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Harvard Says Computers Don't Save Hospitals Money

Posted by kdawson on from the always-jam-tomorrow dept.

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."

20 of 398 comments (clear)

  1. Transferability by oldhack · · Score: 5, Interesting

    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.
    1. Re:Transferability by Anonymous Coward · · Score: 1, Interesting

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

      This article is stupid.

    2. Re:Transferability by arth1 · · Score: 3, Interesting

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

      Yes, that would be as unbelievable as designing the Eiffel tower without a computer.
      The number of pieces in the Eiffel tower is in the same order of magnitude as the number of human genes (the bolts can be compared to base pairs). Clearly not doable.

      The old saying that "when all you have is a hammer, every problem starts looking like a nail" is true for computers too. We think of a computer solution first without even considering how something can be done other ways.

    3. Re:Transferability by MattSausage · · Score: 5, Interesting

      As a personal anecdote, computerized medical records most likely saved my father's life.

      He woke up in the middle of the night with unbearable pain in his abdomen, and when he didn't fight my mom about going to the hospital she knew it was serious. Five hours later and untold scans and prodding later (not to mention a significant amount of morphine) they determined a blood vessel leading to my father's colon had been blocked and basically part of his colon was dead or dying. Not having the facilities or expertise to handle the necessary surgery in my mid-size town of Owensboro, KY, they sent him to the University of Louisville Medical center telling us that basically, even done by the best surgeons in the business there is a 3 out of 4 chance he wouldnt' make it through surgery unless it was done in the next few hours. The trip to Louisville takes two hours. Following the ambulance we arrived in Louisville in an hour and a half, and he was in his room and being prepped when the doctors realized they didn't have any scans of his abdomen, the EMTs had left them behind in their rush to get us all there. Faxing them was the only option, and to do that they would have to get in touch with someone in Owensboro, convince them who they were, have them look up the records, and then get them to a fax machine that could handle the scans. It could take another hour.

      Except my mother (who, frankly, is the smartest person I know) insisted that she be given a copy of the CD with all the electronic scans and data the doctors had collected that morning. I thought the surgeon was going to kiss her. 20 minutes later my father is in surgery, and 5 hours after that (or so, it was a long day) he was back out and kept in ICU for two weeks before finally coming home. The doctor had said if he'd had to wait much longer chances would have shot up considerably that my father would have died. So, there is at least one example of how Electronic Medical Records did help a doctor save a life.

    4. Re:Transferability by benjamindees · · Score: 2, Interesting

      I agree completely that accountants have screwed up both IT and many business processes, in lots of industries. I see tiny little microcosms of the fiscal and accounting scandals everywhere I go. It's one thing to track costs and enable billing. It's quite another to design an entire company's information technology around some vendor's proprietary system that's designed only to do one thing well (financial engineering) and not to be interoperable.

      I have told every one of my clients "invest in IT to improve efficiency". And what have they done? They hire an IT guy, stick him in a broom closet, hand him the latest version of Microsoft Whatever(TM) and tell him to use it. Few take it seriously.

      One of the major problems is that really implementing IT to improve efficiency requires change. Having domain knowledge means that you aren't taken seriously by the IT people. Having IT knowledge means that you aren't taken seriously by those with domain knowledge. Having both means you aren't taken seriously by anyone.

      Telling everyone that they need to re-think major processes from scratch gets you laughed out of the room. At this point, IT has been sold for so long as a magical cure-all that will make the world a better place that you basically have to sell IT as a magical cure-all if you want your solutions to even be considered.

      --
      "I assumed blithely that there were no elves out there in the darkness"
  2. I work in a major hospital by Anonymous Coward · · Score: 4, Interesting

    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.

  3. The key being ... by devloop · · Score: 5, Interesting

    "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.

    1. Re:The key being ... by malkavian · · Score: 4, Interesting

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

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

    2. Re:The key being ... by martyros · · Score: 4, Interesting
      Best quote from the article:

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

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

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

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

      --

      TCP: Why the Internet is full of SYN.

  4. like rain by saiha · · Score: 1, Interesting

    So which is it, irony or coincidence that I am reading this online within minutes of this being posted?

  5. Like my Father Said ... by foobsr · · Score: 2, Interesting

    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)
  6. Let me add to this by Etrias · · Score: 2, Interesting

    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.

    1. Re:Let me add to this by Anonymous Coward · · Score: 2, Interesting

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

  7. Computers need to be implemented correctly... by mgchan · · Score: 3, Interesting

    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.

  8. building bad clinical systems is harder by r00t · · Score: 5, Interesting

    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.

    1. Re:building bad clinical systems is harder by Lord+Ender · · Score: 2, Interesting

      Here's what I want:

      • The federal government creates one big wiki-like system with strong (2-factor) authentication. There is an entry for each person, with full name, birthday, location of birth, SSN, and photograph.
      • All hospitals would be required to upload X-ray data, test results, and other important notes to the patient wiki.
      • When you go to any hospital anywhere, doctors would immediately have access to your medical history. You would never get extra X-rays, never have to fill out pointless "list every medical condition you or your family have ever had" forms

      That would be incredibly easy to implement. The most expensive part would be getting smart cards and SecurIDs to hospitals, but if stock trading sites can do it, a government program could.

      --
      A slashdotter who didn't build his own computer is like a Jedi who didn't build his own lightsaber.
    2. Re:building bad clinical systems is harder by hesiod · · Score: 2, Interesting

      Perhaps he meant unnecessary paperwork, not all paper... but even so, hospitals DO have transcriptionists. The doctor picks up a phone, dials a couple numbers (or uses a bar code reader or something, given the right equipment) and starts reading off their diagnosis. Then a transcriptionist somewhere else (perhaps around the world) gets that recording and types out what the doctor said into the phone. Ideally, the doctor gets that document back and approves it, though that part rarely happens. Then it's attached to your medical record.

      Having worked with older doctors, I know how hard it is to get them to look at a computer, much less get them to use one. And I don't think it would improve their work flow anyway; in fact it would probably hinder them.

      Old dog, new tricks, and all of that. But newer doctors are becoming more receptive... to having their own staff use computers. They still don't like to use them themselves.

  9. Re:Well by Anonymous Coward · · Score: 1, Interesting

    We had the same experience signing up for insurance with State Farm. We got 3 types of insurance from them, and the lady sat there and asked us our name, address, phone number, and many other questions 3 times in a row.

    She also had her sweater on inside out and typed with only 1 finger on each hand.

    Not only that, but when my wife filled out a customer satisfaction survey describing the experience, State Farm sent it directly to the lady we complained about, who then called my wife about it. WTF State Farm?!

    I was sorely tempted to change insurance right then, but laziness got the better of me =\

  10. often the users by ILongForDarkness · · Score: 2, Interesting

    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".

  11. Baloney by C10H14N2 · · Score: 2, Interesting

    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.