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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!
"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!
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.
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)
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.
> That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.
That used to be a favorite argument to explain away poor clinical system adoption. But it does not hold true anymore. An average doctor today is at least as computer savvy as an average teenager. They may not use SMS, twitter or use facebook as much as the teens, but they certainly know how a computer works. This isn't the 90s when computers were optional in life.
> Computers take more work to use when you don't have a nice grasp on not only the software or function you're doing, but the regular logical deductions you make from repeated observation and experience.
Good clinical software should not need you to be an expert in computers... just that software... the one they use for several hours each day. And if it takes considerable experience to get up to speed... that's a usability problem... not a user problem.
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.
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)
That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.
This is exactly what I witness. I am working as a Software developer in a University Hospital in Europe. Just an example:
It often happens here, That some one enters data into a system. Then another devision needs said data and guess what they do? Data is printed out, faxed internally to another devision and usually a subset of the data is entered manually into another system again. Despite the fact that all involved users have access to both systems and if they'd use the systems appropriate, data would be exchanged automatically between theses systems (data exchange doesn't always happen automatically for several logical or obscure reasons).
As it looks like (from talks with IT stuff from other hospitals) we are not a special case. Especially non academic employees in a hospital are really resistant in learning how to use these "new" technologies (it works much better with younger employees).
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.
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!
"The study also showed most of the IT systems were aimed at improving efficiency for hospital management -- not doctors, nurses, and medical technicians"
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.
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".
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.