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Harvard Says Computers Don't Save Hospitals Money

kdawson posted more than 4 years ago | from the always-jam-tomorrow dept.

The Almighty Buck 398

Lucas123 writes "Researchers at Harvard Medical School pored over survey data from more than 4,000 'wired' hospitals and determined that computerization of those facilities not only didn't save them a dime, but the technology didn't improve administrative efficiency either. The study also showed most of the IT systems were aimed at improving efficiency for hospital management — not doctors, nurses, and medical technicians. 'For 45 years or so, people have been claiming computers are going to save vast amounts of money and that the payoff was just around the corner. So the first thing we need to do is stop claiming things there's no evidence for. It's based on vaporware and [hasn't been] shown to exist or shown to be true,' said Dr. David Himmelstein, the study's lead author."

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398 comments

Transferability (5, Interesting)

oldhack (1037484) | more than 4 years ago | (#30280240)

Well, that's mouthful, but with electronic records you can at least switch doctors without having to take X-rays, tests, and other records again. No?

Re:Transferability (1)

Psaakyrn (838406) | more than 4 years ago | (#30280248)

Apparently they did it wrong then. Sounds like it's more of spent on improving work-flow/patient-flow.

Re:Transferability (2, Informative)

jma05 (897351) | more than 4 years ago | (#30280354)

One would wish. Doctors either spend more time with electronic systems than with paper systems... or if it is a good system... about the same time.
The current systems haven't made doctors more productive. There may be an exception or two though in select settings where considerable grant dollars were poured in to build a locally optimized system.
Building good clinical systems is hard.

Re:Transferability (5, Informative)

AK Marc (707885) | more than 4 years ago | (#30280582)

"The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld."

The systems aren't put in help the doctors. They are put in by the non-medical managers to help their jobs. And they fail at that. A system designed for doctors with the goal of reducing error and improving care could work. But that's not what the systems are. They should start working now to have all records be electronic, X-rays, MRIs, personal history, etc. should be in formats that can be directly shared between doctors. Then processes and systems that are designed to help the medical care should be used to put that information to good use and let patience get improved care for a lower cost. But the systems are all billing systems first, and care second. And that's why they fail, and always will. Improving billing doesn't help care, and can often make it worse, as having a doctor or nurse putting in billing codes will only slow down the process.

Re:Transferability (-1, Flamebait)

Anonymous Coward | more than 4 years ago | (#30281120)

Who is the biggest bogeyman on slashdot? That parasitic creature known as the "manager." He is the one that apparently sucks all the profit from the artists in the RIAA world. He's the one that keeps coders from programming efficiently in the business world. Now we learn he also keeps doctors from doing their work in the medical world. Seriously - when are you slashdotters going to realize that part of the reason that nobody takes you seriously is because your analysis is so junior high level?

Re:Transferability (1, Interesting)

Anonymous Coward | more than 4 years ago | (#30280754)

I would like to see him try to do0 the mapping of a genome with paper and pencil.

This article is stupid.

Re:Transferability (2, Informative)

ximenes (10) | more than 4 years ago | (#30280252)

Your records belong to you. You can request them (and depending on the hospital / doctor's office, they may claim you can only receive copies or that they will only send them directly to your new healthcare provider) at any time and take them with you.

Re:Transferability (1)

oldhack (1037484) | more than 4 years ago | (#30280288)

They don't necessarily keep good track of your x-rays and such, I was given the impression from an orthopedic guy. Not to mention hand-written notes that are impossible to decipher. But good to know the rules, though.

The key being ... (5, Interesting)

devloop (983641) | more than 4 years ago | (#30280286)

"IT systems were aimed at improving efficiency for hospital management"

Doctors and other medical personnel do not typically hold much power
when it comes to IT.

Software vendors aim to please management, they are the ones who take
the purchasing decisions.

Your typical Lab software for example might not have a straightforward
way to cross-check isolates for emerging resistance trends,
run critical screens or automatically report to a global EPI database,
but it sure has 1,000 ways to generate Aging Reports and auto resubmit insurance claims.

Re:The key being ... (4, Interesting)

malkavian (9512) | more than 4 years ago | (#30280940)

Wow, in the hospital where I work, the doctors frequently turn up to the IT department saying how they've just bought in a new system and they need it supported. If they get told 'no', they complain to the directorate that IT aren't supporting a system based on IT. The directorate lean on IT (with not so veiled threats) until IT support a system they'd have vetoed if they'd be involved in procurement..

The problem that has been evaluated is that the research was done on an organisation with no true enterprise architecture (at the business silo stage at best). In other words, somewhere that hasn't invested in IT (and likely has the doctors doing what they feel like, with 'homegrown' Access databases and applications, trusting what the vendors say when they produce shiny pamphlets, and either not hiring people who understand how business and tech should map, or not giving them the clout to be able to change the way the organisation works to successfully be able to change things so that they do).

Re:The key being ... (1)

Antiocheian (859870) | more than 4 years ago | (#30280982)

Please back that up.

Re:The key being ... (1)

wisty (1335733) | more than 4 years ago | (#30281026)

I'd believe it. But whether it's doctors getting conned by vendors, or administrators (or IT) making decisions without the inputs of doctors the result is the same - useless and troublesome IT systems.

Maybe in America, but look at Belgium! (0)

Anonymous Coward | more than 4 years ago | (#30281028)

Doctors do not hold much power when it comes to IT.

Excuse me? In Belgium, IT transition was bottom-up; it started with the GPs. This is because our health care system is also heavily based on the work of GPs, they are the most basic and essential doctors for a well-working system. There are loads of software companies making tools for keeping track of patient records. In later stages, these companies developed intercommunication protocols, so a follow-up on a patient with another doctor is easy as hell.

My dad is a GP. He keeps track of all examinations, medication prescribed, etc within an integrated environment. Pharmacists run different software, but intercommunication protocols make sure the GP gets a message when the patient picked up his prescribed pills. When the GP refers someone to a specialist, he gets a detailed report in his software environment about the examination the specialist performed. Same with bloodwork, urine analysis, ...
This software propagated to hospitals, so it is now omni-present throughout all levels of health care. Management probably uses the most basic information from this system to provide financial reports to the government or university.

Of course, in a country where health care is driven by monetary gain, IT transitions will be driven by management. And will fail horribly. Dr. Himmelstein would do good to look at a country like Belgium; we are regarded as the best, most efficient health-care in Europe. Looks like you Americans finally took your first steps in our direction, but you're still not quite there...

Re:The key being ... (4, Interesting)

martyros (588782) | more than 4 years ago | (#30281170)

Best quote from the article:

Himmelstein said that only a handful of hospitals and clinics realized even modest savings and increased efficiency -- and those hospitals custom-built their systems after computer system architects conducted months of research.

He pointed to Brigham and Women's Hospital in Boston, Latter Day Saints Hospital in Salt Lake City and Regenstrief Institute in Indianapolis as facilities with some success in deploying efficient e-health systems. That's because they were intuitive and aimed at clinicians, not administrators.

Programmers of the successful systems told Himmelstein that they didn't write manuals or offer training. "If you need a manual, then the system doesn't work. If you need training, the system doesn't work," he said.

In other words, computers are not a magic bullet. They only work well when you actually invest the time to find out what you need them to do, and then make them do that.

Re:Transferability (5, Informative)

jma05 (897351) | more than 4 years ago | (#30280318)

Nope. The current Electronic Medical Record systems are not capable of exchanging information freely. There is no standard data format that everyone can exchange.
There are a few standards that can package data, but they are not adequately specified for seamless interoperability.
If you request records, they can print them out quickly for you though.

Re:Transferability (4, Funny)

wisty (1335733) | more than 4 years ago | (#30281034)

But what if it's in XML? It would inter-operate then.

Or better still, a binary blob wrapped in XML. That would really make it easy to use!

Re:Transferability (1)

adolf (21054) | more than 4 years ago | (#30281102)

But what if it's in XML? It would inter-operate then.

Or better still, a binary blob wrapped in XML. That would really make it easy to use!

I don't know whether to laugh, or to cry.

Re:Transferability (1)

Linker3000 (626634) | more than 4 years ago | (#30281100)

A good point. I have been working on a committe developing standards for the transmission of information between veterinary records in the UK (and we have interest from other countries). The so-called VetXML standard is already being used for insurance claims and lab results, with referrals on advanced testing.

As per /. standards, I did not RTFA, but I would suggest that "Poorly designed computer systems do not save money" would be a better title.

I have just finished phase 1 of the roll out of a new clinic management package within our group - we have 31 veterinary clinics in the UK and 9 are now on a new system with improved workflow, easier client and patient management and better management reporting. We can see and benchmark clear benefits in time and cost - fair enough, the major benefits are at the back end (reporting etc), but clinic staff have already praised things like quicker patient searches and more accurate billing, stock management and recalls administration.

There are clear benefits of the new system so I am confident to say that not only is it more efficient and will save money compared to a manual system, but it will also do the same compared to our other two clinic management packages - one is old and reliable (accessed through VT220 terminals or PCs running an emulation package) but very outdated and has no serious reporting or connectivity abilities, the other is 'modern' but buggy (crashes often), poorly written with a bad database schema that is totally space inefficient.

I think it's wrong to dismiss computerisation per-se, but there are good and bad examples of system implementations to be seen everywhere.

Re:Transferability (1)

Z00L00K (682162) | more than 4 years ago | (#30280746)

If they don't save money - do they use the computers in an efficient manner or are they just advanced typewriters?

Don't just computerize the process (4, Insightful)

WuphonsReach (684551) | more than 4 years ago | (#30280242)

There's an old saw we had back in the 90s at UPS.

Don't just computerize a process (or blindly apply technology to replicate an existing process) and expect to see savings.

Re:Don't just computerize the process (1)

x_IamSpartacus_x (1232932) | more than 4 years ago | (#30280384)

Michael Scott stands justified! Real business is done on paper!

There are four kinds of business: tourism, food service, railroads and sales... and hospitals slash manufacturingand air travel

Re:Don't just computerize the process (1)

tg123 (1409503) | more than 4 years ago | (#30280674)

There's an old saw we had back in the 90s at UPS.
Don't just computerize a process (or blindly apply technology to replicate an existing process) and expect to see savings.

Please mod the previous poster up.

Having just done a semester of "Systems analysis and Design" to create a computer system as complex as a health care system take lots of time and resources.

Cycles of Planning , prototyping ,design and testing then you have to do it all over again ... again and again.......

Just Computerising a process means a change to rid the company of inefficient processes is wasted.

I work in a major hospital (4, Interesting)

Anonymous Coward | more than 4 years ago | (#30280246)

And have significant responsibilities for patient care and management. Computers have made my life much easier. With electronic charting I can follow all of my patients directly from a terminal that I carry with me. The charting software we have includes basic spreadsheet and summary functions that are highly customizable. I am able to track trends and make decisions for my patients based on sight and intuition rather than having to sort through paper charts and bad handwriting. Its all at my fingertips. I don't know where Dr. harvard did his research but maybe he just has bad software. My computer system is outstanding and I honestly don't know if I'll ever be able to work in another hospital.

Re:I work in a major hospital (0)

Anonymous Coward | more than 4 years ago | (#30280506)

An image forms in my mind, the image of an employee working at Medical Software Inc., stiffly reading the newest marketing brochure.

A flash of light, then another image: a management representative of Major Hospital (a Microsoft subsidiary) lazily lying on the beach during his Medical Software Inc.-sponsored vacation trip, unmotivatedly repeating the words he was trained to say.

Re:I work in a major hospital (1)

hax4bux (209237) | more than 4 years ago | (#30280510)

Ya, I don't understand the conclusion either.

I have nothing to do w/health care, but bar codes alone should have been a big help.

Re:I work in a major hospital (0)

Anonymous Coward | more than 4 years ago | (#30280544)

The problem I have observed is that administration uses computerization as a means to cut payroll by reducing staff. We don't realize an efficiency benefit because the 2 of the three lab workers who can now do their work in 1/3 the time thanks to bar codes have been laid off. The problem is almost always administration. They understand only jack and shit.

Monetary efficiency (1)

Mathinker (909784) | more than 4 years ago | (#30280770)

> an efficiency benefit

Your post assumes that efficiency is measured in units of lives saved or care given, but the administration is measuring efficiency in units of money. If your observations were widespread, the computerization should save the hospital money, but the study says otherwise.

Re:I work in a major hospital (0)

Anonymous Coward | more than 4 years ago | (#30280718)

Speaking as a pharmacy technician, barcodes have not improved my job in the slightest (at least, not as currently implemented).

Our buyer always seems to be shifting brands of drugs according to what is available and what is cheapest, and all those new drugs have to be inputted into the system before you can properly use them.

Plus, the scanners we have to use are slow and unreliable; this past weekend, all but one of them were broken.

Using the new system is at best not any more efficient than the old system, and often takes me about twice as long.

Let me explain... (4, Insightful)

denzacar (181829) | more than 4 years ago | (#30280594)

You: Computers have made my life much easier.
Harvard study: Computers don't save hospitals money.

Note the slight difference there?

Re:Let me explain... (1)

Rakshasa Taisab (244699) | more than 4 years ago | (#30280728)

So what you're saying is that doctors used that efficiency increase to improve patient care, rather than cost cutting. This be good no?

Re:Let me explain... (3, Funny)

denzacar (181829) | more than 4 years ago | (#30280776)

Good? For whom? Patients? Screw them!

We are talking bottom line here sunny.
And that bottom line better be in black and with plenty of big numbers.

Now get out of my way, I have to practice my for the annual Doctor's Golf TournamentTM. It is for some charity or some other bullshit excuse.

Re:Let me explain... (5, Insightful)

daveb (4522) | more than 4 years ago | (#30280742)

>You: Computers have made my life much easier.
>Harvard study: Computers don't save hospitals money.

>Note the slight difference there?

yes - but you missed the bit about efficiency. "Computers have made my life much easier." is usually how we express efficiency.

Over a decade ago I did a stint at a hospital looking after the pathology database. When it was down and paper records were required then lives were at risk due to the lack of efficiency (time spent accessing paper). It honestly scared me!

  I'm sure things are much much more reliant on computers now. Computers are not just for the hospital admins.

Efficiency? (1)

denzacar (181829) | more than 4 years ago | (#30280932)

"Lives were at risk due to the lack of efficiency"?
What part of "money" did you not understand?

 
See... the good Doctor Himmelstein would like to run a hospital (whose job is to save lives and provide the unquantifiable product such as health) as a slaughterhouse.
Bodies come in - work is done on them - bodies come out and you get money. Simple and straightforward.

Aaah... but hospitals can't be run as a profit-based business - cause they are not. Hospitals provide "service" needed to run the society.
You know... just like other public service "businesses" like police, fire department, army, public education...

So, your idea of efficiency having to do with providing the said service, and idea of efficiency Doctor Himmelstein has (I can't help imagining thunder and lightning in the background every time I say that name) - are two VERY different things.
His efficiency calculation only has to do with money spent per body coming in and money gained per body coming out.

Now... if you could somehow CHARGE the patients for every time a computer is used... Hmmm...

Re:Efficiency? (0)

Anonymous Coward | more than 4 years ago | (#30280994)

>"Lives were at risk due to the lack of efficiency"?
>What part of "money" did you not understand?

The summary (who rtf anyway) claimed " The study also showed most of the IT systems were aimed at improving efficiency for hospital management — not doctors, nurses, and medical technicians."

The guy talking about being worried about downtime is calling BS on that claim. The article is not just about the $$ as you suggest

Well (5, Insightful)

ShooterNeo (555040) | more than 4 years ago | (#30280254)

Here's a relevant quote from "Superfreakonomics" :

The diagnosis was clear: the WHC emergency department had a severe case of "datapenia," or low data counts. (Feied invented this word as well, stealing the suffix from "leucopenia," or low white-blood-cell counts.) Doctors were spending about 60 percent of their time on "information management," and only 15 percent on direct patient care. This was a sickening ratio. "Emergency medicine is a specialty defined not by an organ of the body or by an age group but by time," says Mark Smith. "It's about what you do in the first sixty minutes."

Smith and Feied discovered more than three hundred data sources in the hospital that didn't talk to one another, including a mainframe system, handwritten notes, scanned images, lab results, streaming video from cardiac angiograms, and an infection-control tracking system that lived on one person's computer on an Excel spreadsheet. "And if she went on vacation, God help you if you're trying to track a TB outbreak," says Feied.

To give the ER doctors and nurses what they really needed, a computer system had to be built from the ground up. It had to be encyclopedic (one missing piece of key data would defeat the purpose); it had to be muscular (a single MRI, for instance, ate up a massive amount of data capacity); and it had to be flexible (a system that couldn't incorporate any data from any department in any hospital in the past, present, or future was useless).

It also had to be really, really fast. Not only because slowness kills in an ER but because, as Feied had learned from the scientific literature, a person using a computer experiences "cognitive drift" if more than one second elapses between clicking the mouse and seeing new data on the screen. If ten seconds pass, the person's mind is somewhere else entirely. That's how medical errors are made.

END QUOTE
I agree wholeheatedly with the last bit : I can't count how many times I've been to a doctors office or library or other institution and had to wait for a person to pull up my information on "the system". If you're gonna build a friggin computer system to handle local records, for the love of God don't scrimp on the hardware! Optimize the software! It should be INSTANTANEOUSLY fast!

Re:Well (0)

Anonymous Coward | more than 4 years ago | (#30280294)

Your talk will offend the abstract programming, managed code, XML parsing, virtual machine overlords.

Re:Well (2, Insightful)

Sarten-X (1102295) | more than 4 years ago | (#30280356)

...But it has to look pretty, or the folks with access to the bank account will never buy it! It also needs animated sliding panels, customizable positions for all controls, and must fit the graphical style of Windows 7, so the office staff don't get confused. When the programmers are done with those important goals, then they can work on the petty stuff like speed and usability.

Let's not forget, it also absolutely MUST interface with the mainframe they kept records on in the 80's, just in case they need that information (but there's no budget for migration), and according to the boss's nephew who "knows computers", the next big thing will be X, whatever that is, so the system must use X, to do whatever it is that X does.

Re:Well (5, Informative)

greenguy (162630) | more than 4 years ago | (#30280428)

I work in a hospital as an interpreter, so I see a lot of how people use computers... and how they don't. Generally in the ER, the patient first sees the triage nurse, who asks a series of questions. The answers all get entered into the computer. Then the patient sees their actual nurse, who asks many of the same questions again. This information may or may not get entered in the computer. Then the PA comes in and asks the same questions a third time. This time, the information gets written on a piece of paper, or maybe a tablet computer. Eventually, the attending physician stops in just long enough to ask the same questions a fourth time, and doesn't enter the info anywhere. If the patient is admitted and sent to another department, the process starts over.

Re:Well (5, Insightful)

jamesh (87723) | more than 4 years ago | (#30280628)

I made a call to HP (abbreviated to protect the company :) recently to have a failed disk replaced under warranty. I went to great lengths to explain that I was a consultant acting on behalf of the customer, gave HP all of my details and all of the customers details etc. I could hear constant typing in the background so something was being entered somewhere. About 20 minutes later I got a call from my office saying they had HP on the line asking who the onsite contact was, who the customer was, and where the part should be sent.

It's not just hospitals... I think I can generalise the conclusion of the article - if the solution (IT or otherwise) isn't designed/built right, and people don't know how to use it right, then it isn't going to work right and is going to make peoples lives harder not eaiser. Seems kind of obvious when you put it that way though.

Re:Well (1)

martin-boundary (547041) | more than 4 years ago | (#30281062)

Could you explain why this is a bad thing? The way you describe it, there are four people who each independently verify the information, instead of what? One person who enters some data into the computer and three people who read it back?

If each person has a 25% misdiagnostic rate, then four independent people asking questions gives a combined misdiagnostic rate of less than 1%. If three people trust the diagnosis of the first person, then the combined rate is 25%. Regardless of the actual numbers involved, many people talking to the patient independently should improve the chance of a successful treatment.

Parkinson's laws (5, Insightful)

vurtigalka (922428) | more than 4 years ago | (#30280644)

Results like these shouldn't surprise anyone aware of Parkinson's laws. From Why it is Important that Software Projects Fail [berglas.org] :

The boundless creativity of politicians and bureaucrats to develop new and more complex regulation is bounded only by the bureaucracy's inability to implement them. The absolute size of the bureaucracy is constrained by external factors, so the only effect of automation can be to increase bureaucratic complexity.

Parkinson's laws are as valid and insightful as always. If someone by chance have missed them, here they are:

Parkinson's First Law:
Work expands or contracts in order to fill the time available.

Parkinson's Second Law:
Expenditures rise to meet income.

Parkinson's Third Law:
Expansion means complexity; and complexity decay.

Parkinson's Fourth Law:
The number of people in any working group tends to increase regardless of the amount of work to be done.

Parkinson's Fifth Law:
If there is a way to delay an important decision the good bureaucracy, public or private, will find it.

Parkinson's Law of Delay:
Delay is the deadliest form of denial.

Parkinson's Law of Triviality:
The time spent in a meeting on an item is inversely proportional to its value (up to a limit).

Parkinson's Law of 1,000:
An enterprise employing more than 1,000 people becomes a self-perpetuating empire, creating so much internal work that it no longer needs any contact with the outside world.

Parkinson's Coefficient of Inefficiency:
The size of a committee or other decision-making body grows at which it becomes completely inefficient.

I would also guess... (1, Insightful)

joocemann (1273720) | more than 4 years ago | (#30280274)

That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.

Computers take more work to use when you don't have a nice grasp on not only the software or function you're doing, but the regular logical deductions you make from repeated observation and experience.

From my experience in life, most older people have somehow adapted themselves to 'get by' with technology, but without actually knowing what is really going on. Many will think the monitor is the computer. Many have no idea what the basic components are. And, hell, many are even clueless at the overly-simplified layouts of hardware nowadays with color coding and the square-peg-square-hole approach to basically everything.

Make the majority of a staff fill this description and you can be damned sure plenty of time is being spent moving the mouse around cautiously while looking down the nose in deep confusion and wonder.

question: is a hotkey actually hot? which one is it?

Re:I would also guess... (0)

Anonymous Coward | more than 4 years ago | (#30280412)

Am I in the "older" generation? I'm 41+9/12 years old, but I've been programming as a hobby since I was 13. I am quite comfortable with technology, and I can tell you from personal experience the vast majority of health care related software SUCKS despite vast millions of $$$ in expenditures. In my view, some big issues are (1) the problem is actually harder than it seems , given the extreme flexibility needed, (2) this is not understood by the designers, leading to horrible usability & functionality issues and (3) the good software engineers seem to go to other fields. There are lots others, but I agree this is a very solvable problem. I often wonder what would happen if we had a game design team on the job.

Re:I would also guess... (1)

el_tedward (1612093) | more than 4 years ago | (#30280598)

Not everyone is like this. We have someone (of the walking-slow old variety) at the doctors office i work at who has trouble with computers sometimes. However, she learned things in DOS & had a lot of trouble moving to the GUI. I think you could say learning and being comfortable with DOS would be easier once the learning process is over.

A GUI can be extremely inefficient, though more intuitive, depending on it's design. Dragging and dropping a file, though.. that's easier than using mv blahfile toblah

Depends (1)

Mathinker (909784) | more than 4 years ago | (#30280886)

> Dragging and dropping a file, though.. that's easier than using mv blahfile toblah

IMO, that's only true if both the source and destination windows are already open in the GUI (and even then, perhaps only if the file you want to drag is already visible in the source window and you don't have to scroll or resort to find it). Or, of course, if you are typing-challenged. Otherwise, typing

        mv /path/to/source/file /another/path/to/destination/directory

is almost certainly easier than find+clicking the seven (or more, depending on how you do it) parents of the paths in question and then dragging and dropping.

Re:I would also guess... (1)

tg123 (1409503) | more than 4 years ago | (#30280808)

........ In my view, some big issues are (1) the problem is actually harder than it seems , given the extreme flexibility needed, (2) this is not understood by the designers, leading to horrible usability & functionality issues and (3) the good software engineers seem to go to other fields. There are lots others, but I agree this is a very solvable problem. I often wonder what would happen if we had a game design team on the job.

Your right when computer systems get this complex you need good project management , systems analysis and design.

(Just did a semester of this subject.)

You need to build the system from scratch and the people doing it need to work out what processes are needed and what are not and they need to talk the users of the system then (the poor people) have do it all over again till the system works.

http://en.wikipedia.org/wiki/Iterative_and_incremental_development [wikipedia.org]

Let me add to this (2, Interesting)

Etrias (1121031) | more than 4 years ago | (#30280470)

Having worked in an academic medical center and having a bit of exposure to doctors, I can say this...they may be able to patch you up but most doctors don't know shit about computers. It's the reason that most of them still scribble things down in some incomprehensible handwriting--they either don't have the time or don't want to learn a different system for keeping records.

Actual savings probably won't be realized until everyone in the system starts to use it and have information that is easily transferable between clinics/doctors/hospitals. Another hoop to jump through are the HIPPA requirements, not only on the federal level but on individual states as well.

The other thing I looked for but didn't find in the surprisingly short study (only 7 page PDF) is any type of linking the potential administrative gains which were offset by IT costs. The study glances at this question, but admits it doesn't know why the costs had not decreased. Not that this isn't the case, but it's just guesswork which takes a fair amount of bite out of the report. If they could definitely say that yes, IT costs are eating up the savings, then that's something. But with the way our health system is run here in the States, I wouldn't say that our system couldn't be improved upon...of course, that's a whole different discussion.

Re:Let me add to this (2, Interesting)

Anonymous Coward | more than 4 years ago | (#30280620)

Little known fact: we doctors are encouraged to use sloppy handwriting as a way to prevent drug order forgeries. We're like rockstars, we have public and personal signatures.

Re:I would also guess... (3, Insightful)

jma05 (897351) | more than 4 years ago | (#30280500)

> That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.

That used to be a favorite argument to explain away poor clinical system adoption. But it does not hold true anymore. An average doctor today is at least as computer savvy as an average teenager. They may not use SMS, twitter or use facebook as much as the teens, but they certainly know how a computer works. This isn't the 90s when computers were optional in life.

> Computers take more work to use when you don't have a nice grasp on not only the software or function you're doing, but the regular logical deductions you make from repeated observation and experience.

Good clinical software should not need you to be an expert in computers... just that software... the one they use for several hours each day. And if it takes considerable experience to get up to speed... that's a usability problem... not a user problem.

Re:I would also guess... (1)

Frosty Piss (770223) | more than 4 years ago | (#30280602)

35+ old fogies that don't know that IE isn't the Intertubes? Good grief! How old are you? Oh, wait, there's a MySpace linky in your sig.

Re:I would also guess... (2, Informative)

Spliffster (755587) | more than 4 years ago | (#30280854)

That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.

This is exactly what I witness. I am working as a Software developer in a University Hospital in Europe. Just an example:

It often happens here, That some one enters data into a system. Then another devision needs said data and guess what they do? Data is printed out, faxed internally to another devision and usually a subset of the data is entered manually into another system again. Despite the fact that all involved users have access to both systems and if they'd use the systems appropriate, data would be exchanged automatically between theses systems (data exchange doesn't always happen automatically for several logical or obscure reasons).

As it looks like (from talks with IT stuff from other hospitals) we are not a special case. Especially non academic employees in a hospital are really resistant in learning how to use these "new" technologies (it works much better with younger employees).

no shit (5, Insightful)

PhrostyMcByte (589271) | more than 4 years ago | (#30280292)

Almost everyone who's ever used a line of business app could have told you this. Good LOB apps will ask the question "how can we use PC to make the experience more efficient?". Bad ones will just say "paper sucks, lets make it digital!" have the exact same fields a paper would have, but make you type it. The bad ones might be marginally easier for management because of their rudimentary search and reporting, but are usually no different or even worse for the actual day to day users.

Yet management is continually suckered into thinking less paper == more efficient, and there are _a lot_ of bad LOB apps out there because of it.

Uggggghhhh (2, Funny)

WiiVault (1039946) | more than 4 years ago | (#30280314)

Seriously having a centralized database won't save time tracking down something vs a massive filing "complex" in the basement? I'm sorry but that is just bullshit no matter what the study says. Thats like saying I would be better off with a folder full of images as opposed to Picasa and iPhoto to help manage. Perhaps the time spent would similar if I were a retard or a caveman unfamiliar with a PC. But I assumed people in the medical profession had some semblance of intelligence. At worst a computer should be no less effective, and hey it lets you sit on your fat lazy ass too!

Re:Uggggghhhh (0)

Anonymous Coward | more than 4 years ago | (#30280560)

If entering something into your precious database takes longer than before and documents have to be retrieved only seldomly, than you lose efficiency. If the system is designed to please management or whoever manages funds, it degrades efficiency of it's actual users.

Last I talked to a doctor about hospital IT, he basically said they now have to scan in every paper form and manage digital duplicates of most of their data. Real hospitals aren't the pretty showcase nirvanas where every nurse, doctor and cleaner runs around with a laptop/pda and no paper in sight.

Don't forget that medical records have to satisfy a host of regulations that your holiday photos can ignore. You can't just throw a database at every problem and call it a day.

Re:Uggggghhhh (1)

WiiVault (1039946) | more than 4 years ago | (#30280666)

Yes, but you must young if you have never encountered the problem of lost paperwork. Anybody older than 50 is likely to have had this happen at least a handfull of times. Digital covers this problem (if done right), which I'm pretty sure was a major element of the pitch in the first place. Efficiency doesn't mean shit when the info is already lost.

All depends on how it is implamented (1)

wisnoskij (1206448) | more than 4 years ago | (#30280324)

I know when I did some work for a school library one part that stood out as very inefficient was the registering of new books.
They had a word document template, like one that could be printed off, you had to fill them in then email them to the main office (so that is 200 documents if their are 200 new books).
Then they would go threw them and enter them into a database.

And i am sure a lot of people even printed off the sheet.

It does not matter how fast and efficient using a computer is, if everyone continues to treat them as electronic paper or do everything in paper and then transfer it over.

No technology will instantly make huge advancements in efficiency if the users do not know to use it properly.

Of course... (4, Insightful)

Anonymous Coward | more than 4 years ago | (#30280332)

If you hand a bunch of Luddites a computer system they will tell you it isn't saving them any time.

The system has to meet the needs of the users.

The users have to want to use the system.

If you don't meet both of these requirements it will fail.

Workflow (0)

Anonymous Coward | more than 4 years ago | (#30280336)

It has to do with adhering to the old systems workflow, and not adapting new workflow systems to the new technology.

End of story, nobody thought to update the workflow, so of course, it won't be any faster.

Wow, gee, really? (1)

PakProtector (115173) | more than 4 years ago | (#30280408)

Just because something's new doesn't mean it's necessarily better than the old?

...And the Bureaucracy died in a landslide of paperwork...

Computers != Saving money (1)

AmigaHeretic (991368) | more than 4 years ago | (#30280424)

Computers in hospitals have never been about saving money. Of course they cost more than writing stuff down on paper and shoving it in a folder.

Computers are about 'patient safety' and are a tool to help elminate errors. Test results came back from the lab? Computer system gives messages/popup reminders to actually CALL the patient and let them know the results are in. Non computer system, a piece of paper comes back saying you have cancer and the nurse files it and thinks "I'll call when I get back from lunch" and then forgets to every call you and let you know the bad news.

So, yeah of course a computer system cost more, but computers 'can' do some neat things.

Re:Computers != Saving money (1)

Spliffster (755587) | more than 4 years ago | (#30280968)

I am working in a large Hospital as software engineer. I can tell you, that it's more safe to give a nurse a piece of paper than a computer. why? because the nurse's primary goal is to treat the patient and to to use this scary computer thing!

It might be about safety (i don't answer you the answer) but -- as I see it -- it is about having alot of data (especially history and current results) at your fingertips (from the perspective of a doctor). This safes time and enables them to see the bigger picture in less time. However, most of the data doesn't enter itself into the systems.

Cheers,
-S

Like my Father Said ... (2, Interesting)

foobsr (693224) | more than 4 years ago | (#30280438)

TFS: For 45 years or so, people have been claiming computers are going to save vast amounts of money

Reminds my of ancient times (yes, about 45 years ago) when my father was sitting over nicely striped printouts (blue and white) at home in the (late) evenings, swearing about the introduction of (then) a mainframe for bookkeeping. He was not convinced that the thing would save either work nor money and never changed his opinion.

CC.

Re:Like my Father Said ... (1)

Idiomatick (976696) | more than 4 years ago | (#30280862)

Yet my grandfather bought a mainframe for his tile distributor and it saved him tons of money.

Reminds me of... "Its not the size it's how you use it."

Corporate is as corporate does (1)

GodfatherofSoul (174979) | more than 4 years ago | (#30280452)

From what I've seen of the corporate world, these decisions are made by two groups of competing bullshit artists who've worked their way up to command decisions. One is trying to sell you a product that may or may not do what you need and the other is trying to low ball you *regardless* of what the sticker price is. Management needs to either promote more techies to these levels or put them in places where they can make *real* feedback on the process.

The crux of the matter (1)

stimpleton (732392) | more than 4 years ago | (#30280472)

Larger modern health care environments such as large hospitals, regional health committees, working groups etc, largely boil down to two Us-and-Them viewpoints.

One is Management and the other is doctors/nurses, the later arguing they should make the health care decisions, and essentially have primary say in the implementation of said environment.

The result from an Information Systems viewpoint is that it is pushed from management with little buy-in from health professionals.

With all due respect to Dr Himmelstein he firmly sits in the second camp - doctors should have the say in the running of a hospital. He is also against "administrative waste" - the old "too many admins in the hospital" arguement.

Thats all well and good, but when the balloon goes up, and there are questions to answer, administrator's administrate, while doctors do what they should be doing: patient facing time.

Re:The crux of the matter (1)

MichaelSmith (789609) | more than 4 years ago | (#30280856)

Its funny because I have to go to the local public hospital regularly for my broken arm. Renovations are under way and the Fracture Clinic has acquired a nice new office since I started going there. The new office has attracted a manager who divides his time between chatting up the receptionist (he must be desperate) and standing outside empty consulting rooms saying c'mon, a patient could be in here.

Re:The crux of the matter (1)

Another, completely (812244) | more than 4 years ago | (#30280868)

Maybe I'm misinformed, but don't most (private) U.S. hospitals treat doctors like customers? In several computer systems that I saw in New York state, they were providing different report styles and different input methods (from e-mail to hand-written) for the different doctors. The reason I was given was that they had to do this, since doctors who didn't feel the hospital system suited their unique requirements would suggest different hospitals to their patients. The resulting computer systems were very inefficient, compared with what they could be with more cohesive planning.

Also, isn't a large part of paperwork involved with billing, and filing the right forms with the various payers? I don't suppose the insurance and government agencies publish WSDL interfaces for their claims, so that probably needs to be transcribed to paper, right? What portion of administrative cost goes to copying data by hand from the computer?

It would be interesting to see the same study in a single-payer environment; or even in a simpler mixed-payer environment where supplementary coverage claims are filed by the patient, rather than the hospital, and the competition between hospitals for the preference of independent doctors is a bit less fierce. It may be that the U.S. healthcare system is just an extreme case.

It is all really a pretty rainbow? (0)

Anonymous Coward | more than 4 years ago | (#30280484)

I wanna know the specs for a computerized hospital wide system, service interruptions (hardware failure, ...)? My life is not just in the hands of a doctor, a 7 year or so trained medical professional, but a misanthropic programmer that drinks to much coffee. All i am saying there are cons to a computer system as well.

Re:It is all really a pretty rainbow? (1)

tg123 (1409503) | more than 4 years ago | (#30280890)

I wanna know the specs for a computerized hospital wide system, service interruptions (hardware failure, ...)? My life is not just in the hands of a doctor, a 7 year or so trained medical professional, but a misanthropic programmer that drinks to much coffee. All i am saying there are cons to a computer system as well.

Having worked in medical records with a paper based system your life is also in the hands of the clerk who handles your records.

You just gotta hope that the clerk can find your chart that one of the nurses or a specialist as locked in there office when your sitting in emergency wondering why the doctor has not seen you yet. "Can not see the patient without there chart".

Yeah but... (1)

zenasprime (207132) | more than 4 years ago | (#30280488)

...have you actually seen the so called "software" that hospitals are running their businesses with? I'm lucky if our software doesn't crash, lag, not save records, etc while I'm trying to do my work. And don't even get me started on our "administrator", who routinely doesn't even bother to test whether or not an upgrade is going to work on the test server, if they even had a test server (which they don't).

Re:Yeah but... (1)

nedlohs (1335013) | more than 4 years ago | (#30280576)

If he doesn't have a test server, then of course he routinely doesn't test upgrades on it - it would be physically impossible to do so after all.

Re:Yeah but... (1)

zenasprime (207132) | more than 4 years ago | (#30280614)

That would be my point. It's impossible for them to test upgrade on a mission critical system because they don't even have a testing environment to make sure the entire thing doesn't crash after the upgrade. You'd think they would invest in one considering that every time they do an upgrade, teh system crashes and it doesn't come back up for a week as they try and figure out what went wrong. ./sigh

Re:Yeah but... (1)

MichaelSmith (789609) | more than 4 years ago | (#30280870)

When I broke my arm there was a long wait for X-Ray because their system had a virus. Later I got my X-Rays on CD and it came with convenient DLL files to help load the data. If I ran windows I would have been a bit worried about that.

okay, this really bothers me (1)

el_tedward (1612093) | more than 4 years ago | (#30280528)

But I'm glad it says that these systems are targeted towards management. It sounds to me like a lot of the people running hospitals enjoy buying themselves fancy toys.

I work as a go-fer at a doctors office. There's two doctors there with roughly a dozen nurses. I wouldn't have a job if we didn't have the shit paper filing system we currently have. Several people who work there wouldn't have jobs if we didn't have the shit filing system we have there. It's a waste of my time that I could be spending at collage not doing homework. Is that a bad thing? No, I'm gana grow up to be a l33t computer hacker and get lots and lots of money. Those nurses that get fired when the office gets the electronic records keeping may go on to get licensed as hardcore full on RNs. There's plenty of room in the expanding healthcare system for more nurses. It's not going to kill jobs, but a system of server to server sharing (yeah, someone needs to find a way for this to work so doctor in california can find out about the STDs I got diagnosed with here in [place where the job market is bad]) mah patient info would eliminate errors when things are coded properly (I do get quite annoyed with myself when I find a file I put in the wrong place, but our file system has more room for error than you think it does. Files just take... a long time to find).

Also, we have an accountant who is going over all this stuff, so hopefully they read this article and not waste money on things the doctors really don't need. Like buying a sports car, a prius, and then a new battery prius to save the environment.. The doctors are currently in a legal battle of who has the biggest e-peen though, (50-50 share in the company, tee hee) so I really don't care that much about how things turn out at the office.

Also, I know all this stuff because I work for my mommy.

Designed for Entrepreneurs (4, Insightful)

wrook (134116) | more than 4 years ago | (#30280532)

Computerized health care systems are not designed for the benefit of hospitals. They are designed for the benefit of entrepreneurs.

Health care is a multi-bazillion dollar industry where information is managed via bearskins and stone knives. Development of an integrated computerized health care system will net the intelligent investor more money than even Microsoft can dream about.

This is the message that people I will call "serial entrepreneurs" pitch. Their intent is not to build such a system (that would be nigh on impossible given the absolute chaos of incompatible processes that currently exist in hospitals). They simply want to build a system that looks close enough that stupid investors will throw millions of dollars at it. The potential payoff is so big (seemingly) that people will keep throwing money at it even after said entrepreneurs have razed and burned a stack of companies.

Of course, eventually there *will* be a company that succeeds (mostly by accident). That company will run suspiciously like SAP where there will be a very complex set of computer programs designed to support an even more complex set of processes. These processes in turn will have nothing to do with the underlying business of providing health care. However senior management will be ecstatic that they finally have a unifying computer based process, and the only people who fully realize its true futility will be the people doing the work. They, of course, will be ignored.

What about VISTA? (0)

Anonymous Coward | more than 4 years ago | (#30280554)

Did the Harvard study include the computer system used in the Veterans' Administration hospitals?
It is an in-house system started in about 1980.
It seems to serve the VA particularly well -- doctors, patients, labs as well as management.
It is known as VISTA, and it can be tried and downloaded from a VA server.

Timing (1)

snorris01 (571733) | more than 4 years ago | (#30280584)

This study sure seems conveniently timed in relation to the current healthcared 'debate'.

Here's to hoping it is good science and not mostly partisan.

I'm getting tired of that crap.

Wrong question addressed in study: (1)

oDDmON oUT (231200) | more than 4 years ago | (#30280618)

Background/true story:

Mid 1990s.

Large hospital invests in an extremely expensive computerized charting system.

Staff were not paid to chart after their shift concluded. Instead, despite being overworked, they were expected to chart as they went through the day.

Said charting system had a key combination called "Magic Lookup", whereby pressing two keys for a given patient data field inserted the value put there from a previous charting input (i.e. temperature, blood pressure, ambulated, etc., etc., etc.). When used, this combo would give an audible chirp, of a quite different sound than that of regular input.

At the end of shift one could stand in the hallway and listen, while a five minute or so chorus of crickets erupted as staff made heavy use of "Magic Lookup" in order to get the hell out the door.

This was an excellent opportunity for such charting f*ck ups such as "Ambulated = YES" a bilateral stroke patient to occur.

It was also an excellent reason for my choosing a career in IT, rather than the nursing degree I was going for at the time.

I would love to see Yale do a study measuring the negative patient outcomes affected by IT systems put in place by hospital administrators who've been served vendor Kool-Aid® over the last 15 years.

um twits running hospitals (1)

CHRONOSS2008 (1226498) | more than 4 years ago | (#30280658)

A) when you have massive budgets people in that IT industry formmicrosoft WILL RIP YOU OFF
try linux and open source ITS FREE just hten have to hire a tech or three vs the entire marketing dept of MS plus 4 lawyers and a IT farm team
B) get rid a stupid old men running your IT depts they dont have a clue what a computer is , hten go back to A)

C) repeat as needed A) and B) save BIG BUCKS

They save lives, not money (0)

Anonymous Coward | more than 4 years ago | (#30280692)

Remember - Harvard has other agendas beside the public good.

Computers let you employ dumber, cheaper people (1)

petes_PoV (912422) | more than 4 years ago | (#30280730)

Most IT is about dumbing down. It lets you shed highly trained, expensive staff who are hard to recruit by replacing them with some electronic "brains" and a pair of minimum-wage hands to carry out the machine's orders. For most organisations the key driver is not cost (no matter what they tell you), it's risk. Risk that people will fail, risk that someone else will get to market before them, risk that their tame geek will walk away and take all their I.P. with them, risk that they aren't seen to be using "best practice" and risk that the shareholders will ask why they're doing what everyone else is doing. If that means following the herd and computerising everything - then so be it.

It's a bit like having an autopilot on a plane, it does most of the work (thank god) and only needs a pilot to make sure everything is running properly and to reassure the pax that there's a credible-looking face at the pointy end of the plane.

There are a few places were employing IT has, genuinely made things faster or reduced their cost to a point where they can be deployed more readily. Crime detection: fingerprints, DNA and surveillance cameras (with facial recognition) are the most ovbious. Whether that can be considered progress, is however, another question entirely.

Bollocks (1)

iamacat (583406) | more than 4 years ago | (#30280768)

Palo Alto medical foundation implemented online system to allow any doctor or patient to access patient's records and exchange e-mails. If you see a specialist and then go to a primary care physician for annual exam, he/she immediately sees what happened to you and what tests need to be done. Many routine matters like prescription renewals or questions about OTC drugs can be handled without revisiting the clinic. How is that not saving money or even health/lives?

Computers need to be implemented correctly... (3, Interesting)

mgchan (1690418) | more than 4 years ago | (#30280794)

And they usually aren't.

I'm a radiologist and computers have definitely improved patient care and saved the hospital money (or alternatively made the hospital more money) in our field. From digitized images and the ability to outsource to overnight coverage to voice recognition to get turnaround for finalized reports in an hour it has undoubtedly worked. And that's with in most cases only fair implementation of a computer system.

With most hospitals, the problem is that they like to do a piecemeal transition. Digitize a subset of notes and vital signs, half the time what you need isn't there so you have to look through the paper chart AND the computer chart. Or the vital signs are only half in the computer and half on a chart, so nurses double their workload. And when it's set up, they do it with an IT-centric interface that doesn't make intuitive sense to most users. When I use them I can see through my background in computer science and engineering why things are done a certain way, but it doesn't make any sense to physicians, nurses, etc.

Then they add in a new piece, such as more vital signs (but in a different section), some dictated notes, some linking to the outside. Outpatient notes are digitized, inpatient notes are still handwritten, etc. ED notes are separate, with their own system. It's a complete mess. This method is a waste of money and time, all for the sake of early deployment of a suboptimal system and minimal re-training of the staff to use a new system.

The VA had a decent attempt with CPRS. They digitized everything - from physician admission notes to clergy notes. At least everything is in one place, but people are overwhelmed with data and it's too easy to copy and paste incorrect or inaccurate information. The interface is also suboptimal (graphing lab values involves selecting a range of tests, building a worksheet, etc. much like you'd expect an engineer to make it for maximum flexibility, but minimal ease of use). And connecting to other VA systems is hit or miss.

Perhaps the best method is to build a new hospital from the ground up. All patient records get digitized (scanned, at least, if not run through some OCR). Have a tightly integrated medical record system developed in collaboration with health care practitioners. That would save the hospital money, in the long run, compared to them starting from scratch with paper records.

OT but you can probably help (1)

MichaelSmith (789609) | more than 4 years ago | (#30280974)

I get my X-Rays in DICOM format from my public hospital. I convert them to PNG and post them on my blog [glitch.tl] . I must have a DICOM library loaded because gimp will read those files on ubuntu but it refuses to load some of the files, in particular the more recent ones.

Do you have any suggestions for reading DICOM which don't involve running windows and using the DLLs on the CD from the hospital? Thanks.

Remote access to specialists (2, Informative)

The Famous Druid (89404) | more than 4 years ago | (#30280832)

I recently showed up at the ER late at night, with a broken wrist.
The ER doctor looked at the X-rays, then called the fracture specialist at home, who looked at the X-rays on his home computer, and passed on his advice to the ER doctor.

Let's see them do that without computers.

How you save money in the health system (1)

prefec2 (875483) | more than 4 years ago | (#30280846)

Honestly if you want to increase the average health care, which means the health care for most people and only pay 50% of what you pay now, just change your health care system to any system in West Europe (except the British one). Even the German one is better and that still sucks. BTW computer can be a helpful tool to manage data, but that is often not the real problem. In most cases it is bad management, induced by the wrong goals.

NHS Comparison (1)

asc99c (938635) | more than 4 years ago | (#30280918)

For a while in the UK, the government has been spending billions of pounds on NHS IT systems. There is enormous potential to improve the situation, but so far it just hasn't been used. The prime example is electronic medical notes as mentioned in the article.

Currently, I live and work 22 miles apart. I'm only allowed to use the doctor near my home, even though they are only open during working hours. The reason for this is my medical notes - f I need an emergency home visit (I never have) they will need my medical notes. Therefore it's essential my doctor is the one near my home. The government has spent millions on electronic systems for keeping these medical notes electronically, instead of paper based. Yet they somehow can't share the notes between two surgeries. If they could, it would vastly improve patient care. I could have a half hour trip to the doctor for my asthma checkup, instead of needing half a day off work. And if I ever visited hospital they would be able to see all notes taken about me by my GP. Although in my case there's nothing really to know.

In terms of saving money, I actually agree with the current intended usage. Computers currently will only be able to save money on administration type work. I don't think they will be able to significantly help doctors save money on direct patient care. That task is too difficult for computers right now, which is why we pay doctors a lot of money to do the job. I suppose it depends on where you draw the line between admin / patient care. What would scheduling operations, along with marshalling the resources of operating rooms, and correctly trained doctors and nurses fall under? I'd call that admin and say that it's the sort of thing a computer could probably do better than a person.

Hospitals implement tech badly. Lose benefits (1)

syousef (465911) | more than 4 years ago | (#30280980)

News at 11.

Seriously, if you don't have improved efficiency after a tech implementation, you've done it wrong. Try tying vendor's and staff's earnings to efficiency.

Re:Hospitals implement tech badly. Lose benefits (1)

twoshortplanks (124523) | more than 4 years ago | (#30281096)

The trouble with that is that you're then forcing them to be assessed on the metric you're assessing on them or inadvertently game the system (intentionally or not). I can think of plenty ways to make hospitals more "efficient" if you can compromise patient care...

What is the cost of a life ? (1)

oneguess (1690450) | more than 4 years ago | (#30280990)

Firstly, like most statistical analysis this one is also flawed because it does not take into effect any other increase in costs. e.g. Population increase, inflation, swine flu, etc.. Secondly there is no analysis of the value of the information being provided by computerisation. What is the value of BI? Thirdly most CIO's are poor at managing IT and its costs. In my experience they have no idea how much it should cost and pay millions/billions for a person in a nice suit to rip them off. The price being paid for the computerisation is too high. Fourthly computers are only useful if they are made useful to all users and it is used by all users. In my experience the product is dropped and everyone else is expected to pick up pieces while the people at the top enjoys the credit and bonuses. Finally what is the price of a life or the price of a mistake? How many are saved or made by computerisation ? This is only one study and provides more questions than answers. However it may open some eyes and force people to improve their computerisation or maybe just their CIO ?

Difficult measure (1)

OpenSourced (323149) | more than 4 years ago | (#30281084)

How to say if computers save money to a hospital? Do you take into account reduction in errors, perhaps malpractice errors that could cost millions? Do you take into account expanded possibilities? If you now have a service that wouldn't be possible without computers, are the profits of that service included in the study?

I once made a program for a manufacturing company, that sequenced the production in the different machines. They had at the time one person making the sequence for the machines manually. They had like 14 machines, and things were starting to go a bit out of hand, so the program idea. Now the company has grown, they have two different plants and about 40 machines, that work much faster than before, so the workload is even bigger. There are now two persons making the sequence. They have payed a lot for the program and changes and maintenance through the years. They have saved a lot also by reduced inventories and less errors. They have one person more, but probably they'd have needed more if it weren't for the program. But more important than that, is that they have changed procedures _because_ they had the program. They have reduced the size of manufacturing runs. They have achieved some quality certifications that have won them (who knows how many?) clients. I'm not just trying to say that computers save money, but that I wouldn't know even how to start to measure how much. I much fear that the study is a bit shallow. A similar study could conclude that this company has lost money by getting the program because they have doubled the personnel costs. As the article is skimpy on details of procedure, one is left to wonder, but my main idea is that it's practically impossible to conduct a meaningful study in search of that answer.

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