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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."
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?
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!
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.
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.
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.
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
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.
That's only part of the story. A LOT of systems are put in by heads of medical departments who engage directly with vendors, who tell them this system will cure all their ills and make the world a better place.
They then buy in this system without asking anybody, and turn up at IT saying "We've bought this, put it in now please". Most hospital directorates back the clinicians (politics, gotta love it) and force IT to support this, even though it may duplicate information held elsewhere, or not be able to communicate with anything else. This crucifies efforts to create an enterprise class architecture.
That being said, there are (in the NHS) many moves towards having everything standardised and digital (PACS, for example, works nicely; Dicom imagery across all hospitals connected to the NHS network. That's your XRay and MRI imagery right there).
The problem is that very few places take IT seriously. It's viewed as a "wave a magic wand and things happen" discipline. Few want to hire system admins, let alone systems architects.
And without people to actually work at integrating IT to the business, and without them having the remit to be able to affect business processes to help this symbiotic relationship take hold, then places will continue to scrabble ineffectually.
If you're building a house, hire an architect. If you're building an IT system to prop up your business correctly, hire a systems architect.
You could, of course, be happy with your IT system being the logical equivalent of a house built on mud with 22 windows on one side of it (never facing the sun) and no stairs to the upper floor that can be used.. But hey. You choose the path you walk.
Seriously - when are you slashdotters going to realize that part of the reason that nobody takes you seriously is because your analysis is so junior high level?
I have a masters in business. When the people making the business decisions are divorced from the operations of the business, the item that helps them most may not help the company at all. Having seen the results of such decisions, I assure you the consequences are quite real, and because of poor managerial decisions.
Learn to love Alaska
There's even more to be said for well-written software. What your post boils down to is, "poorly written software will not work as advertised." You're not going to get much argument on that here. The problem with the article (and your conclusion) is that they implicitly assume that all computer-based solutions are equal in quality. Since that isn't true, the analysis is ignoring a crucial component.
Wow, I so just NEVER post anonymously but... I work at a healthcare company. Specifically, a Healthcare IT company. A very big one. One which develops an elctronic medical record, amongst other things, and is joined at the hip by several hospitals (we are a non-profit, they founded us)...
Think about the flaws in how the government works, and you can start to grasp the problem. These institutions are setup, not to make a profit, but to do a job. To that end, they are going to do that job... come hell or high water. Its noble, its great, its a bureaucratic wet dream. They even budget the same way. In fact, last year is the FIRST TIME IN MY CAREER that when the end of the fiscal year rolled around, we did NOT hear talk of needing to use up the rest of our budget before we lose it.
The problem is, that they create a whole bunch of fiefdoms, give them a mission, and then let them just creep that mission over the years. New servers, new disaster recovery plans. More security.
Then we interact with government, and everyone has a stake in healthcare so...more regulations? Ever heard of hippa? No? Then you don't work in healthcare. We have yearly ethics classes, a whole department whose job is to police ethics internally. Increasing regulations seem to push us forward a lot.
We are a mini-government. In many ways, I like it. How many other workplaces have an appeals process on disciplinary that can go all the way to an employee review board of randomly selected employees from other departments? We essentially have a jury system built into the company!
And while governments have a feedback loop through voting, we do too. We have the board, which is chaired by big wig stakeholders, many of whom are hospital administrators and power player doctors. They allocate our budgets, they push agendas... which feed through us, and back to the hospitals, and their management.... which is our feedback loop.
Its a labyrinth of departments, groups, teams, on down the line. An undulating stack of bureaucrats each moving forward, increasing his scope. Every department knows money is being wasted. However, its the other guy wasting it, because we are on a mission. We have to deliver this service right here, no matter what it costs.
I wish I had time for more but, my group has a mission. Maybe later I can wax poetic about how "middle heavy" institutions like this grow. Remember those articles on the Gervais principal and how it relates to "The Office". Google it and reread it... realize that these organizations work under those dynamics, but remove the "organization falls apart" feedback loop. Imagine that model running its course for the 150 years that some hospitals have been around.
Of course, theres been corruption too. We grumble about not even being able to take pens or free classes from vendors anymore. A whole host of new policies, all because a couple of guys were scamming contracts. These policies will never go away... only grow. (something which I have seen at 2 of the places that I have worked. In one they were fresh policies from a scandal that happened while I was there, and one from a scandal 20 years prior)
THAT is where the problem is. This constant slow creep of policies, regulations, departments.