loop to help to improve the software for future versions.

My experience of "IT in Healthcare" is the closed shop encouraged by the NHS which means you HAVE to buy from a very small set of approved vendors who then provide last year's hardware at next year's prices!

Re:NHS IT: last year's hardware at next year's pri (1)

Ihlosi (895663) | more than 5 years ago | (#28464557)

So why not have the ability to "skin" the interface to keep the primadonna clinicians happy?

Imagine the question "Which button do I have to push?" for each and every necessary function of the system. And more than one button (or, god forbid, navigating a menu) is not accepted.

Re:Electronic Health Records is very hard (3, Insightful)

nofx_3 (40519) | more than 5 years ago | (#28463703)

A very large HMO has spent Billions on an EMR, with major IT consulting involved, and little to show for it.
I assume you are talking about Kaiser Permanente's HealthConnect here? I think the key is that the groundwork has been laid. It takes a long time and a lot of money sometimes to be a pioneer in the healthecare industry. Ultimately it will likely benefit KP, as it will takes years for other systems to catch up if it's even possible for them to (most lack the integrated delivery system that made this possible for KP).

Re:Electronic Health Records is very hard (1)

boliboboli (1447659) | more than 5 years ago | (#28463739)

Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.

This ^^ With the exception it's usually more than only 3 doctors. My father-in-law managed a the business for a group of radiologists for 28 years and his 'challenges' at work really surprised. I was amazed at the ancient filing, tracking, and billing methods they used; Mainly because the doctors don't want to spend the money on it and/or can't agree on a course of action.

Re:Electronic Health Records is very hard (1)

fbjon (692006) | more than 5 years ago | (#28463951)

In Finland there are already systems for EMRs, where I'm working they were introduced around 2002 or so, and gradually phased in from a purely paper/folder-based system. Moreover, although different districts use different systems (or a few different systems at least), they have to interoperate in exchanging records. As I understand it, there's an initiative to make systems across the EU interoperate, but I'm not directly involved in the EMR stuff anymore and I can't remember the schedule for that.

Now, it may not be a dance on roses, but things aren't in the stone age here, at least. :)

Re:Electronic Health Records is very hard (5, Informative)

c0p0n (770852) | more than 5 years ago | (#28464163)

I would imagine the picture is very different depending on the country. I work on long term conditions monitoring systems in the UK and obviously our main client is the NHS. Even though our systems (or similar systems from other companies) will save the NHS a lot of money in the medium term it's been very slow to adapt due to the layers and layers and layers of management and middle management which also has a high rotation rate. It's not phobia to tech but politics (ie predecessor project on hold while I get mine to completion type of thing) for the most part.

About the article, it's fairly misleading and uninformed in my experience:

Too bad the medical industry has a vested interest in inefficiency.

Please spare me the conspiration theories. A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings. This, the big medical companies can't provide anyway, there's no conspiration, you wouldn't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products, therefore they simply sell same old.

Re:Electronic Health Records is very hard (5, Insightful)

lurker412 (706164) | more than 5 years ago | (#28464281)

I, too, spent many years working as a developer and IT administrator. While there are certainly some technical problems--security, privacy, and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral. Doctors are accustomed to a great deal of autonomy, and many do not care for the structure that systems impose. The VA has been more successful than most organizations because they can impose systems by fiat. Doctors are often subject to intense time pressure and will resist anything that slows them down. In the short term, it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system. Many don't care about the long-term problems that this creates. While administrators are more likely to be aware of the long-term benefits, there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways.

The premise of the the original article appeals to conspiracy theorists, but I have to say I have never seen any evidence that supports it. The author also fails to provide any. Rather than look to greed, it makes more sense to look at the UI failures of most commercial systems and the inadequate attention given to training and support during implementation.

Re:Electronic Health Records is very hard (2, Insightful)

ronaldo1 (11627) | more than 5 years ago | (#28464653)

U.S. Department of Veterans Affairs developed VistA - for everyone.

I am surprised the open source pundits dont know about this one.

http://en.wikipedia.org/wiki/VistA [wikipedia.org]
disclaimer: i work for the dva on vista every day

I have a different theory (3, Informative)

timeOday (582209) | more than 5 years ago | (#28463479)

Hold the conspiracy theories. It's relatively easy to install a stand-alone diagnostic device. It's a thousand times harder to migrate a system that's ingrained into how everybody does their work from moment to moment throughout the day. It requires conformity, and that means resistance (sometimes well justified!)

Re:I have a different theory (5, Informative)

nikolag (467418) | more than 5 years ago | (#28463969)

I don't have a theory I have experience.

I work for hospital that went digital (for patient recodrs) in 2006. All (billing) administration was internally digital (using different, obsolete system working on DOS and floppy disks) from 1997 and to outside world also, depending to health insurance company involved.
After 6 months of education, switch was made in one day. It was horrible, but after two weeks things were looking just as before. After several months, 75% of administration was more efficient than before, and now, 3 years later, we still print outgoing documentation, but doctors rarely look at papers. Nevertheless, printing expenses went 30% down this year.

Last year all waiting lists were computerized, and made available (with no patient data) at the web pages. That saved us so many work hours at all departments, but two people switched to that department. This year we are looking into making all internal administrative procedures digital. Hospital restaurant was really happy after we made their menu available online at intranet.

Several months before introducing the system, all work places received computers with unified user interface, and demo program installed. It was made really clear that someone should consider finding another job if they refused to work with system. People near the retirement (2-3 years) were exempt from this rule.

The problem very often lies in wanting too much (all). Process should be step-by-step. Billing first, patient records second, intra-hospital administration third or any other way. Every step should be planned, because people will suffer at it, and don't rush it. It takes months, sometimes years for one (new) work flow to settle in.

Radiology department is still not filmless, probably because it costs as much as putting all patient records in computer. Volume of data that our radiology department produces in one day is equal to 1-2 years of data from whole hospital. On the other hand, introducing PACS and RIS is so much more widespread, but the volume of data makes project harder in the long run. After testing almost a dozen of PACS/RIS demonstrations, one free PACS amazed us with results, holding test data (0.5T of images) and working better than some very expensive solutions.

Re:I have a different theory (0)

Anonymous Coward | more than 5 years ago | (#28464443)

EMRs != Digital records. EMRs is about storing information in a machine readable and interchangeable format- ie all your data conforms to an XML Schema or similar- whereas digital records are a baby step in that direction- the formats are proprietary with a lot of free-form text. A lot of hospitals use digital records that are either simply scans of paper charts or electronic equivalents of paper charts. These systems require human intervention or natural language processing to do all the magical things people want to do with EMRs. The advantages of these systems is that they are much simpler and work quite well as long as you're trained on and in the system that uses them. But if you're in an outside hospital or whatever, you usually resort to print outs and faxing for record interchange. And if you're a researcher, you still have to read all the fucking patient documentation and manually collect the data, you can't just do an SQL query over the entire system.

Most hospitals have digital records by now, or at least have some tiered system where records are recorded on paper then digitized later. Very few have EMRs. My wife works at one of the few that is trying full blown EMRs in some departments. Most people find it extremely frustrating compared to the older electronic charting system, because it takes a lot longer to explain what you're doing to a computer then it does to type it out so another human can understand. The UIs on the EMR programs are pretty terrible, screens and screens of checkboxes and giant drill down lists. And 25% of the time they end up clicking "other" and free handing it anyway because the data standards aren't specific enough yet for what they want to do. After 6 months it still took about 5-10 times longer for physicians to document their patients with the EMRs then it did with the the electronic charts.

Anyway, the benefits to hospitals and doctors of full blown EMRs tend to be abstract or delayed, but the frustrations and costs are immediate. The cost/benefit analysis for paper -> electronic charts is a lot more clear cut, which is why it's happened already at most big hospital systems.

Re:I have a different theory (1)

fbjon (692006) | more than 5 years ago | (#28464611)

At the university hospital where I work, things work exactly as you describe. Billing is one system, data for insurance companies another. General EMR handling and input, laboratory system, cancer treatment, radiology... numerous systems that do different things, but interoperate.

I cannot even begin to fathom the monster system that could encompass all of it in one go.

Re:I have a different theory (1)

dcherryholmes (1322535) | more than 5 years ago | (#28464655)

I am curious which free PACS you are referring to? I built a custom PACS system for a major hospital consisting of bits of dcm4chee, the dcmtk toolkit, and a bunch of bash scripts that glued it all together. Our research staff were comfortable enough with the command line to be able to go "fetch [HISTORY NUM] [# previous studies]" as well as several other utilities, and it worked well enough for us. The main advantage of the system was to be able to cron-job the fetching of the next day's patients prior studies in the middle of the night, something none of the commercial systems (all GUI-fied) allowed us to do.

Easy to test (4, Informative)

Allicorn (175921) | more than 5 years ago | (#28463487)

Were your hypothesis correct then there should be a visibly greater level of non-clinical IT adoption in tolerably resourced, state-funded healthcare schemes - eg the UK.

Re:Easy to test (1)

arethuza (737069) | more than 5 years ago | (#28464011)

I can see how you might think that. However, while the UK NHS can be truly excellent in the actual care provided (not always, I admit) the organisation is now plagued by management and IT consultancies spending billions and achieving very little complicit with the muppets who run this country.

OK I apologise, I was being unkind to muppets there. I don't think that there has been any evidence that the furry little buggers were morally and financially corrupt, unlike the leaders of a certain county...

Some insight perhaps? (0)

Anonymous Coward | more than 5 years ago | (#28463509)

I work for a company that makes ophthalmic ultrasound machines.
1. They cost roughly $30000USD per system, plus a couple grand for training. Most large hospitals and HMOs are run by bean counters who refuse to spend any more than they absolutely have to, and they could care less if everything is still paper records. Smaller organizations are just so cash-strapped that they CAN'T spend money on non-essentials. Government hospitals (like VA hospitals) have NO money to even fix aging equipment, let alone buy new or have fancy things like IT.
2. Quite a few medical people are, frankly, pretty average intelligence, if that. Some are complete doorknobs and barely know how to use a PC let alone deal with using a network. Almost all of them are so damned busy that they don't have the TIME to learn non-essential skills like computer and network use, let alone having time during the day to actually USE the stuff, unless it's absolutely necessary to do their jobs.

Re:Some insight perhaps? (4, Insightful)

drDugan (219551) | more than 5 years ago | (#28463619)

Government hospitals (like VA hospitals) have NO money to even fix aging equipment, let alone buy new or have fancy things like IT.

HUH ????

The VAs electronic health system is called VistA, and it is the EMR in the largest health system in the US. It covers all veterans, it is used nationwide, and it is so prevalent that most everyone who talks about standardizing medical records and medical data all talk about matching the VistA system in doing so.

It's a good thing (0)

Anonymous Coward | more than 5 years ago | (#28463529)

"making medical records available for data analysis" will also lead to easier abuse and leakage of said data.

All your medical data managed by one IT service provider ('cause that's where IT in healthcare usually leads to)? There's no way this could go wrong.

Incidentally what was the name of the social website that tries to sell its users' data after going out of business?

one word: protectionism (3, Interesting)

drDugan (219551) | more than 5 years ago | (#28463551)

The nugget of this is not explained really in the article:

Cost is *NOT* the barrier, but "lucrative business model hidden" what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.

In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons. For good reason, society has left medical care in the hands of competent, trained people. However, competency and training has been industrialized to only 1 kind of person, with one kind of standardized training: the MD, and basically no one else, regardless of training or ability is allowed by license to practice medicine, or reap the financial rewards of such extreme responsibility. NPs have wiggled their way in a bit and DOs are close, but basically no one else.

When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money. They will lose their self-created and maintained monopoly on responsibility for care.

Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about.

Re:one word: protectionism (2, Interesting)

umghhh (965931) | more than 5 years ago | (#28463637)

I suppose engineering approach i.e based on merits would not work here and the reason is simple: this is one of t he two remaining guilds in modern world (the other one being lawyers) and thus any change has t o come from within. If the change is perceived as a cost and burned or even threat then it is not going to happen. Unless that is the system collapses under its weight of its own fat.

Re:one word: protectionism (1, Insightful)

addsalt (985163) | more than 5 years ago | (#28463699)

When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments

As patients, we often forget that most diagnoses are really just a SWAG. A doctor usually can't be 100% confident that his diagnosis is correct, but does his best based on his expertise and the training he has. If I were a doctor, my daily concern would be malpractice suits. I don't even want to know how many incorrect engineering decisions I make in a year. If I had to be concerned about being sued for every one of those incorrect decisions, I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.

Re:one word: protectionism (1)

drDugan (219551) | more than 5 years ago | (#28463823)

ironically, lording over the data is a large reason why care providers often still have to make SWAG diagnoses, instead of having a long progression of better medical knowledge fueled by accessible research and outcomes data.

Re:one word: protectionism (1)

nikolag (467418) | more than 5 years ago | (#28464019)

As patients, we often forget that most diagnoses are really just a SWAG. A doctor usually can't be 100% confident that his diagnosis is correct, but does his best based on his expertise and the training he has. If I were a doctor, my daily concern would be malpractice suits. I don't even want to know how many incorrect engineering decisions I make in a year. If I had to be concerned about being sued for every one of those incorrect decisions, I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.

It stands that You make considerably smaller amount of false engineering decisions. When did You have default value range 1-100 out of possible 0-300 units? It is common thing in medicine.
If You put voltmeter at test point number 321, you measure exact that voltage, while in medicine, blood sample can literally be different because the room walls were of different color or because nurse said something or it was not taken in the morning but after the lunch.

It seems to me that considerable number of problems comes from the fact that engineers are used to work with models, while medicine is done in the real conditions. I agree that science part of medicine makes difference, but the ground is still shaky.

Just remember, if something is done in one hospital/county/state one way, there is no way that all of it will be the same in next hospital/county/state.

Re:one word: protectionism (1)

Ihlosi (895663) | more than 5 years ago | (#28464067)

If You put voltmeter at test point number 321, you measure exact that voltage ...

... but you misread the number.
... but your voltmeter is broken/uncalibrated/set to the wrong setting.
... but the documentation is wrong, and the voltage you wanted to measure is really at test point number 320.
... but the exact voltage doesn't do you any good since the problem is caused by transients that are too fast for your voltmeter.
etc. ;)
Oh, and there's no such thing as an "exact" measurement. Not even in engineering.

Re:one word: protectionism (1)

PeterBrett (780946) | more than 5 years ago | (#28464599)

Oh, and there's no such thing as an "exact" measurement. Not even in engineering.

Especially not in engineering.

Re:one word: protectionism (5, Informative)

dmr001 (103373) | more than 5 years ago | (#28463733)

Parent either is full of it or lives in a parallel universe.

1. Cost is not a barrier? Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).
2. MD's have a monopoly? What planet are you on? DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in." As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money. I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records. Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars. (I am looking forward to upgrading my '94 Corolla by 2014.)

EMR systems have poor market penetration, in my direct experience over the last 9 years, because:
1. Many, if not most, suck in a medium to large way;
2. They are incredibly expensive;
3. They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;
4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)
If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
TFA refers to cardiac CT to prevent heart attacks. The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.

Re:one word: protectionism (1)

fbjon (692006) | more than 5 years ago | (#28464045)

Those points about EMRs look to me like a stagnated market, rather than inherent difficulty. In particular point 4, isn't HL7 [wikipedia.org] precisely what solves that?

Re:one word: protectionism (1, Insightful)

drDugan (219551) | more than 5 years ago | (#28464073)

Sorry, but as a physician, you come to the table with a prior of zero credibility in a discussion of financial matters.

Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.

Physicians in the US have created a closed system that requires a *state license* to enter, and then they earn 3-10+ times the median salary:
http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary [payscale.com]
commensurate with remarkably low unemployment (while the rest of the US are now around 9.4% and rising).

I'm a strong supporter of anyone who creates high value earning as much as possible. When one builds value or manages high responsibility, they get the money.

Unfortunately, physicians in the US are not creating significant value despite the costs and their salaries. The costs to the US society have gone now above 17% of the nation`s Gross Domestic Product (GDP), and rising at rising four times faster on average than workers` earnings since 1999. That means more than 1 in 6 of *EVERY* dollar of value created in the US goes to this racket (sic). High cost, by itself, not a problem: health is extremely important BUT, health results in the US are not very good, on a cost comparison basis with other 1st world countries:
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Sep/Why-Not-the-Best--Results-from-a-National-Scorecard-on-U-S--Health-System-Performance.aspx [commonwealthfund.org]

For all this expense, and all those salaries, US health is not as good. Why?

Becuase care providing is a controlled, state-sponsored monopoly. In any other industry physicians would all have been fired and improved long ago for such a horrible financial mess coupled with such poor comparative results. As a physician you and your peers created and profit directly from the high costs in the system.

I agree with any of your assessment of EMRs. They are dead on - but interested physicians driving this technology forward with a sincere interest in human health and not solely on protecting their business and on profits would have made EMRs a priority more then 30 years ago when research in this area first started, and solved all those issues.

And as for "Medical care in most locales in the US has long been collaborative, team-based system" - that`s comic. A physician`s definition of "team" and what everyone else in the work world means with that word are miles apart.

Re:one word: protectionism (1, Insightful)

Ihlosi (895663) | more than 5 years ago | (#28464101)

Becuase care providing is a controlled, state-sponsored monopoly.

This might be news to you, but it's pretty much the same as in the other first world countries, which are getting better medical outcomes at lower overall costs.

Re:one word: protectionism (0)

Anonymous Coward | more than 5 years ago | (#28464133)

the US has just enough regulation to maintain the monopoly, but not enough control to ensure central planning for good outcomes - that would be... horrors, "socialism"

the same is true for the cell phone market - state supported companies given permission to monopolize and provide crappy service here.

it's the worst of all possible cases - either getting out completely and allowing the market to work would be better services, or stepping in all the way and providing centrally planned services would be better too, than this.

Re:one word: protectionism (0)

Anonymous Coward | more than 5 years ago | (#28464593)

The reason these systems suck and are expensive is because they are the result of "design by committee". What would be a good approach is that there is an existing system (home-grown perhaps) which gets transferred to another hospital, where a representative group gets together and says "This and that needs to be changed, the rest is OK."

What happens instead is that a committee is formed out of hospital representatives who don't know much about IT, and IT managers who don't know much about hospitals (and, frankly, not about IT either). Since every hospital is absolutely unique and works completely differently from every other hospital (sarcasm intended), a new system needs to be designed from scratch. The hospital representatives list requirements they don't _really_ understand, the IT managers perform CYA tactics because they don't oversee the implications or the _real_ requirements (and they don't actually mind - if the hospital asks for a five-nines system they are more than happy to comply since they can raise the cost tremendously).

Then, there are patient representation groups who interfere because they have privacy concerns, insisting on physically separate ADSL lines going from MD offices to chemists and hospital IT lines because "the internet can be eavesdropped" (I'm not making this up), restrictions get built in so that some kind of card reading device is needed at every desk which the doctor has to sign in on to send prescriptions out (what happens now is that the doctor has more pressing things to do than sign the prescriptions, so their assistants send them out and he signs them in bulk in the evening - what will happen after the card reading devices are installed is that the doctor will simply leave his card in the machine and move on to the more pressing work), etcetera.

Result: The system gets more and more expensive, more and more bloated, and in the end doesn't get implemented.

Re:one word: protectionism (4, Insightful)

dr_canak (593415) | more than 5 years ago | (#28464617)

"4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)
If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize. "

Whenever this topic comes up, the same answer always eventually comes out to address "4", which is of course VA's VISTA/CPRS. Not only is it customizable and extensible, but the program and code are free to anyone who wants it. And I don't see the programmers from the VA winning any Nobels any time soon ;-). Read "The Best Care Anywhere." Even if you disagree with the premise, Longman presents an interesting section on how VISTA, and later CPRS came into being. It's his position that an important (if not primary) reason there is not adoption of electronic medical records in the private sector is because it can actually create a competitive disadvantage.

Massing huge amounts of electronic, easily accessibly medical information on an individual is really only advantageous to the patient, provider and system if the patient remains with the same providers and same health care system, which of course is true for the Veterans treated by VA. Long term, detailed information on a patient is advantageous on the patient level because you can monitor more easily preventive health measures and track health status over time; for the provider it means decision making can be more informed which should improve outcomes; for the system it means better outcomes and presumably more competitive advantage. But here's the rub: patients don't stay with the same providers or same systems. Health care has become so complicated that person's change their care plan, and hence their providers and health care system often. If I'm Blue Cross, I can guarantee you I know exactly what the rollover of the person's in my panel are from year to year. If I'm a hospital administrator, I know exactly how many person's come and go through the plans I have contracts with and how many are seeking care at my facility. As you point out, unless a facility takes a stab at VISTA/CPRS, EMR's can be insanely expensive to develop. And deployment, penetration and compliance within a facility/system is a herculean task requiring a major change in culture to ensure adoption. So, as some sort of health care system administrator, for every patient that moves to another plan and hence gets care from other providers in other hospitals, I have just given my competitors an enormous advantage in their care of this patient. The patient is able to bring them their complete, beautifully printed out and organized medical record to aid their providers in the care of this person.

Now, of course, it also says I would have the same benefit when patients come to my system. The problem is who is going to budge first? And if someone else budges, and I can attract those patients to my system, then maybe I don't have a good incentive to develop an EMR for my facility in the first place. Maybe I should spend more money on a finely landscaped, aesthetically beautiful, modern bed tower? Because, really, the patient is going to leave and go elsewhere eventually. When they change jobs, their health care plans change. When life circumstances change (e.g. they now need a family plan), their health care plan changes. There's a ton reasons person's change health care plans, and very few of them have to do with actually wanting to see a certain person or get care at a specific facility. Without these lifelong relationships between patient, provider and system, it's hard to convince a facility of any size, be it a small practice of primary care providers to large health care systems buying up hospitals, to invest the time and energy in an EMR. And it will remain this way until there are clear financial incentives to do so; or the health care system is totally revamped such that lifelong relationships between patients and providers is again feasible.

later,
jeff

Re:one word: protectionism (0)

Anonymous Coward | more than 5 years ago | (#28463757)

When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.

This all sounds good, but how exactly does charting via PC (instead of by hand) somehow change the rules that Doctors (regardless of if they are DOs or MDs) are the ones who write the orders that all the other practitioners follow? Granted, FNPs (Family Nurse Practitioners) and PAs (Physician Assistants) can now write orders and scripts, but thats because they are now filling in the position of general practitioner that most MDs have abandoned in pursuit of more lucrative specializations. Plus, there is currently a push to make it mandatory that by 2015 all nursing practitioner programs are based on DNPs (doctorate of nursing practice), and not masters....so they are still all docs...

Re:one word: protectionism (0)

Anonymous Coward | more than 5 years ago | (#28464111)

I find it interesting how huge pressure from law practitioners changed medicine in united states. All this segmentation parent is talking about can be traced to increased liability pressure, long and expensive education and some other things.

Have you seen how much money it takes to become an MD? Did you see how much hospital spend on liability? Ant to top that all, what are the profits (holy grail of capitalism, I agree) of health insurance and pharmaceutical companies?

Re:one word: protectionism (1)

ndogg (158021) | more than 5 years ago | (#28464293)

In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.

Sure, all those people must be in cahoots. There must be a conspiracy here.

DOs are close

Yes, let's promote a profession with foundations as dubious [quackwatch.com] as baby twisting motherfuckers [youtube.com] .

What's wrong with redundancy? (1)

Khamura (664892) | more than 5 years ago | (#28463599)

Am I alone in thinking that some systems are better off with a buffer of redundancy rather than streamlined efficiency?

Re:What's wrong with redundancy? (1)

fbjon (692006) | more than 5 years ago | (#28464057)

There's nothing wrong with redundancy, unless it's redundancy of the wrong kind.

Positive uses (1)

The Clockwork Troll (655321) | more than 5 years ago | (#28463617)

While liability is a concern, the medical industry needs to see that there is a real bright side [recomdata.com] to analysis of medical data as well.

No evil conspiricy (-1, Troll)

addsalt (985163) | more than 5 years ago | (#28463639)

I wish fear mongering didn't sell articles. Before all the rants begin about how the elitist and corrupt medical community don't want the public to see how they are being manipulated, we need to remember the group of people we are talking about. Most doctors office decisions are made by doctors. While this is a highly skilled group, I wouldn't expect IT to be a strong focus in med school. A much simpler explanation for why IT is not strong in your local doctor's office is because they don't know enough about it to trust it, or understand why and how it could help.

Re:No evil conspiricy (1)

Ihlosi (895663) | more than 5 years ago | (#28463705)

A much simpler explanation for why IT is not strong in your local doctor's office is because they don't know enough about it to trust it, or understand why and how it could help.

Some older doctors might even be scarred for life from their encounters with IT in medical school. I have a case like that in my own family - for his dissertation, he did a statistical evaluation of certain accidents (probably trivial today, just punch the data into a spreadsheet and you're done in less than five minute) ... with punch cards.

He'd only touch any kind of computer with a ten-foot pole ... if the twenty-foot pole is broken. Heck, most electronical devices that come with more than one button and don't read minds drive him bonkers, unless he learned how to operate them thirty years ago. Navigating a menu (like that of a cellphone) is a completely alien concept to him.

Some people just relate to computers like geeks relate to people, really. ;)

Dartmouth College Institute for Health Policy ... (1)

vic-traill (1038742) | more than 5 years ago | (#28463649)

From TFA:

The amount of unnecessary spending is huge. In a project that analyzed 4,000 hospitals, the Dartmouth College Institute for Health Policy and Clinical Practice estimated that eliminating 30 percent of Medicare spending would not change either access to health care or the quality of the care itself.

The first thing I did was go looking for who funds the Dartmouth College Institute for Health Policy and Clinical Practice. Following the second search result [dartmouth.edu] was just too damn funny - excellence.php needs a bit of work, I guess.

Who benefits by data-mining EMRs?. (1)

vic-traill (1038742) | more than 5 years ago | (#28463813)

Replying to my own post is in horrific bad taste, so I expect to get the bejesus mod'd out of me, but ...

I don't know how the dollars add up, and it also smacks of conspiracy theorism, but advocating automation in health care as a cost saving measure, with a side benefit of data-ming the hell out of electronic medical record systems looks like enlightened self-interest for health insurers

And when the Dartmouth College Institute for Health Policy and Clinical Practice (author of one of TFA's cited sources) looks to be financed by health care suppliers (J and J), and really large health insurers (Wellpoint, United Health) through their charitable foundations, my spidey sense really starts tingling.

None of which means that there isn't any merit in the article. Maybe I'm just being too cynical at 4:00 a.m.

lots of work for very little gain (4, Informative)

petes_PoV (912422) | more than 5 years ago | (#28463663)

The NHS has showed that throwing money at the problem doesn't, in fact, help. For years they've spent billions on trying to get everyone's records on line. There's been lots of fine talk about the advantages of having the records of a patient who lives in Dorset available to a GP in Fife (for example). However, in practice, the benefits (as for most IT projects - especially government run / sponsored ones) seem to be mostly theoretical, uncostable and intangible.

However, the biggest stop to systems like this is the medical staff. Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med. school, just to be a secretary") and they, personally, don't gain anything from a system such as this. Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.

In the end, it's a people problem - not a tech. problem.

Re:lots of work for very little gain (0)

Anonymous Coward | more than 5 years ago | (#28463985)

...a patient who lives in Dorset available to a GP in Fife (for example)....

Wait a minute. You live in the UK and advocate more databases containing sensible data? You do know that the UK is kind of a running joke around here as far as lost data is concerned, do you? After all, you are the world leader in fields like "forgetting confidential documents in public trains", "losing harddrives with private information" and the "accidental publication of whole databases". :D

Re:lots of work for very little gain (1)

badfish99 (826052) | more than 5 years ago | (#28463999)

Of course, in the UK the situation is not helped by the fact that the first 100000 people whose details are entered into the system will be rewarded by having all their private medical history copied onto an unencrypted CD which will then be left on a train by a junior civil servant.

Re:lots of work for very little gain (1)

malkavian (9512) | more than 5 years ago | (#28464367)

Throwing money at a problem with sod all in the way of technical review doesn't help. That's exactly what the government in the UK did with their NPfIT project (National Project for Information Technology), which is the system whereby all medical records are supposed to be digital and available nationally.

The specifications were a joke, with each of the "commercial partners" building it differently, with different understandings of the data to the extent that I have the strong suspicion that they wouldn't actually be fully compatible with each other.

Also, the decision on the system was taken by a quick look at it in ONE hospital, where it worked perfectly, and then it was decided that would be the core for everything, without working out if it would really scale properly. Then there was the whole set of "revisions" where the initial would mean you couldn't do things you historically could, and you'd be stuck in a backwater for a decade.

Whole rafts of products were promised which still aren't available and working for it, making it pretty rubbish for day to day usage (in many cases, extra people have had to be hired to perform the 'work arounds' to cope with the increased workload of having to follow a seriously strict method of entering data, such that followup appointments take about 15 mins to book, where they used to take a few seconds with a receptionist).

The chap who headed the whole thing up in the early days was one Richard Granger, whose large claim to fame was that he initially failed his degree, and it took his mother writing to Princess Anne to lean on Bristol University to let him do a retake of the exam (which normally isn't allowed).

The core Cerner product at the heart of it is actually pretty good as a one off. But scaling up isn't what it was designed to do. As every slashdot story needs a crap analogy, I have one for it that I mention to people to describe my take on it:

To deliver newspapers to the door, you'll find it hard to get better than a kid on a bike doing a paper round. The whole NPfIT project makes the assumption that because that's a good mechanism for delivery, it's got rid of the fleets of heavy trucks, and does the entire delivery from the printing works by hiring tens of thousands of kids on bikes instead.

Why would anyone want to use lousy software? (2, Interesting)

meander (178059) | more than 5 years ago | (#28464543)

However, the biggest stop to systems like this is the medical staff. Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med. school, just to be a secretary") and they, personally, don't gain anything from a system such as this. Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.

I speak as a general practitioner of many decades, and I've been playing with computers since the early 70's. The main reason medical records software is not accepted is that it sucks.

My 24" screen holds far less information than a bunch of scribbled A4 pages. Time is what I lack, and scrolling through pages & sections on a screen is just not very efficient.

Yes, there are some great aspects in most of the software I have used over the last decade, but as far as being a place to store info that I want to easily access & collate later, all too often it is too bloody slow & awkward.

Except for one feature of electronic records, I would go back to pencil & paper.

The only really successful feature was the first; writing scripts & recording the fact that a script was written. In the 'old' days, you would write a script, then the phone would ring, on hanging up, you forgot to record what you had just prescribed, leading to problems down the track. Software to prescribe & automatically store a record of that transaction has been fantastically useful for both myself & the patient.

I have sat here for some 10 minutes, and the only other feature I like is that my notes are more legible to me down the track. As a computer nerd, I want to love these systems, but so far they are not very good.

Re:lots of work for very little gain (0)

Anonymous Coward | more than 5 years ago | (#28464561)

Would you rather have your doctor spend 10 minutes explaining to you why he is doing what he is or typing your chart into a database? Doctors job is to save lives, not spend his valuable time typing stuff into a computer.

Up coding (1)

MrMarket (983874) | more than 5 years ago | (#28463715)

We're tired of waiting for docs to adopt EMRs, so we're about to roll out a claims-based PHR for our members to keep track of basic things like physician encounters, vaccinations, drug lists and interactions, etc -- basically anything you can get from an insurance claim. I'm not looking forward to the switchboard lighting up on day one when they discover they've been diagnosed (a.k.a up-coded) with conditions for re-reimbursement reasons rather than actual diagnostic reasons.

Too much testing required (1)

Gribflex (177733) | more than 5 years ago | (#28463789)

There's another good reason.

In the IT Healthcare Sector, teams have to perform intense amounts of testing on all aspects of the system (right from the specs, to the product, to the docs, to the training - the whole deal). Some of the testing can be done in house, some has to be signed off on by external bodies.

This kind of process is expensive, long and inflexible. None of these things is conducive to rapid development or innovation.

Re:Too much testing required (1)

criptic08 (1255326) | more than 5 years ago | (#28463919)

We trust software to route trillions upon trillions of dollars. We trust software to take humans into space. I dont see the problem.

Re:Too much testing required (1)

centuren (106470) | more than 5 years ago | (#28463989)

We trust software to route trillions upon trillions of dollars. We trust software to take humans into space. I dont see the problem.

While I've yet to see or write any software that manages to actually take a person into space, it's true that software is used for a lot of important parts of society that require our trust.

It's also true that we have seen software fail horribly at many of these things. Software didn't work so well on wall street in the 80s. Software hasn't exactly performed well with elections. We read about massive security breaches into government systems, or places that store huge amounts of personal info.

It's an easy issue for me; I simply won't trust an IT solution to be implemented in a way that doesn't make my medical information horribly vulnerable.

Re:Too much testing required (2, Insightful)

Gribflex (177733) | more than 5 years ago | (#28464115)

Agreed.

All I'm saying is that if the level of validation for medical software/hardware is along the level of that required by Nasa, then we should expect rates of innovation and total cost to be commensurate with the IT Systems used in space shuttles rather than IT Systems implemented in other fields.

This stuff moves slowly because we make it move slowly. Is that bad? Probably not; but it shouldn't come as a surprise.

real or perceived difficulty? (1)

CaptainNerdCave (982411) | more than 5 years ago | (#28463841)

is it some sort of real problem, or just the expected difficulties? is it the curmudgeons in bureaucratic positions that are afraid of "new", or is there something else at work here, like mentioned above (easily finding extra charges, etc)?

for a while, i sold insurance for AFLAC. around my area, there is a HUGE hospital system, Meritcare; the last time i checked, they had around 20k employees (that's 10-15% of the working population, depending on the radius used for calculating).

they will not permit AFLAC to come in and offer their products because of the perceived difficulty of presenting and making it available to everyone.

maybe it's just me, but if wal-mart can find a way to share something with all of their employees, i'm pretty sure a relatively small hospital system can.

Information is a double edged sword. (0, Redundant)

Bob_Who (926234) | more than 5 years ago | (#28463875)

I agree. I think there is a lot of fear and apprehension of putting data "on the record", particularly in a litigious society. It is as likely to work against you as in your favor. If on the one hand that information limits privacy or insurance policy coverage for patients, it may also be implemented in exposing incompetence, neglect, and greed. Its a double edged sword, since in truth, people behave like there is an angle on one shoulder and a devil on the other. We only want to reveal the good stuff, so the diploma is on the wall, and the malpractice settlement remains undisclosed. Information Technology won't do a thing to change human nature, but it sure as heck will make our medical process more efficient. Lets move forward then, in spite of the perceived cultural drawbacks and fears.

Re:Information is a double edged sword. (1)

Ihlosi (895663) | more than 5 years ago | (#28463907)

I think there is a lot of fear and apprehension of putting data "on the record", particularly in a litigious society.

Reverse the burden of proof in lawsuits, and you'll notice a sudden eagerness in putting everything on the record.

As someone who has worked on it... (5, Informative)

freedom_india (780002) | more than 5 years ago | (#28463883)

...there are multiple reasons and road blocks (natural and artificial):
1) Healthcare is about making profit. It is not about caring for health. I have seen many IT companies bite the dust during proposals by stating their systems could help caring for health quicker and much better. That's the last thing Blue Cross or anyone else wants.
The idea for IT companies is to open a presentation with how to increase profits. That, as far as i know, is the only presentation which interests the healthcare company.
2) There are combinational factors; for instance doctors and software don't go well together psychologically except in times of peace, which is rare. Instead of adopting touch screen systems and throw-away laptops small enough and tough enough, most companies insist on producing massive software run in PCs and Servers in a serene a/c room. Excuse me, which doctor has sanguinely traversed through a maze of Visual Basic or PowerBuilder application menus?
3) IT companies should seriously stop considering "integrated" systems which connect doctors with nurses with patients with pharmacies. No, for the last fcuking time, no we don't need integrated crap. All we need is a simple system that can be accessed with a max of three clicks and accepts voice input.
4) Record management: HIPAA is not exactly an easy job. Any standard created by a committee is, by definition, an as$ to work with.
5) Changes in systems result in changes in behavior and processes: something hated by surgeons, doctors and hospitals.
Don't attribute to malice what can be explained by stupidity.

Re:As someone who has worked on it... (3, Interesting)

FranTaylor (164577) | more than 5 years ago | (#28464001)

Your reasons 3 and 4 contradict each other.

Re:As someone who has worked on it... (1)

FranTaylor (164577) | more than 5 years ago | (#28464053)

HIPAA is a fact of life, it's not going anywhere. Deal with it.

Re:As someone who has worked on it... (1)

freedom_india (780002) | more than 5 years ago | (#28464273)

HIPAA is something you MUST do. Federal Law states it.
The law doesn't state i should like what iam tasked to do.

Doctors (2, Insightful)

drunkahol (143049) | more than 5 years ago | (#28463887)

Quite simply it is that Doctors believe they are the most intelligent people in the room whenever they walk in. They will accept no management advice, no time allocation advice, no parking advice, no dietary advice . . . no advice.

They believe that they are already operating in the most efficient manner and that any change will put patient lives at risk. Well . . . actually they don't believe this, but this excuse is used every time they don't like something. A quick "OOooooo - patient lives at risk" and any progressive idea is already on the back foot.

This ideology permeates through the health care system with consultants at the top right down through the chain to the nurses.

Getting these people to agree on ANYTHING is a Herculean task.

A friend of mine (a Doctor) was on a committee trying to bring more IT into the healthcare system in Scotland. He is very IT minded (read geek) and was keen as mustard to help push things along. Within a handful of months, he was at the end of his tether due to the sheer deluge of nonsensical crap that was being floated purely to waste the committee's time and ensure that nothing got done.

Re:Doctors (2, Insightful)

Anonymous Coward | more than 5 years ago | (#28464037)

Or maybe we IT guys are so incredibly annoying with our demands to computerise every last bit of everybody's lifes? I can only assume at some point you just fade out all this "integrated this and that"-"workflow bullshit bingo" crap that consultants regularly throw at people.

I'm a software engineer and I'm fed up with all the bullshit consultants and marketing people throw around. Have you looked at the product websites of applications from big companies? They are a load of hypothecial catchphrases and marketing dribble that sounds nice but once you actually have their Crap(TM) in front of you, it does NOTHING of the vaguely advertised stuff. It's just another complicated system that you have to get used to and that fails whenever you need it.

Re:Doctors (1)

Datamonstar (845886) | more than 5 years ago | (#28464091)

This is nothing new, totally off-topic and wrong. Doctors are pretty much like what the grandparent stated, for the most part. Big-headed and pissed off that the went to school for so long and there's still someone who can tell them what to do. Trying to get a doctor to do anything out of their normal routine is like pulling elephant teeth. Especially when it comes to IT. They think of it as something that is subsidiary to their role as caretakers, when it's actually central to it, as it is in pretty much any industry and they are completely in denial of that fact.

Re:Doctors (0)

Anonymous Coward | more than 5 years ago | (#28464179)

You are the closest to right. I don't think badly of doctors, but I have seen enough offices and hospitals (which are making forward thinking IT decisions quicker then private or small community practices) to know that doctors are uninspired to learn anything new. Same with nurses and assistants. Everyone has spent so much time memorizing books of symptoms and and insurance codes that learning an actual new process of communication is beyond the average practice to justify.

Also, some patients are the same way, they want an old office thats like the first office they ever visited, with a clipboard and the same 4 pages to fill out every time. The customers don't want (or simply just fear) change and the doctors agree and abide.

Conspiracy? (3, Insightful)

jandersen (462034) | more than 5 years ago | (#28463929)

There's ample room for conspiracy in the murky world of health care, but I don't think it is in IT - instead, look at medical companies and the way medicine is prescribed and used, if you are looking fopr conspiracies.

There are many good reasons why computers aren't used universally in health care. Two of the biggest are education and resources - doctors and nurses aren't really taught to use computers in their work. And while having a well designed computer system can be a huge advantage in any line of work, that is actually only true once everybody is fully trained; until that has been done, it is actually less efficient. And the situation in most countries is that there are too few medical staff anywhere, so where would one find the resources to make it happen?

On top of that comes concerns with incompatible, existing systems, privacy issues etc. Not to mention the fact that nearly all public IT projects so far have been hugely over budget and behind schedule. I think that perhaps the only realistic way this can be solved is by creating a good, open source health care system and let it mature and grow into general use from the grassroot up.

IT is only one facet of healthcare (5, Informative)

Anonymous Coward | more than 5 years ago | (#28463933)

I think there has always been a serious barrier to the uptake of new information technologies among the medical profession. Most HATE taking notes which is why note taking is left to the junior medical staff on ward rounds. Most clinicians take very brief notes, especially surgeons and only verbose when practicing defensive medicine. Most have a personal way to annotate their notes which cannot fit into any template (eg. unconventitional acronyms, stylized diagrams etc) and are loath to learn new ways of doing things. Sometimes surgical notes only make sense to that particular surgeon or surgeons of that sub-specialty (eg. ophthalmic vitreal surgery... very difficult to decipher...pain in the arse reading their notes.. ) Why? I think some of you guys need to see the amount of stuff medical specialists have to learn and the years of training (at least five here in Australia for specialty training, ( that is after 5-6 years medical school and another 1-3 years as general intern and resident) and then another 2-3 years for sub-specialty training which can involve 2-5 exams and possibly a PHD during the training). There is an incredible amount of stress on the person and their families. (Yes, I think the high standard of medical training IS necessary and not just economic gate-keeping by the medical colleges). During all that training before you are a qualified specialist, your hourly rate can be lower than the hospital cleaners or even not allowed to claim paid overtime at all, as the public hospitals here in Australia frequently runs out of money.

At the end of all that, I don't think many like to be told how to take their notes.

I don't think you need conspiracy theories to explain poor uptake of EMRs. In NZ where basically doctors can't get sued (generally speaking), doctors STILL hate EMRs and do poor job of entering data into systems. I once worked for an older surgeon and we got called for an emergency laparotomy on a drunk 19 yo male who lacerated his spleen in a car accident. The surgeon hated taking notes and hated talking to patients but was one hell of a surgeon. All his patient notes consisted of scribbles on flashcards. The young guy's abdomen was full of blood. We had no idea at the time where the bleeding was coming from. The surgeon was clamping major arteries by feel blindly as the suckers couldn't keep up. After five hours the surgery was over and the young guy lived. I tell ya, I had a new found respect for the "old school" surgeon. There are times when you REALLY don't care whether a surgeon is good at filling out forms or has polished bed-side manners.

Who keeps the records? (5, Interesting)

www.sorehands.com (142825) | more than 5 years ago | (#28463939)

I had an interesting experience in China. In 1996, when I received treatment, I kept my own records (they gave me a little paper booklet). This eliminates all the record keeping costs of the doctors and hospitals.

It might be an interesting model to look into here.

Re:Who keeps the records? (1)

Ihlosi (895663) | more than 5 years ago | (#28463959)

It might be an interesting model to look into here.

Frivolous malpractice lawsuit incoming in 3 ... 2 ... 1 ...

Oh, yes. This is China. Malpractice lawsuits probably aren't allowed or severely limited.

Re:Who keeps the records? (0)

Anonymous Coward | more than 5 years ago | (#28464227)

This is China. Malpractice lawsuits probably aren't allowed or severely limited.

Actually they're regulated by Happy Youth Litigation Dam, but I've heard Western researchers are making a big thing about loopholes...

Re:Who keeps the records? (2, Interesting)

drunkahol (143049) | more than 5 years ago | (#28464397)

I actually took part in a trial of a system like this at my local GP's when I was still at school. I've still got the credit card sized optical card that has a store of all my patient records at that time.

Don't know what the reasons for the demise of the project were, but carrying your own data around with you is exactly what people don't like about ID cards. It could also scratch easily and doctors had no access to the data unless you were actually in the practice with your card.

Centrally stored universally accessible (with applicable restrictions if you ABSOLUTELY need them) are the only way forward. Been knocked over by a bus in a strange city? Have medical complications that it would be just great if the Doctors treating you had access to?

Re:Who keeps the records? (1)

will_die (586523) | more than 5 years ago | (#28464483)

For most people this would be a lost item, not unlike the medical records from your childhood.
This was and idea brought up by Bush, but it was for people who were expecting medical problem and instead of having a medilert braclet you had a one that stored your medical records so in the even of an emergency all your latest tests, images and records would be on you.

Compter illiteate & overstretched staff more l (5, Insightful)

yes it is (1137335) | more than 5 years ago | (#28464031)

(Disclaimer: IHAPSITF - I have a PhD scholarship in this field).

In most healthcare systems, staff are very busy, and computer illiteracy is rife. To get good with these electronic systems you've got to use them constantly, and when half the staff or more don't understand why they're doing a particular thing in a particular way. There's also a workplace culture of written notes, and often a limited number of computer terminals per staff member. So with queuing for terminals, fairly high friction processes for retrieving data and so on and so forth, there are quite high barriers to entry from a human point of view.

Don't get me wrong, EHRs have potential, and can reap benifits (especially for management - they can also make floor staff's job harder). Some kind of robust iphone-like device which is a secure platform for data entry and retrieval, might make it sufficiently easy and efficient from an end-user's perspective to decrease implementation barriers.

Doctors hate technology (1)

Datamonstar (845886) | more than 5 years ago | (#28464043)

No really, Doctors hate technology for the most part from what I've seen, as they see it as intrusive and contradictory to their long history of practice. The number one concern I hear voiced is that having to deal with electronic records, especially with the patient present takes the doctor's attention away from the patient and that's a big no for most physicians. The other one I hear alot is that from the patient's viewpoint it looks a whole lot less intimidating and polite to have a doctor staring at a paper chart than a hand-held device. Something about a person staring into a screen as they attempt to hold a conversation with you is still a bit unnerving and something that we haven't fully gotten used to for the most part, I guess.

Re:Doctors hate technology (1)

hrvatska (790627) | more than 5 years ago | (#28464223)

It's not just doctors, I think many people hate technology unless its benefits are obvious and it's as easy to use as a refrigerator.

Re:Doctors hate technology (1)

raind (174356) | more than 5 years ago | (#28464269)

From what I've seen - the whole community, Doctors, Nurses and staff have more pressing ideas of what they want to accomplish other than looking at a bsod; or dumb terminals. They are busy actually caring for patients. That being said I wish they were more tech savy.

re (1, Interesting)

Anonymous Coward | more than 5 years ago | (#28464175)

Some things people fail to account for:
A) Cost. Some of these data entry systems are pricey! Some physicians who only have 5-10 years of practice time left and with private practices do NOT want to invest the time or the money to adopt such a system. The software runs thousands of dollars. You assume each and every physician is just REAPING in the cash and has 30,000 to invest in a computer system. Plus the cost of inputing old records into the data system on top of that. Granted its a system of healing people and what not, but everyone is out there to make a good living for themselves as well. You invest a lot of time and money to have an opportunity to treat people. A lot of delayed gratification as well. Most of ya'll probably went to work right after college/masters, assuming you did one at all. Some doctors don't get out and make money till they turn 30. Some even later than that. A neurosurgeon has 9 years of residency training at least.
B) Time of entry. Having used some of these systems. They are a pain in the butt and not that quick. In private practice. Its much easier to write out a note than spend 15-25 mins trying to write an electronic note. Time is limited and using these data systems are not efficient for most physicians! Especially with all the overhead costs of providing care, most doctors do not have the time to spend more than 10? mins per patient. Anything more and they can't pay the rent or the staff, etc.
C) None of the systems are compatible with each other. For these savings to be realized, Every doctor and point of medical care would require the same software and access. That is not going to happen without any intervention from a big brother.
D) HIPAA sucks. Adds a lot of overhead, headache and costs.
E) DOs are MDs, just a different philosophical background on the cause of the disease. But in the end they are physicians. Nurse practioners are not doctors and will never be. They do not receive the same amount of knowledge and training. Average primary care physician spends 4 years in college, 4 years in medical school and 3 years in residency. NP does what? 2 or 4 years max? BIG difference.
F) Doctors are not the big problem here. Granted some do over order exams. Some do it to protect themselves legally. You know its not there,but you need a way to document that its not there when you get sued.
G) HMOs and insurance... can't be sued for making business decisions. Setup a lot of roadblocks to not cover patients and create as many road blocks to keep from paying doctors for service. I worked with a urologist. HMO basically said we think this procedure was worth $150 (used to be he got $1500 for it 10 years ago). Its a take it or leave it proposal. Then if he wants to take it, HMO requires that he personally call in and go through a convoluted phone system that costs him/her time and money. They want to make it as long as possible so that the person calling in will just give up that money and move on. Like a mail-in-rebate essentially ...

Too few computers, too little bandwidth (5, Insightful)

ldrydenb (1316047) | more than 5 years ago | (#28464185)

I can't speak for the US or private medicine but I've seen numerous electronic record systems piloted in the NHS.

My colleagues would love to have fast access to up-to-date clinical notes rather than play pass-the-parcel (or more often, hide & seek) with a patient's paper case-file(s), but wards tend to have one or two computers per ward and community services may have one computer between three to five staff. So at the end of a shift, when ward staff would be writing their notes, there'd be a queue for the computer. Similarly, before setting out on their visits at the start of the day and after returning from their visits at the end of the day, all community staff want access to the computer at the same time. Also, security dictates that as little information as possible is stored on the user's machine, so the intranet is swamped at these times and users face frustrating lags (I've been unable to access records in time for an appointment as the system was "oversubscribed").

To increase computer access to usable levels in my former service would have required a 3-400% increase in the number of computers provided to healthcare staff. I have no idea what the resource implications would have been for the service's intranet, but I imagine that a commensurate increase in server capacity (and in the IT department staffing, to take care of all of this) wouldn't be cheap. As a health service manager, having to decide between enough hospital beds or enough computers, which do you suppose is more likely to keep you in your job?

Re:Too few computers, too little bandwidth (1)

DanJ_UK (980165) | more than 5 years ago | (#28464317)

As a health service manager, having to decide between enough hospital beds or enough computers, which do you suppose is more likely to keep you in your job?

Wish I had mod points.

Medical IT sucks (4, Insightful)

greenguy (162630) | more than 5 years ago | (#28464231)

As a medical interpreter, I see health-care IT up close all the time. (I'm writing this in an ER, on an overnight shift.) TFA has a lot of good points, but think the biggest single reason the IT sucks is the sheer complexity of medical information, but also of our byzantine and baffling health system in general.

All the health systems in town use the same medical-records company, because it's local. Its design reminds me of Windows 95, and the nurses know more about the workarounds for the bugs than about the intended use. The thing is, few of the doctors and even fewer of the nurses are interested in computers. They're interested in medicine, and computers are a pain in the neck even *before* they break down. They can't tell when the computer is behaving unpredictably, because as far as they're concerned, the computer always behaves unpredictably.

Am I trying to blame the victims, here? No. I'm saying this is a detailed and ongoing focus group, and they're telling us that the whole IT system is a disaster. And as far as I'm concerned, the most damning critique is that no one I've talked to wants them to change it, because, almost to a person, they're convinced the upgrade will be just as, if not worse.

Re:Medical IT sucks (0)

Anonymous Coward | more than 5 years ago | (#28464669)

The medical system is like the government system. Employees "play the game" which means they do their best to game the system not serve it.

IT only serves to create a paper trail that people don't want, symbols of status where administrators get high end workstations yet can't even type, and rules regarding HIPAA and other legal requirements which require investments in hardware and the hiring of competent IT workers who would take away from the profits of doctors.

This is a case where you can say to yourself "Hey! Why don't I go back to school and earn more accolades! Then I'll be respected!"

Ha!

IT staffers have to learn a whole new pecking order that's very cut-throat, female-centric and completely uncommunicative unless you are willing to double as a waiter in board meetings. Of course, by submitting to that pecking order, you'll compromise your responsibilities and authority because you're in a male dominated field supporting a female dominated one (Really! Don't believe me on that one!) and they WILL ensure your submission on all things.

All educated professionals rise above this? Not on a bet! It would shine a light up a lot of slashdotters for them to pay some dues in a hospital. Tell a hospital administrator to "RTFM"! It would be a great object lesson.

time... (1)

hh4m (1549861) | more than 5 years ago | (#28464359)

this is a very touchy subject as medical records are very sensitive information... im sure most would agree that there is no room for sub par implementations in this case. so all in all, they have to get it right, any small mistakes made on the IT level could prove quite disastrous...

as the world has become globalised, the only right way of doing this will be an international database... formed by an international consortium... which can regulate standards, credentials etc...

there is no room for mistakes...

The Many Layers of Complexity (5, Insightful)

trydk (930014) | more than 5 years ago | (#28464419)

As always this is a relatively simple problem wrapped in layers of -- to a certain extent unnecessary -- complexity.

The simple idea is to have a system that records the patients history of illnesses and treatment (including medication, obviously) and which is easily communicated across different places of diagnose and treatment (GP, specialists, consultants, hospitals, ...).

This specific problem could easily be solved with standard software like Lotus Notes, Microsoft SharePoint and similar systems, but that is where the simplicity stops and the layers of complexity start.

Sorry if I am going down a well-travelled trail here.

Firstly, it is very difficult to get people and organisations to standardise on a single system for good and for bad reasons. (Like "We've already got Lotus Notes, why should we get a Microsoft product?" -- plug in whatever conflicting product/system names you can think of.) This means that a single system probably is out of the question, which leaves us with a standardised interchange format instead.

OK, now we have a gazillion systems happily exchanging information in a standardised format, so everybody is happy, right?

Wrong!

Because secondly, who is responsible for the safekeeping of the data? This is two-fold: Who is responsible for storing the data and who is responsible for who has access to the data?

So 2a, Responsibility for storing the data: If every place of diagnose and treatment is responsible for storing own data, how can a patient be sure that any specific institution treating her has access to all the information? This needs some centralised storage or at least "mediating" (much like peer-to-peer systems, e.g. torrents, need a "meeting place", like The Pirate Bay, where they can find the trackers so they know where to find the peers). Either system suffers from the problem of connectivity dependence, i.e. if they cannot get access to either the storage, the "mediator" or the peers, information cannot be retrieved. This is still better than paper-based systems, if you are treated in different places, geographically.

This leads to 2b, Responsibility for who has access to the data: I would obviously like for my GP to send information directly to the hospital and for the nurses, doctors, consultants and surgeons treating me to see my records, but -- being the famous person, I am ... not -- I would be quite weary if just about anyone could look at my records. How is this problem solved?

Thirdly, who would be responsible for correcting errors and mistakes in the records? This problem is not really an issue relating only to electronic records, but is a general issue, which crops up all the time. Should you, as the patient, be allowed to correct mistakes you know about? If that is the case, how do the professionals make sure that you are not trying to tamper with the system for some ulterior motive (everything from trying to cover medical problems for insurance purposes to hypochondria)? If you are not allowed to correct mistakes, how do you tell them that you did not receive a certain medication two years ago and, in fact, is allergic to it?

Fourthly, a system relying on doctors, specialists and consultants to type would probably be doomed, at least for now. It seems that doctors, etc. at all the hospitals I have seen, rely on dictation, having a pool of secretaries typing it in and updating the records, which introduces unnecessary delays and adds an extra risk of introducing errors.

These are some of the many problems facing such a system and I am sure I have left out many, just as relevant. I honestly do not believe that the fear of transparency regarding the treatment is the major stumbling block for the introduction of electronic medical records, but rather the diverse types of problems facing the system.

wrong answer (5, Insightful)

August_zero (654282) | more than 5 years ago | (#28464485)

"Hypothesis: making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model"

Besides being perhaps the most ignorant thing I have read this morning, this statement reminds me of the irony inherent in listening to tech people whine about how medical caregivers have no trust or knowledge of IT, while the caregivers complain non-stop that IT has no idea how to design a decent medical record system.

Health Care vs FedEx (2, Interesting)

readin (838620) | more than 5 years ago | (#28464603)

I recently saw President Obama make a comment about how FedEx can track every single package everywhere, but we can't even get medical records to follow a patient from one doctor to another.

Well, Fed Ex is a private entity with very little government regulation, while medicine is subject to government involvement all over the place. The government either pays for medical care (medicade, medicare), determines how it will be paid for (tax incentives) or mandates that it doesn't need to be paid for (get wheeled into any emergency room and they must at least stabilize you, or so I've heard). Government then regulates the tracking of information (privacy regulations - no such privacy regulations apply to FedEx package locations). If something goes wrong, government is involved in deciding malpractice verdicts and awards. From start to finish, government has its hands in the mix.

I remember reading about the difficulties the IRS had with automation due to the complexity of the tax code. Is it any wonder the medical profession would have trouble automating given the complexity of the rules associated with health care in this country?

A couple other key differences between FedEx and Health Care. First, most people feel no moral obligation to provide package shipping to everyone in the country.

Second, it is far easier for consumers to evaluate the effectiveness of FedEx than it is for them to evaluate the effectiveness of their medical care. With FedEx, you can verify that the contents weren't broken, and you can compare the speed similar shipments sent by other companies. That's easy. With doctors, well, recently someone I care about had an abscess in his neck. The doctor was thinking the pain was just lingering effects of a sore throat. But when it didn't clear up. he theorized an abscess and sent the person to the emergency room for an MRI. The abscess was found and removed by surgery that night. Did the doctor nearly cost this person his life by not recognizing the abscess until it was close to breaking through a vein causing blood poisoning? Or did the doctor save this person's life by recognizing the abscess in time? It's not so easy for someone like me to know.

No... it's because of the software quality (3, Informative)

RaigetheFury (1000827) | more than 5 years ago | (#28464665)

Go to any doctors office and ask how much they like their software. There is so much crap out there it isn't even funny. I know for a fact, one software company that services more than 20 hospitals and 200 doctors office recently discovered that they had a rounding error in displaying pharmaceuticals. Obviously nothing extremely dangerous... but the fact is there just isn't that many affordable quality software companies out there.

Hell, http://www.physiciansehr.org/index.asp [physiciansehr.org] and companies like it make it their sole business to find software suitable for your office, and help in the transition. It's huge business.

I don't honestly believe most medical practitioners are worried about that being used as medical malpractice fodder when weighed against the benefits. The problem comes with the cost and quality. Most doctors don't understand nor care since they have little interaction with it.

I've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99% of them suck ass. I officially dub "suck ass" a technical term meaning, someone was smoking crack when designing the user interface and knew more about making an annoying, non-user friendly piece of trash than making ANYTHING remotely useable by the medical field.

The transition will happen eventually but some standards need to be in place and universally accepted accreditation certificates need to be available to say "Yes... this software meets these standards". We all know that this will be abused and the bare minimum met... but you have to understand... the standards are SO low... that companies release bugged software knowingly...

Just ask E-Cast. I can't wait for a federal investigation to happen to those guys.

Disclaimer: I do not work for E-Cast, nor have I ever worked, contracted for or through any group associated with E-Cast.

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