Slashdot Mirror
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.
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.
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.