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Harvard Says Computers Don't Save Hospitals Money
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."
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?
Fuck systemd. Fuck Redhat. Fuck Soylent, too. Wait, scratch the last one.
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.
Wolde you bothe eate your cake, and have your cake?
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.
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!
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?
"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.
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.
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!
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.
Troll is not a replacement for I disagree.
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.
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.
So which is it, irony or coincidence that I am reading this online within minutes of this being posted?
Just because something's new doesn't mean it's necessarily better than the old?
...And the Bureaucracy died in a landslide of paperwork...
Edward@Tomato - /home/Edward/ man woman
man: no entry for woman in the manual.
"Qua!?"
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.
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.
TaijiQuan (Huang, 5 loosenings)
... and surgically insert another.
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.
I swear to God...I swear to God! That is NOT how you treat your human!
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.
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.
In post Patriot Act America, the library books scan you.
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.
...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).
to hell with wether it saved a dime. did it improve patient outcome? cost saving it the wrong wrong WRONG aim of a hospital.
If you mod me down, I will become more powerful than you can imagine....
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.
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.
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.
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.
You: Computers have made my life much easier.
Harvard study: Computers don't save hospitals money.
Note the slight difference there?
Mit der Dummheit kämpfen Götter selbst vergebens
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.
Some days it's just not worth
chewing through my restraints.
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.
Remember - Harvard has other agendas beside the public good.
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.
politicians are like babies' nappies: they should both be changed regularly and for the same reasons
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?
> 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.
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.
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.
Quidquid Latine dictum sit, altum videtur (anything said in Latin sounds important)
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.
> 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.
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.
"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...
Mit der Dummheit kämpfen Götter selbst vergebens
They save lives, not money.
I get my X-Rays in DICOM format from my public hospital. I convert them to PNG and post them on my blog. 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.
http://michaelsmith.id.au
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.
These posts express my own personal views, not those of my employer
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 ?
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...
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.
Rome taught me patience and assiduous application to detail. Virtues which temper the boldness of great, general views.
We are over ambitious. The more code we write, the more bugs we create.
The trouble with hospital data is that it is messy. You have to accept that.
It's tempting to design a hospital data system with specific fields for each item, every procedure enumerated, and every field validated. You want to normalize your data. You want it neat and tidy. You can work very hard trying to enforce this. You're screwed though, because life isn't like that.
You'd be better off with relatively "dumb" software, almost like a wiki, that lets you efficiently handle arbitrary text and arbitrary data blobs. It needs fast Google-style search. It needs to allow arbitrary associations so you can handle stuff like a patient claiming to have the same social security number as a different patient or a patient who claims to have a different identity than he did the last time he visited.
Then you need to keep medical staff away from both paper and computers. Data entry is for data entry specialists.
When "computerizing" medical facilities, the argument is not about how much cheaper treatment is going to be, but how much better it will be for the patients.
So, computers are "bad", right?
How about scanners, computerized microscopes, computer assisted operation tools and/or any other monitoring system?
Sure, they cost more than if they were not used/purchased, but aren't all these meant for BETTER healthcare, and not cost reduction ???
All calculations was made by hand, saving money for calculators as well.
But the whole text is not.
If you go to the original post linked in it from computerworld, you'll have a different impression on that research. I am amazed nobody commented about this so far (although I haven't read all comments). Regardless of it all being well done or not, it is very sensate if you read it through, unlike the slashdot text from Lucas, which generated some angry comments.
It is true the research showed computers don't save money for hospitals. Absolute majority of them, but not all. And Dr. David Himmelstein quote is also there, but in the end, after everything else was explained. Anyway I don't blame Lucas123 for the same reason I won't try to sum it up. It is a complicated subject. Just wanted to point people to actually go and read the source.
I will just say that it is evident computers are bluntly necessary nowadays and there is no way for any research to show otherwise. Of course the only way to truly show computers are not a good option, in that case, is to have at least two similar hospitals running side by side, one computer-less. And nobody will do this as it is clear water that the second won't be sustainable.
There are too many variables...
Computers installed and maintained in a competent fashion, running software which is appropriate to the job at hand and being used by staff who are proficient with that software can save money, potentially a lot of it...
On the other hand, many IT projects are terribly mismanaged, poorly budgeted, installed by cheap unqualified staff, running unsuitable software which expects people to adapt to its way of doing things rather than the other way round, and used by staff who are unsure how to use the system correctly and are often too fearful to touch it unless forced to..
Ask the average joe on the street, and they will tell you that computers are extremely unreliable black boxes, they have no idea how they work and are very fearful of touching them incase they break, especially at work where they're likely to face disciplinary action for breaking the computers.
In a lot of cases, computers are simply not appropriate, and in many more cases computers in the form that get installed are completely unsuitable for the task and are actually inferior to what they replaced.
You also have the attitude of third party suppliers and corrupt people high up in the client organizations where the situation changes from "what do we need" to "how can we justify purchasing something from "... IT is one of the worst affected industries for this, because people generally have less understanding and are therefore easier to fool.
The goals of these people is not to save money, it's not their money to save, it's someone else's money that they are in charge of, and their primary goal is to siphon as much of it out and into their own pockets as possible.
http://spamdecoy.net - free throwaway anonymous email - avoid spam!
"So the first thing we need to do is stop claiming things there's no evidence for."
That would rule out 99 % of all claims.
"The study also showed most of the IT systems were aimed at improving efficiency for hospital management -- not doctors, nurses, and medical technicians"
No, they dont save time.
But, they do save people....
Sigh... Vista... the VA's medical informatic system reduced dispensing (medicine) errors by something like 90%.
So in the words of my forefathers... Intercourse Efficiency
was whether the Hospitals could have at all managed to deliver the kind of services WITHOUT the systems that they are using today. We know that hospitals can operate without computer ( there are enough of them where I live, in India ) but the real question is how efficiently do these computer-less hospitals operate ? the queues ? the chaos ? if not the gross corruption ? We know that computer system cannot solve a problem when the underlying physical system is broken but it sure helps to have a computer around -- a computer is necessary, but not sufficient to solve major business problems. And do not expect to calculate a Return-On-Investment on IT systems ( of the kind that can be done with other machines ) .... consultants and CIO have tried for years to do so and have realised that the answer simply does not exist.
Insight into much, Influence over nothing !
"Bottom line: they have met the enemy, and he is them."
Bottom line: Doctors don't want medical treatment to be more efficient.
Many many years ago, a study over the modernization of household appliances and stuff affected the workload of the average housewife. In the end, it showed the amount of work that could be done in a day was just about the same.
Let's start off with the basics.
Time = Money.
Mistakes = Money
There are actions that need to be complete and the longer actions take the more people are needed to perform these actions. Therefore... the longer actions take to complete the more money it costs the hospital. Think "Nurse what drugs has this patient been given?". Most hospitals keep digital records of all medications given which helps doctors make decisions. This simple task could take 5-10 minutes pouring through 200 pages of charts and possibly missing pages.
Think bad handwriting where the nurse AND the doctor can't read what it is. Get the idea?
Mistakes also cost money. One of the biggest benefits is that Doctors can quickly see what Jonny has been taking and don't accidentally prescribe something that will kill him when mixed with other things. It also helps the doctor quickly see trends and change their decisions quickly whereas with paper records they might not as easily notice.
This paper is written by someone who hates computer systems and doesn't take into account how medicine has changed in the last 20 years.
This is just coming from a guy who works at a Veterinary College... our patients are cats and dogs. Our system has been attributed to saving hundreds of lives because of how statistics can be generated on the fly. Comparing test results with a click of a button and seeing trends, easily, efficiently... without error. The ability for alerts to come up letting a doctor know that a drug they are prescribing may cause an allergic reaction with this patient.
I can easily say Dr. David Himmelstein has flawed research with far too many missing puzzle pieces and flawed logic. This system has saved our hospital MILLIONS in potential lawsuits alone.
in the title. I've been around Hospital IT quite a bit in my career, and have never seen a system sold on saving money. They're sold on getting clinical data to the physician as soon as possible. A computer system and network costs far more money than a slip of paper, but I still want my lab results stored and transmitted electronically because it is faster and more efficient, both in a particular moment and over the span of various visits.
I developed products in this space for a number of years. One big problem we always encountered was the in-house proprietary systems. Time and again we would hear "we'll buy your system as long as it can interface with this shiny, homegrown monstrosity that we developed". Of course the person most responsible for the purchasing decision (at least from the technical end) was also usually the manager who was responsible for creating (or at least maintaining) the inhouse monstrosity. To throw it out is to admit a giant mistake, to potentially cut staff (and hence reduce power) and so instead they try to make vendors jump through hoops. Our natural response was to wrap our products with integration services, which breeds a support nightmare (no two customers have the same thing) and is also very labor intensive, and hence expensive, making it very hard to justify for the projected "savings". As an example, I once spent a year (mostly on my own time each night at home) logging in remotely to a hospital system, running migration scripts to move image data from an inhouse system into our system. Each morning I would tell the customer's technician to load a new batch of disks, then I would kick off the migration each night. And mind you, this is ONE customer at ONE hospital. And of course first I had to write the migration scripts ... another sunk cost.
The more you regulate a company, the worse its products become.
Let's say you have $5 in your pocket, and you somehow manage to spend $10 of it. Now how much money do you have? If you can answer this question correctly, then you are far too smart to work at any level of the US government...
Your records belong to you.
Not really. In the United States the DATA in your medical record belongs to you. The physical medium on which the record is stored belongs to the entity responsible for maintaining that record. A close analogy is that you own the copyright but they own the physical copy. You have a right to inspect your medical record and petition your health care provider to correct factually incorrect data.
In the United Kingdom NHS medical records belong to the Department of Health.
I don't know, but I have heard that doctors love a system of badly filed, illegibly scrawled, notes - a system that only they can understand. Doctors do not want a system where data can be easily transfered, or easily reviewed. Doctor's want to protect their turf, and they want to be immune from any possibly legalities.
Whenever I see a "study" in a pop-media publication, my first thought is: who funded this, and why? IMO, there is usually some agenda involved.
MIT releases research proving that lawyers don't save hospitals money either.
Suck it Harvard!
Of course the hospitals in the study could not afford good software. They spent all their money on "the machine that goes 'ping'".
In the mid 80's, I first heard the notion of a paperless office. Friends of mine told me I better find a new line of work (I repair office machines). Well, here we are 20+ years later & I'm still doing the same thing. Not only did we not get a paperless office, we have MORE. Every time the government comes up with a new regulation, my business goes UP. Add to that, these machines are now interconnected and do multiple tasks. All a computer does is make it easier for bureaucrats to justify themselves by producing more and more detailed reports on the tookpick inventory. Unfortunately, they still don't understand how a computer or interconnected device can help the guys in the trenches do their job. Most of my career has been spent inside a large hospital complex, and a few years ago they started computerizing everything. Now it appears that it takes the nurses longer to do their jobs because of the do-dads they have to carry around and scan everything they do. Does it help cut down on mistakes, more than likely, but, if you want to see things really slow down, watch what happens when the entire system goes down, and the younger nurses/staff don't know how to treat someone the old fashioned way, by writing everything down and doing everything by hand. It's the same principal as why teachers require you to "show your work". You could punch something into a hand held calculator all day long but if you don't know the basics of how to do something, you're screwed.
I took a tour of our local hospital's IT facilities. The main thing they've saved money on is not having to reorder blood tests; computers mean less errors reading doctor's handwriting. That, alone, helps save lives by having fast, accurate results. There are several other efficiencies, such as storage and backup of patient data, CT and MRI modeling, etc. Those may not save money (maybe they do), but they make saving lives drastically more efficient.
They shouldn't make sweeping generalizations that no one is saving money or becoming more efficient.
Are extremely change adverse as well. I worked at a large cancer centre. After a software upgrade that added a lot of extremely helpful features I still got tonnes of complaints for things like "the close dialog button moved from the bottom left of the form to the bottom right". Sure you have muscle memory, but it is an extremely minor difference and you still know what you need to do, but still it was a big deal for them. It was sometimes to the point where doctors just didn't want to deal with any change so they had a nurse do all the computer stuff for him like open the patient image and "click the button show image for me and call me when the image is on the screen".
Did nobody read Nicholas Negroponte's Being Digital ? I think I re-read his book once every two years just to remind myself why this computing stuff is not intuitive and to remember that I have developed a skill set that does not relate to any reality other than that of the computer.
I don't want to take anything away from physicians. They're smart people and every one I have been to recently is capable of dealing with a personal computer. Some have dedicated touchscreen systems to help to record patient information and to write prescriptions. Others use computers to reduce the need for office staff to push paperwork. Still others have gone "paperless," and are trying to keep all records electronically so that they don't have to have a room just for patient records.
I also don't want to take anything away from hospital administrators who have to handle the tremendous losses of an emergency room with 9 to 12% of cases coming in with no insurance and no ability to pay for necessary treatment, combined with a mandate that they take all comers, regardless of whether or not the hospital will wind up picking up the tab. They're trying to reduce the steps necessary to manage a pretty large organization that must be large in order to be able to stay afloat.
But I'm looking at this Harvard study in the same way that I've been looking at the Women's breast exam and mammography study as well as the recent pap smear study where statistics are being slightly misused. And the end result of this study will be used to invalidate the Administration's claims that computerization will result in a savings, just as the last two studies have been used to claim that any health insurance reform that passes the House and Senate will be used to limit care. Never mind that it's false.
The administration's computerization proposal is all about patient care and not administration. The Harvard study covered computerization of administrative tasks. Will there be a savings? That is yet to be seen.
A computer application needs to be easy to use. It needs to be so analogous to the types of everyday tasks that the nurses, doctors and support staff does that they can readily understand and work with it. That's Negroponte's point. Furthermore, any application (and user interface) written to streamline patient care needs to actually make things easier to provide patient care than the methods currently being used. If this is not the case, it will take a long time for any savings to be seen because adoption will be very slow.
If you are a programmer and you are working on something like this, you need to spend a day with a nurse. You need to spend a day with a doctor. You need to observe their procedures and really understand them, which means they need to explain things that they did to you. And that's a problem because no nurse or doctor really has time in their day "for this nonsense." So, what's probably needed here is a programmer who actually studied medicine, which is probably a seriously small subset of all programmers out there.
I work in television. And I remember when the first computerized video editors came out that changed the editing paradigm for us. they were pretty slow. It took a long time to load material into them and then the end result had such low resolution that you could not determined whether or not the camera's focus was properly pulled. You had to take the end result and go into a very expensive suite and reassemble everything with a computer list created for that purpose. Of course personal computers got faster. And their capabilities got better. And compression of pictures got a lot better. Today, there are a number of video editing tools out there that enable us to do our jobs very well and everyone understands the worth of loading material into the systems. Additionally, there are different editing systems available that use different paradigms for e
Gods don't kill people, people with gods kill people.
I work in a clinic that is inside of a Hospital. Our Docs have Hospital duty, basically on call during the day/nights and weekends. So what i see in the clinic could be different than a Hospital but i bet you it boils down to the same old thing. Money.
I was very lucky this year and finally received the 'OK' to upgrade my servers from Server 2000, to Server 2008. It took me several years to buy the two servers necessary to host the new 2008 servers(will be virtual servers). With Medicare cut's, echo, cath, nuc, we'll even have more of a hard time with that. Anything labeled "Medical" is 30x more expensive. And Doctors tend to work as much as they want. This is a huge problem since if they are okay with earning 50k, 100k less than the company as a whole suffers. There are multiple docs like this. You can't tell them what to do because it's their company.
Our EMR software is more guided to our line of work as well. However it still has major flaws and could preform better. The problem with it is that it was designed by doctors. At first it sounds good until you see the SQL end. Doctors designed that too. So the whole program, designed by these docs(not mine some can barely can turn on a PC), really is a mess that no one can fix but they just keep piling on to it. It's bloated to all hell.
I think the key to success is to break the EMR system down to individual sectional needs. Like a TV. a TV isn't built (or a good one at least) with a DVD/blu-ray player, xbox306, ps3, wii, cable tuner, etc. etc., inside of it. No it has ports to link it all to the TV. EMR software should be similar in the fact that there should be a standard "Link" so that when you have your Cardio EMR and you need to link it to your Lab EMR, you can. The billing side of all of this is probably the worst joke as i would say it's the hardest of all of this.
Sometimes, the answer is to just destroy it all.
So this is all based on survey data that hasn't been verified as true. So, based on the PERCEPTIONS of the people taking the survey this might be true, but I have a real hard time believing that the "old way" was as efficient as using computers. Every other industry has benefited from computerization so why has the medical field not?
This is the biggest load of bone headed Harvard BS I've ever seen. Let's see some university hospitals throw out their billing systems. Start sending insurance claims on paper. But wait, there is a LAW that doesn't allow paper billing! This study is crap! Sure hospitals waste a ton in IT. I wonder if that is related to the fact that hospital IT is the lowest paid of any industry that employs IT.
I worked on an EHR procurement process for the last several years and, yes, there's a LOT of crapware out there, but I have seen systems deployed that were almost entirely reliant on the input of the actual front-line providers and they'd sooner saw off their own arms than go back to paper records.
"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."
They already do. It's called HL7. It's been around for twenty years. Teleradiology is nothing terribly new anymore either.
As for "having a doctor or nurse putting in billing codes," look, if they're worth half their salt, they can already rattle off the ICD9/10 codes with sufficient accuracy from memory that it's actually faster than scribbling the condition on paper.
Yes, even GOOD systems can fail if deployed poorly. ITFA they admitted "we sucked when we used paper, then we went to computers and lo-and-behold, we still sucked just as badly, almost precisely so, ergo, we're pretty sure it was the computer's fault." This is a typical case of bad management pointing the finger at the technology to cover their own incompetence. I'm sure when they were on paper they blamed the f'ing pencils.
I read the linked Harvard study (I know, unprecedented!). I found the measurements a little misleading -- and I'd appreciate any contrary opinions on this. The degree of computerization was measured by taking the number of electronic systems that the hospital uses and dividing it by 24 (the total number of computer systems they measured). These computer systems included things like "patient billing", "staff scheduling", and "materials management". Not that those things are unimportant in and of themselves, but when we count those towards being a "computerized" hospital, it tends to water down the importance of other computer systems. For example, a hospital that uses a computer to make their nurse schedules and credit collection is considered as computerized as a hospital that uses computerized physician order entry (CPOE) and electronic medical records (EMR). I don't think you can group those two together and say they belong in the same category when analyzing quality of healthcare at a hospital. :)
The study actually presents a sub-analysis of quality measures for hospital that use CPOE and EMR and shows that there are significant quality improvements when these systems are used. I think that when we talk about computerizing hospital processes, these are the systems that we consider -- not whether HR uses computers for payroll. I think it is a little disengenuous for the conclusions of this study (and reporting thereof) to state that there is no relationship between computerization and quality of care.
Disclaimer: Without CPOE and EMR, I would be unemployed
I work for a company which provides a unique remote ICU solution. We have proven that it signifigantly reduces mortality, and shortens length of stay, as well as allowing more beds to be monitored with fewer intensivists.
If you're simply talking about 'electronic records' a la Obama, well yeah, that's a load of hooey and is more about the government having easier access to your data (for non health purposes).
that management software doesn't work well.
The best way to get maximum possible benefit from management software is to write it in house.
Every company does management differently, and has specific business rules the go all the way to the center of their business.
The Kruger Dunning explains most post on
To test this theory, go into a hospital and unplug all the IT systems. I'm willing to bet costs go up.
Computers and machines in general just do what you tell them to do. So who wrote up the requirements? It's very likely that an administrator did... so no wonder the systems were designed to make administration more efficient. This means that the inputs and outputs were designed for good bookkeeping - not efficient medical practice. Doctors and nurses now have to learn to do things the 'administrative' way rather than the 'practitioner' way... and likely it is not very efficient for them.
A good fix for this would be to develop a new view of the system which is organized and designed for the doctors and nurses but translates to a view for administrators.
Unfortunately this will up the cost and now that the work is being done twice will likely swallow up the savings for the near term... so the hospital board is unlikely to approve it and simply insist on more 'training' for Doctors and Nurses.
A fool throws a stone into a well and a thousand sages can not remove it.
My mom is a retired R.N. and she's friends with quite a few older doctors out there. One of the big complaints she's heard repeatedly from them is, hospitals are starting to demand they get on-board with using their computer systems. If they refuse, and want to keep track of things on pen and paper, or using their own favorite methods, the hospital simply bars them from working there anymore.
So the computer illiterate doctors are often voluntarily retiring, rather than deal with the learning curve this late into their careers. A few just run their private practice and stay out of the hospitals, so they can do things the "old fashioned way" for a few more years until they're ready to retire.
I'm from Soviet Canuckistan you insensitive clods!
Seriously though, I would think that IT and the health industry would be about increased service (say in patient records) not about saving money.
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Another false argument. The author fails to account for the massive increases in regulations and the resultant paperwork it produces. He's living in a dreamworld where everything has been the same for 45 years especially with regard to drugs and compounding. You can call his research poor at best. He's the type of doctor that prescribes medications having no idea what their effects are resulting in an immediate call from the pharmacist downstairs, "Dr., you can't prescribe that medication X when he's still taking Y. We went over this last week. It will kill your patient." "Oh well, just fix it then."
What would Harvard know about saving money? It's easy to tell other people how to do it if you just get hand-outs from the government and 'generous donations' from parents of students who otherwise wouldn't graduate high-school. Besides, I would like to see a hospital make a profit after they get sued by the family of a patient because someone misplaced a clipboard or an X-ray. Oh, and I wonder if Harvard heard of HIPAA and HiTRUST - good luck protecting patient records by encrypting paper copies. Can you believe someone up there gets paid to suck stuff like this out of their finger?
I'm a practicing surgeon - I graduated from medical school in 1985 and have seen a lot of change in those 2+ decades. (I'm also a C programmer and maintainer of a couple of widely-used OSS projects - basically spent lots of time wondering whether I should have continued in CS instead of going to medical school).
The real improvements I see are:
1. Dramatically faster/easier access to patients' lab results, imaging, and previous reports and consults. As a student, I used to have to walk to the basement and copy numbers from printouts posted on a wall, swipe the X rays for my attendings to look at, etc. I know it sounds like "walking five miles to school in the snow", but anyone who denies that computers make clinical info more accessible is really full of it. I'm not so certain that the better access to records has always improved medical decisions, but it certainly hasn't hurt.
2. Mind-boggling advances in imaging technology - CT, MRI, ultrasound - the speed and quality of modern imaging would have seemed like something straight out of science fiction years ago. Again, the better pictures don't always lead to better decisions, but they often are really helpful, and provide answers that used to require much more invasive or painful studies.
3. Surgical technology - laparoscopy and related advances.
So computers haven't saved hospitals money? Well, they haven't eliminated world hunger or global warming, either. I think this study has the wrong end point.
Electronic Health Records are generally not marketed as a way to save money. They make it easier to get reports and make it safer for the patient. Whether or not this is enough to justify the cost, who knows.
Things EHRs do better than paper charts -
With paper charts it's much easier to lose or miss place a chart - This probably happens more than you think.
Drug interaction checking with an EHR can make sure that a med someone put you on a year ago and didn't get into the chart is less likely to conflict a new med because the EHR will tell the doc that when he/she tries to prescribe it.
Making sure that people with chronic problems such as diabetes are scheduled to get in for they're check ups rather than slipping through the cracks. This also generates more revenue for the hospital.
No I didn't RTFA, just the damn summary yet it looks as though Harvard's MBA's screwed up another investigation. Instead of looking for hospitals where patient care had been improved, they cut costs and screwed the entire study by looking at how computers helped save money. Stupid Gits. Even I know that if you look at how computers saved money, you aint going to get anything on how the computers improved patient care. As an example, my local hospital has dramatically upgraded their entire IT infrastructure and gone to E-records. My mothers primary care doc, is part of this system and has 24/7 access to all lab reports, X-Rays/MRI's/CatScans and anything else that's in the sytem, which has helped tremendously and this is an example of how computers and IT has improved patient care. Yes the evidence is ancedotal but it certainly has improved things for her.
As others have said, the systems are out there and it's just a matter of knowing who's got them. If we bother taking the time to really learn from those who've improved levels of care, we might finally be able to get some type of Universal health care that provides basic coverage in the United States, which should improve the overall health of the country. Yea I know, wishful thinking as to many people want access to those records.
Mod me up/Mod me down: I wont frown as I've no crown
One problem is that some of the software that is used might not be so great. There's this one piece of software that I use that is ridiculously inefficient. When you do a electronic medication review, the software opens up an internal Internet Explorer browser window that medications administered for the current day. So to get to a particular day, you have to click a link in the browser window. So if you want to see information from several months ago, it takes a considerable amount of time. And that doesn't even factor in the times that the program doesn't respond when you click the link.
The human resource software can also be problematic. Set up is a pain. One particular web staffing solution I've used is so poorly designed that it's barely usable. But by far the worst one I've seen is this one staff scheduling software. It was clearly first written for DOS, because the calendars and job statuses are still represented using single characters, including symbols. So to decipher what they mean you need a friggin' rosetta stone. An "#" might be used to represent "out sick" for example. Then you get such fun situations with upper and lower case letters. So "A" could mean "Annual Leave" while "a" could mean "Absent". To make things even more complicated, there are several different calendars, from a preliminary one to a final one. So you could conceivably get confused and make changes to preliminary calendar thinking that it's the final one. Couple this with the fact that you have to select a date range, and it gets confusing real fast. It literally takes months to train people to use this piece of garbage.
Why the heck can't you just have one calendar for one employee? And instead of representing schedules using dollar signs and exclamation points, why can't each day just say a full word or phrase like "7 AM - 3 PM"? Or "tentatively scheduled for 11 AM - 7 PM"?
In this day and age, we have display devices with thousands and pixels and user interfaces that allow you to zoom in and zoom out. We have plenty of metrics of usability. Yet we're still stuck with the lousy design paradigms of yesterday. It's no wonder that this technology costs so much but does so little.
That's true in just about ANY industry. Managers are prima-donna's who think they are the center of the universe, and everything else is relegated to Pluto. If that happens, it's not the fault of "computers" per se, but of how they are used.
Table-ized A.I.
I've been in IT for more than 20 years and very very rarely have I seen automation be a money saver. No matter the industry.
Automation does enable other things however. Many businesses would not be possible without automation. For example global overnight shipping...and large hospitals. I work for an average size metropolitan hospital and I can tell you - even at our modest size - the business of tracking patients, all their meds, tests and even what room they are in would not be possible. At least not without a staff that would dwarf what we currently have. Processing the mess that is the medical "reimbursement" system in the US is a whole other topic. Even WITH automation that requires a staff of about a third as many individuals as we have inpatients.
Health care IT is finally starting to get to the point where there is a definite direct benefit to the patient too. For example - medical imaging has reached a point where it's virtually all digital. The patients studies are pushed back and forth between providers (hospitals). In our case we recieve patient transfers from a very wide rural area. The smaller hospitals and clinics send us the patients scans digitally and most of the time the surgeons at our hospital have been able to plan treatment before the patient even arrives.
We also have IV pumps that know the safe levels of the drugs they are putting into the patients. If a nurse makes a mistake - say not moving a decimal appropriately when she is setting up the infusion rate (very common error) - the pump will not allow her to put 10x the drug into your vein... We can also get the infusion information pulled back to the patient record and even locate where the pumps physically are thanks to their wireless connection.
Saving money is truly the last thing that should be considered for hospital automation.
"Smile, listen, agree, and then do whatever the fuck you wanted to do anyway." ~Robert Downey Jr.
"....most of the IT systems were aimed at improving efficiency for hospital management — not doctors, nurses, and medical technicians...."
And there's your problem. Ask any hospital chief of staff, and they'll tell you that most doctors think the sun rises and sets over their arses. Trying to get a bunch of them to participate as stakeholders in an IT project is something I wouldn't want to wish on anyone . . . . Except for the twits who wrote this article.
Regards;
is that the doctors are rewarded for inefficiency.
Today doctors are being paid on a "per visit" basis. So, doctors get paid more if they take a long time to diagnose.
Given that this is a problem with the doctors, EMR or no EMR, the efficiency will not increase.
System should move towards the British NHS approach. Doctors need to get paid on a "Per person/per Year" basis. The "Per person" approach will ensure that the doctor has no incentive to treat you forever. The "Per year" clause will ensure that the patient can switch doctors in case he is not happy.
Implementation of Information Systems is not just technology, cool displays, reports and widgets. Repeat after me: It is CHANGE MANAGEMENT! Your lowest common denominator user can fail the system if the change is not managed.
"At the end of the day the only way that "computers" save a business money is if they allow for staffing levels to be cut."
I think we have a winner. Unless computers/tech increase the amount of patients you can process (which is part of the problem in primary care and just not an issue in hospitals) or reduce costs (less errors, waste, etc) they must lead to increased cost. If they make it easier to bill for more unneeded crap (automated or easy billing codes) they almost certainly will massively increase cost. Talk about unintended consequences.
I don't think that's correct. The end result of medical treatment being more efficient is that there will be a lot less opportunity to bill for unnecessary procedures, for example.
Efficient medical treatment would cause prices to drop.
About 5 years ago I attended a dinner in Michigan where Senator Debbie Stabenow gave a speech on how we would save the auto industry by switching to electronic medical records. The theory was that that would reduce the 1200 or more per car that GM was spending on health insurance and pensions for retirees.
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I hate to tell you, but you're not very convincing. You've made a lot of assumptions which are probably correct for you, but stack things in your favor. Well, I agree with you, then. But the whole point of my post, quite a bit of which was in the title "Depends" (for which I apologize, it's bad form to use the title as an essential part of a post), is that, well, it does depend on quite a few factors.
The assumptions you make:
As to how often one does "cold" moves of files deep within filesystems to other directories which are also deep within filesystems, well, I actually do type things like "scp uid@remote:/this/is/a/fairly/long/pathto/file ~/Desktop" quite a bit, because I know that if I open the remote filesystem in a GUI window, even if I have the exact source location bookmarked, the file manager will often have to wait quite a while while all of the directory information travels over the network (e.g., if the directory contains a lot of files, or the connection is slow). I admit it's less common for me to type two long paths, since I mainly use Emacs' dired mode as my file manager (and yes, it does have a kind of GUI-like flavor even if given the way I use it, its input is almost totally text/typing-based).
During the process of getting 3 degrees and a state state practice certification, I also go an MHA. That's a master's in healthcare administration, an MBA for health care industry (as opposed to providers) management. So I know whereof TFA speaks. I was also a charter member of the international professional group concerned with healthcare IT and associated things, the HIMMS http://www.himss.org/ASP/index.asp Take a peek for yourself and see whether you think they're relevant. TFA did beause they use HIMMS data collected with HIMMS analytics tools. In my over-educated opinion, they did pretty much all the right things for getting data and making use of it to answer their question. But.
I often admit to having signed up for a neuroscience program before even finishing the MHA because I knew I had a defect that prevented me from making use of it as a functioning member of the health care "industry" -- a conscience. And it's true. And that only came about because of what they taught me. Some of that stuff explains why things are as they are, and why TFA failed to note it.
The health are industry became a larger piece of our GNP than defense decades ago. It did so because it was wanted, so people offered it, and made a lot of money. They made more and better care available, and it got used, and they made lots more money. This continued until it got to the size it is now. There was never any intention of making it cheaper. It was a growth economy of its own no different in principle than the economy of an emerging nation. It would be irresponsible to build a tidal pool into the cash flow, and ridiculous to build a pocket of poverty into the model when one is not needed. What is needed is maximized growth. Right about now folks from all sorts of different viewpoints wave their arms like they're putting out a fire in their hair, and making a shape with their pie hole so it can make noises about, well whatever is their rant du jour. But they are not in possession of all the facts. Those come from geriatric and population epidemiology, and are related to the "boomer bulge" or 'greying' of the population.
The health care industry has grown around the population and its needs ever since it was allowed to privatize (as opposed to prior government and churches' subsidies). It would be ridiculous to expect otherwise. And it did so by people who already had their eye on the future. The conditions there were so skewed that the industry had to prepare itself or vanish. Losing money is no big deal. The big piles are already hidden under someone else's mattress. But to vanish from the users' grasp -- that could not be allowed.
Picture it. A cake chart. A horizontal line is made on the bottom row, centered, its width representing the people born that year. The next year the same happens, the first gets pushed up. Repeat every year. When there's no more people in an age bracket, that line disappears. The result, in a growing population, is a pyramid. There's more people born every year than the one before. In a stable population, it'd have parallel, vertical sides. Fine. So the US had this pyramid cake going until WW II. Afterwards, from around 1945 to 1965 there were far more babies born than fit the pyramid, and that year's line stuck out too far. After these 20 years was over and the birth rate was brought back down, there was a large bulge in the pyramid. Year by year this moved up. The bulge is now placed about where the people from within it are retiring (or of that age). And now comes the fun part.
As the boomers leave the work force, the income available for taxing or paying for health care drops. These people begin to pile into the already overburdened government subsidized programs for social security and medicare. There will be less income per yer due to more boomers going into the 'retired' bracket, more money required for more treatment for more people who are living longer than ever before, and fewer to draw on.
From 2030 to 2050 there will
"I may be synthetic, but I'm not stupid." -- Bishop 341-B
IT will only save you money if you can do the same work faster and/or more cheaply than the competition. If all hospitals implement similar systems, that is now the new standard and you don't have a competitive edge that allows you to lower your operating expenses as compared to other hospitals. This is basically one of Parkinson's laws, as mentioned below.
Of course there may be problems with the IT systems in hospitals. So at some point in the future, one company will make a product that works really well and solves these problems. The first hospital to acquire the system will lower operating expenses, increase their efficiency. They can then attract more 'business' by lowering their price. Then the same company sells the system to all the other hospitals, and all their operating expenses will be reduced, efficiencies increased. Prices drop, new baseline reached. Lather, rinse, repeat.
If you want to see computers saving hospitals money, get a physical at Bumrungrad Hospital in Bangkok. The system is multi-lingual, and you get results almost immediately. I don't know that a legacy hospital can pull off the same things, but it is truly amazing to see.
Compared to my physician's scribbles on pre-printed form letters, it really does a lot to make it look like the doctor knows what they are doing and communicate effectively.
It's not the systems. Replace the people with competent workers. Then you'll see real gains!
Yeah. Let's just drop kick all of those pesky little clinical applications that help the care givers deliver the right medications to the right patients. It's probably a lot cheaper just to pay the attorneys and plaintiffs. I'll admit it. I haven't read the Harvard report. Nor will I. Nothing personal against Harvard but if the report is actually as stupid as the slashdot teaser indicates then it would be just a waste of time. While we're at it let's get rid of all of the technological devices that dump our medical data into the clinical apps too. Those really expensive MRI machines are only creating huge data files that make the clinical applications even more inefficient and expensive.
Information in most of the medical records is unstructured. I believe http://www.mediawiki.org/ is right solution for unstructured information instead of multi-million dollar solutions vendors are offering.
I'd like to buy homeland for our 10 million people. http://twitter.com/mahadiga
So much for a noble profession. The new millennium is starting off by killing any pretense that a noble profession of any sort exists.
We can't trust politicians, that's a no-brainer. The press, don't make me laugh. Lawyers in general, judges? No trust there. Teachers and professors don't seem to command much respect these days. We're all for law and order, but how much do you really trust the cops? How about the cops in NYC or LA or NO? Scientists apparently have egos that allow them to do anything to further their cause. And now doctors would rather CYA then have their medical opinions opened to scrutiny.
Firefighters, that might be the last noble profession. Cue the scandal in 5...4...3...2...1...grrr!
Sequencing the genome with paper... Hahaha, oh wow. Do you realize that there are, to go by your car-analogy-without-the-car, millions of Eiffel Towers and each is different in as of yet unpredicatble ways? Do you realize that the entire hierarchical structure of the Eiffel Tower was simple enough to be understood by the architects, and indeed was understood, whereas there has been a whole branch of science expressly devoted to that task for the last half century with genetics?
I'd go and bring secondary structure and "Eiffel tower hairpins" into this, but I'll spare you the mind blow.
"Computers Don't Save Hospitals Money"
let me fix that for you....
"Crappy Software Doesn't Save Hospitals Money"
there, that's better
Short of a full-hospital AI, there needs to be some way to allow doctors and other medical staff to call up any relevant information for a given case - potentially meaning anything at all which has been presented to hospital staff or approved external medical channels. Every question asked, every scan done with any instrument, every moment that a patient is on a security, ER, or ambulance camera, needs to be able to be summoned up with a snap of the fingers or a flicker of the eye. Information is no good if it never goes anywhere, or goes into a dead end in some physical or digital filing cabinet.
Staff could even have their infocloud viewpoint personalised based on their hospital function, personal qualifications, and previous patterns of search/use, edged with additional data drawn from likely helpful sources based on the use-patterns of other staff, the similarities between positions and processes between them, and even a patient's particular medical history. That way, a fresh newbie with a particular job title would start with a default set of views based on the averages of other people who have been doing the job for a while, and which would rapidly adjust and speed up as they establish personal methodologies.