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IT and Health Care 294

Posted by samzenpus
from the broken-by-design dept.
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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IT and Health Care

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  • Hanlon's Razor (Score:4, Insightful)

    by gmuslera (3436) on Thursday June 25, 2009 @02:41AM (#28463455) Homepage Journal
    Is not very surgical, but probably will be the right tool to diagnose this problem.
    • by TheLoinKing (1585107) on Thursday June 25, 2009 @01:15PM (#28468469)
      The Allergists voted to scratch it and the Dermatologists advised against rash moves. The Gastroenterologists had a gut feeling about it, but the Neurologists thought the administration had a lot of nerve, and the Obstetricians stated they were all laboring under a misconception. The Ophthalmologists considered the idea short-sighted, the Pathologists yelled, "Over my dead body", while the Pediatricians said, "Grow up!" The Psychiatrists thought the whole idea was madness, the surgeons decided to wash their hands of the whole thing and the Radiologists could see right through it! The physicians thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter." The Podiatrists thought it was a step forward, but the Urologists felt the scheme wouldn't hold water. The Anesthesiologists thought the whole idea was a gas and the Cardiologist didn't have the heart to say no. In the end, the Proctologists left the decision up to some butt hole in Obama Administration.
  • by dreadlord76 (562584) on Thursday June 25, 2009 @02:44AM (#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: (Score:2, Insightful)

      by rtb61 (674572)

      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 us

      • by Z00L00K (682162) on Thursday June 25, 2009 @04:07AM (#28463881) Homepage

        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: (Score:3, Informative)

          by datapharmer (1099455)
          The biggest problem with the Unified Medical Language is that there are too many fields that aren't required and information is often recorded in a different way be various practitioners. This results in it being not so "universal".
      • by ILongForDarkness (1134931) on Thursday June 25, 2009 @04:14AM (#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.

      • by Yoozer (1055188) on Thursday June 25, 2009 @04:15AM (#28463913) Homepage

        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]?

      • by greenbird (859670) * on Thursday June 25, 2009 @04:18AM (#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.

        • by adavies42 (746183) on Thursday June 25, 2009 @04:57AM (#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.
          • 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: (Score:3, Funny)

              by MadKeithV (102058)

              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...

              Crap, I'm NEVER going to the doctor again!

              • Re: (Score:3, Funny)

                by Ihlosi (895663)
                Crap, I'm NEVER going to the doctor again!

                In Sovier Russia, Mad Doctor and Igor go to you.

    • by nofx_3 (40519) on Thursday June 25, 2009 @03:28AM (#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).

    • by fbjon (692006)
      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 m

    • by c0p0n (770852) <copong@noSpaM.gmail.com> on Thursday June 25, 2009 @05:04AM (#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: (Score:3, Interesting)

        by Hognoxious (631665)

        I would imagine the picture is very different depending on the country.

        I would imagine the article submitter doesn't understand the concept of "other countries".

        I could imagine providers overtesting in a US style pay-as-you-go system - the incentive is clear. But why would the NHS in the UK (OMG!!! teh sosherlizzum!!!!) do such a thing? And as you hint at, the NHS has a long record of failed IT implementations too.

        I suspect the problem is to do with medicine itself - every case is different and partly t

    • by lurker412 (706164) on Thursday June 25, 2009 @05:31AM (#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.
      • by rhsanborn (773855)
        Add in two more issues, which are the incredible amount of power any given, technophobe doctor wields in making technology decisions, and the IT systems they breed. Doctor's control a great deal of the decisions in any hospital for the reasons mentioned by the parent.

        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.

        As a result, an industry of medical technology providers have popped up with people holding medical backgrounds running them and making decisions. These people with medical backgrounds give hospital decision makers warm fuzzy feelings, because

        • I don't know how it works in other hospitals but the hospital I work for, the doctors go to the liaison with a need, the liaison talks to the right people in the IT department and a group is formed to meet the need of the doctors. The only decision making the doctor gets is in the area of "does this meet my needs". The docs have little say in what we do to support the solutions that meet their needs and according to Gallup, we are in the 99th percentile for physician satisfaction.

      • Re: (Score:3, Insightful)

        I think you've pretty much hit the nail on the head. Since medicine itself is more art than science, doctors need to once convey the right information about the patient, but also pass along coded messages about their judgment on the situation that are tailored to the recipient. The example I know intimately is that if you're a pathologist and you see something that looks like it's a little suspicious, but you're dealing with an oncologist and surgeon who you think are a little too hot to trot in the surg
    • Re: (Score:2, Insightful)

      by ronaldo1 (11627)

      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

      • Why Ignore VistA (Score:3, Informative)

        by occamboy (583175)

        It works and docs find it helpful. I'm amazed that it's ignored in TFA.

        Docs won't use EMRs until they need to do so to get paid. That's the long and the short of it.

    • by jellomizer (103300) on Thursday June 25, 2009 @08:38AM (#28465039)

      Medical Doctors are in General very difficult to work with. There are a lot of factors...

      1. Society says they are the smartest people around. They think that too. So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it. And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem. I have had Doctors yell at me, when I call them and say, "I hear you are having some problems with the system, could you explain them to me so I can see how I can fix it?" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment. This makes them high maintenance and people don't necessarily want to deal with them. House may be a cool TV show, but you really wouldn't want to with him.

      2. Doctors are trained in medical not business, they are MDs not MBAs. Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine. Many practices are so overworked that they don't have time to analyze or listen to ideas that will improve their practice.

      3. Most practices are small business. Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database. They feel like they are getting ripped off by paying such high prices for software. So they will go with their crappy methods before getting ripped off.

      4. Open Source is not an option. Sorry Open Source fans. In a career where you can get sued in an instant you need somewhere to point the lawyers away from you. (Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.

      5. MD are known to make a lot of money. This doesn't always attract good, nice, or even smart people. Remember "What do you call the person who graduated with the lowest score in Med School?" answer "Doctor". A lot of people are just in it for the money. They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.

      6. Uneducated staff. For most practices you will have 1 or 2 doctors 1 or 2 nurses (with Associates or BA degrees) then a staff of 4 or 5 with High School degrees. That staff runs the business for the most part. They lack the patience or discipline to learn such technologies and to use it for its best advantage. Also many of them feel sub adequate (as they need to deal with the high egos of the Doctors) so they are afraid to ask questions or point out problems.

  • by timeOday (582209) on Thursday June 25, 2009 @02:50AM (#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!)
    • by nikolag (467418) on Thursday June 25, 2009 @04:26AM (#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.

      • by fbjon (692006)
        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.

        • by rhsanborn (773855)
          Unfortunately, because of lack of standards, while those systems do communicate, it makes it very difficult to get an accurate snapshot of a patients stay. I work with EMR systems, which, at this point is a document imaging system. It means exporting a patients history is not much more than a print or a fax, paper, or digital paper doesn't have the utility of actual digital data. The ability to receive vitals on admissions or discharge, etc. To receive a digital version of all medications administered or pr
        • There is a reason that Health Level 7 standards exist and that every piece of technology in a hospital uses those standards.

      • It sounds like your Iike your hospital does not hold to the meme "do not use one supplier for the whole system".

        Our department does not want to be "locked in" to a single vendor. This is admirable, but it increases the amount of work and costs to build and maintain the system.

        I dunno... no lock in also means more flexibility so there is probably a large benefit in that.

  • Easy to test (Score:5, Informative)

    by Allicorn (175921) on Thursday June 25, 2009 @02:51AM (#28463487) Homepage

    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.

    • by arethuza (737069)

      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...

  • by drDugan (219551) on Thursday June 25, 2009 @02:58AM (#28463551) Homepage

    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: (Score:3, Interesting)

      by umghhh (965931)
      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.
    • by dmr001 (103373) on Thursday June 25, 2009 @03:35AM (#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.
      • by fbjon (692006)
        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: (Score:2, Insightful)

        by drDugan (219551)

        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/Sal [payscale.com]

        • Re: (Score:2, Insightful)

          by Ihlosi (895663)
          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.

      • by dr_canak (593415) on Thursday June 25, 2009 @07:04AM (#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

      • Absolutely (Score:4, Insightful)

        by The Tyro (247333) * on Thursday June 25, 2009 @08:33AM (#28464991)

        It's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR (you can't get ten physicians to agree on damned-near ANYTHING, from what PACS software to use, to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper?) You want to know why physicians dread EMRs?

        Well... being one (and a tech geek to boot), I'll tell you:

        It's the UI.... that and the cost. If you can make it fast, user-friendly, intuitive, lightweight, and inexpensive, the world will beat a path to your door.

        For example, when I was an intern, we were evaulating a hospital-based order-entry system from TDS. It was the old light-pen system, and the damned thing took 14 screens to order an Xray.

        I'm now a practicing ER physician... nobody is under greater time pressure than I am, and the EMRs that I've seen so far will slow me down. My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.

        Make it faster and easier to use than paper. Make it... you know... an actual upgrade? Not some ugly, unwieldy kludge forced by some data-mining, numbers-obsessed bureaucrat. Doctors generally aren't geeks... they care about ease of use. A system that doesn't make it easier to take care of patients will be universally despised, and resisted by everyone on the medical staff.

        Physicians have enough to do, and enough to worry about. Want to have medical staff buy-in? Make the EMR an asset instead of a liability.

    • by ndogg (158021)

      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].

  • 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.

    • 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) l

  • by petes_PoV (912422) on Thursday June 25, 2009 @03:23AM (#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.

    • by badfish99 (826052)
      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.
    • by malkavian (9512)

      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

      • I've been working with the ICS project (similar kind of mandate, but for children's social services - in the UK again) and we're seeing exactly the problems you've described. It's got nothing to do with the system being conceptually difficult, and everything to do with massive, chronic project mismanagement by central government from the very start.

        Specifications were set out without any significant consultation from users, practitioners or even IT project management specialists (a field full of charlatans

    • 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

  • 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.
  • 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.

  • by freedom_india (780002) on Thursday June 25, 2009 @04:10AM (#28463883) Homepage Journal

    ...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.

  • Doctors (Score:2, Insightful)

    by drunkahol (143049)

    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

    • Re: (Score:2, Insightful)

      by Anonymous Coward

      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 mark

      • 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 a
  • Conspiracy? (Score:4, Insightful)

    by jandersen (462034) on Thursday June 25, 2009 @04:18AM (#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.

  • by Anonymous Coward on Thursday June 25, 2009 @04:19AM (#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.

    • Re: (Score:3, Insightful)

      by Rich0 (548339)

      Your example is a good one, but after having all these arteries clamped and fixed, how many patients then go on and die because some nurse adminsters the wrong drug - or the drug that the records say is the right drug but that was due to some kind of clerical error?

      My concern is that for every miracle life saved there are probably 500 lost or otherwise shortened through the medical meat grinder. Quite a bit of pain and suffering too as patients take needlessly long to recover from less critical problems.

      Me

  • by www.sorehands.com (142825) on Thursday June 25, 2009 @04:22AM (#28463939) Homepage

    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.

    • by Ihlosi (895663)
      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: (Score:2, Interesting)

      by drunkahol (143049)

      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 universa

      • by shilly (142940)

        The first example is a really bad reason for doing EMR -- it's the one cited by NPfIT and misses the point that for most trauma, there's neither the time nor the added value to make it worth knowing your medical history at the point of administration of emergency care.

        The promise of EMR is in providing more proactive and integrated care of people with long-term conditions such as diabetes or congestive heart disease, where there are multiple health professionals involved who would benefit from each knowing

      • Re: (Score:3, Informative)

        by Qzukk (229616)

        Have medical complications that it would be just great if the Doctors treating you had access to?

        Buy a damn medalert bracelet. A million times faster than triage staff trying to figure out whether you've given your medical records to google or microsoft and what your userid is to get them back.

    • by will_die (586523)
      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.
  • by yes it is (1137335) on Thursday June 25, 2009 @04:41AM (#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.

  • 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 p
    • by hrvatska (790627)
      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.
  • by ldrydenb (1316047) on Thursday June 25, 2009 @05:08AM (#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?

  • Medical IT sucks (Score:5, Insightful)

    by greenguy (162630) <estebandido.gmail@com> on Thursday June 25, 2009 @05:19AM (#28464231) Homepage Journal

    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.

  • by trydk (930014) on Thursday June 25, 2009 @06:05AM (#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 (Score:5, Insightful)

    by August_zero (654282) on Thursday June 25, 2009 @06:24AM (#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 (Score:3, Interesting)

    by readin (838620) on Thursday June 25, 2009 @07:01AM (#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.
  • by RaigetheFury (1000827) on Thursday June 25, 2009 @07:18AM (#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.

  • Sometimes paper is better than anything else. Certainly with paper, data security comes down to physical security, whereas with digital, security is a mix of physical and electronic security. Paper doesn't crash, paper doesn't need electricity.

  • I worked in a hospital in college and for insurance companies after and I can confirm this. Doctors, for example, are only in it for the money. While some of you may be able to cite examples of good doctors, they are rare. Most are in it to get rich and so it follows obviously that they are going to do as many tests as possible--cost be damned--and if called on it they can claim they're protecting themselves from malpractice suits. In fact, it's just wallet padding. Insurance companies have their own versio
  • by smug_lisp_weenie (824771) <cbarski.4503440@bloglines.com> on Thursday June 25, 2009 @09:35AM (#28465565) Homepage

    One thing everyone seems to be missing here (including the author of the article) is that medical data is an odd duck that just doesn't fit easily into a digital record. (I'm an MD, a medical informatics guy and CTO at a medical software company)

    If you're running a McDonalds you can easily computerize everything: You have a fixed menu your customers can choose from, and every purchase can easily be stuffed into a relational table. Medicine isn't like that.

    Trying to enter a patient encounter into a contemporary medical record system is an extremely unsatisfying experience: Humans are just weird and idiosyncratic and every time you treat someone there will be parts of the patient visit you can't represent symbolically in a piece of software. This is still largely an unsolved problem- If you read the literature on Description Logics you'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software, let alone a doc with little computer training.

    Because of this, most current record systems use a lot of "free text" for storing medical info, which is a pretty ugly hack and everyone realizes this.

    I think this is a major reason for the problems people have with digital records: They don't work very well right now for fully capturing a patient encounter in a rigorous, symbolic fashion.

  • An EMR story... (Score:4, Informative)

    by HikingStick (878216) <z01riemer @ h o t m a i l . com> on Thursday June 25, 2009 @10:10AM (#28465947)
    In January of this year, I went in to an outpatient surgery center for a procedure. My operation was scheduled for 10 AM, so I was on-site just before 8 AM. When I arrived and was ushered back into the staging area, I was next to a septuagenarian who, it turns out, had been at the center since 6 AM. He had been driven there by one of his adult children, and he hailed from a small town three hours away. He left home before 3 AM to make sure he arrived on time--his was to be the first procedure of the day for a particular surgeon. [I picked all this up from hearing him interact with his daughter and other family members who were also present.]

    My surgeon was running late due to complications in an earlier procedure, so when 10 AM rolled around, both the septuagenarian and I were still waiting for our procedures. For me, it would clearly be a matter of time. From overhearing the family, the doctors, and the nurses, however, it was fairly clear that the old man would not have his surgery that day, because he was presenting symptoms that suggested he may have bronchitis or pneumonia.

    As is standard procedure, each surgical patient has a pre-operative screening with his or her regular physician, to ensure that the patient is well before the operation. This man had his visit, including a chest x-ray, but those records never made it to the surgery center. The man's clinic had EMR technology, so one doctor suggested that they just pull up the records. That's where they ran into some problems. The only terminal with EMR access at the nurses' station in the surgery center could not access the records for that patient. Multiple people tried their logons on that terminal, but none of them could pull up the records. There were discussions as to whether or not the clinic was on the same EMR network as was the hospital. One nurse commented that she had cared for a patient in the main building and accessed records from the same clinic system. Finally, another nurse mentioned that there was another terminal in a records room in the surgery center, so she and a doctor headed off to try to access the EMR from there.

    In the mean time, this poor old gent is starting to cough a lot, and appears to be in much pain. No one was able to reach his primary physician by phone, and the patient's home-town clinic was not open that day. The doctor and nurse returned from the records room, and indicated that they had no better luck. An older nurse then mentioned that she thought the main hospital had access to more healt-care networks than did the surgery center. Someone was dispatched to the hospital to try and pull up the records.

    It turns out that my physician was havin a really rough time. His first patient, who was in for what was thought to be a minor rotator cuff repair, apparantly had old baseball injuries about which the physician was unaware. In the end, the doctor was able to patch him up, but three out of four of the primary ligaments or tendons were beyond repair. [That bit of information was picked up by my wife in the waiting room, when the surgeon came out to tell the other man's wife how things went and why they went long, and to tell my wife why I was not yet in surgery.] I'm just noting that so you'll understand why I was still waiting for surgery as the hour neared 1 PM.

    The surgery center called over one of the on-call physicians from the hospital, who checked in on the man numerous times during the morning. He was convinced that the man was too ill for surgery, but the man insisted that his own physician had told him to go ahead. The family members were upset, because travel took a lot out of their father, and he made the three hour trip specifically for the surgery (a hip replacement). The on-call doctor made it clear that there would be no surgery that day. Why were they keeping him waiting is what the family wanted to know. The on-call doctor wanted to consult with the man's physician, because he felt the man should be admitted to the hospital. He was trying t
  • by jockeys (753885) on Thursday June 25, 2009 @10:15AM (#28466015) Journal
    I spent a few years writing commercial healthcare software, and here are a few quick thoughts:
    1. HIPAA is a problem. everything you do, EVERYTHING, has to be HIPAA compliant. this means checking, rechecking, checking a 3rd time and then hiring an outside party to check your checking. if you screw up in any way, it's possible to be held criminally liable, personally. the HIPAA rule book was around 1200 pages long the last time I had to use it. My small company (150 employees) had a full time staff of FIVE that did nothing but interpret HIPAA and document changes everytime some politician lobbied some bullshit minor rule change thru the system. Each time this happened, we had a mere 90 days to version our software to match. This is a big deal when you have 3 developers working on 4-5 million lines of code. Summary: any screwups can land you in jail, so review and testing is off the scale thorough.

    2. Mistakes can be fatal. During my time writing healthcare software, I had to opportunity to work on a system I'll call the Pill-Counting-Robot. It did exactly what you'd think it would do: scripts would come down the wire, the robot would count pills into a bottle and label it. Counting the wrong kind of pill can mean instant death for a patient. Counting the wrong number of pills can make a patient very sick or dead. Printing the wrong instructions on the label can also kill them. ZERO SCREWUPS CAN HAPPEN! None. Not one. We debugged that thing for months on end, trying as hard as we could to break it... we did testing with red and green M&Ms to make sure it never mixed medicine. You really don't even want to hear what kinds of scary mistakes that thing can make when it jams or crushes a pill or breaks a pill in half, etc, etc. Summary: a tiny glitch can kill people.

    3. The final roadblock to quick progress is ancient standards. When scripts go over the wire, they use a format called NCPDP. This was made in the 70's for use over non-duplex modems. It is slow as snot. It cannot handle whitespaces in the wrong place, it can't handle variable length text, and it can't handle certain kinds of punctuation. It definitely can't handle long names or hypenated names (e.g. married folks who share names with eachother). And yet, as bad and old and broken as the standard was, we were required to use it because of a federal mandate. See Item 1. Summary: laws make the field obsolete and obtuse.
  • by plopez (54068) on Thursday June 25, 2009 @11:10AM (#28466655) Journal

    You have the following requirements:

    1) Data integrity. This is very hard. Your typical programmer doesn't understand it. This is a disaster waiting to happen. I personally do not want my records in electronic format. See the disaster called electronic voting as an example now increase the complexity.

    2) You need tight security of records. Electronic security is a joke. And who is liable? How many breaches have there been in the private and government sector in the past few years see this article: http://hardware.slashdot.org/story/09/06/25/0243221/Reporters-Find-US-Govt-Data-In-Ghana-Market?art_pos=5 [slashdot.org]
    And security is orthogonal to ease of information sharing.

    3) Ease of data sharing. A major selling point of electronic data is the ease in which data can be shared. But this is orthogonal to point #2. Also if data integrity is violated and the data stream becomes polluted, as in point #1, this is a major liability.

    Getting all three of these major requirements is hard. Very hard. Probably harder than running tests or doing many surgeries. A simple screw up here can have ramification not just for one patient but for millions. See the nightmare called electronic voting to see what will happen.

    AFAIAC, electronic medical records will cost more in lives and money than they will save.

We warn the reader in advance that the proof presented here depends on a clever but highly unmotivated trick. -- Howard Anton, "Elementary Linear Algebra"

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