Healthcare IT

I’m the first to com­plain about the qual­ity of health­care soft­ware. It’s often ter­ri­ble, ama­teur UI, win32 apps put together by small com­pa­nies that are nowhere near the cut­ting edge. But, sto­ries like this Tech Review arti­cle that state Health­care doesn’t com­put­er­ize more because they are try­ing to hide their huge prof­its are just annoy­ingly simplistic.

Peo­ple out­side of health­care, I think, have the prob­lem of think­ing that since they infre­quently inter­act with the sys­tem, the sys­tem is sim­ple. Not every­one of course, but hope­fully most peo­ple aren’t spend­ing sig­nif­i­cant amounts of time in health­care. That doesn’t mean health­care goes away when you do though, it’s a huge indus­try. Every year over 2 tril­lion dol­lars are spent. 15% of US GDP.¹.

The calls to “com­put­er­ize” need to be seri­ously con­sid­ered. What do peo­ple mean when they say that? To take the exam­ple from the arti­cle linked above,

As a result, ana­lyz­ing the effec­tive­ness of spe­cific treatments–for exam­ple, spinal-fusion surgery ver­sus phys­i­cal ther­apy for back pain caused by a her­ni­ated disc–is unnec­es­sar­ily expen­sive and time consuming.

We could do research like this if we had all the health­care data com­put­er­ized in stan­dard for­mats that were search­able. And I mean all the data, clin­i­cal, lab, imag­ing, sur­vivor­ship, out­comes, (stan­dards for mea­sur­ing those out­comes!). Let me just say, this type of search­ing in a sub­set of results is one of my day job respon­si­bil­i­ties, and even within one large hos­pi­tal I would love it if this were true. The doc­tors would love it even more because they could pub­lish even more, and make all sorts of discoveries.

While this level of com­put­er­i­za­tion and stan­dards would be fan­tas­tic, no indus­try is cur­rently at this level of data mod­el­ing and stan­dard­iza­tion.

Oh sure, you say, look at google, look at microsoft! This is the mis­un­der­stand­ing. Health­care is not a com­pany, it’s an indus­try. Here are some fun men­tal exam­ples of sim­il­iar tech­no­log­i­cal problems,

• change a pack­age from Fedex to UPS in mid shipment
• use whichever cel­lu­lar company’s sig­nal is the strongest wher­ever I am
• see how many jeans i pur­chased last year at Levi’s, Gap, and Express, tak­ing into account the fact that Gap calls some of their jeans trousers incorrectly

The fact that I can’t do any of this doesn’t mean that these indus­tries are “unmoved by the logic of low­er­ing costs to increase prof­its”, or that they have failed to move to the mod­ern era of com­put­ing. UPS and Fedex’s logis­tics and com­put­ing resources prob­a­bly rival Google’s, but they cer­tainly don’t speak the same lan­guage. Most retail stores use some crap com­mand line POS (that’s point of sale, natch) sys­tem that looks like it’s from the 1980s, but it gets the job done. No one goes around lam­bast­ing them for their Lud­dite tech­nol­ogy stance.

The exam­ples in the arti­cle of elec­tronic tick­et­ing and stock cer­tifi­cates are ridicu­lous, so I wanted to make the exam­ples a lit­tle more com­plex. (although not much, jean pur­chases aren’t quite the same as multi ter­abyte gene array data, or 4D real time diag­nos­tic imag­ing, but…) The dif­fer­ences they have to a piece of paper say­ing that you can board plane 1477 at 7pm, or that you hold 100 shares of AAPL stock are hard to elab­o­rate more on.

Don’t get me wrong, stor­ing this data in bet­ter ways would be a dream for me, but lets not pre­tend that the health­care indus­try is some lag­gard trail­ing every other indus­try in tech­nol­ogy. Most indus­tries don’t need inter­op­er­abil­ity, and they don’t have it. It’s cer­tainly a laud­able goal for health­care, and I think that moti­va­tion can only appro­pri­ately come from the gov­ern­ment. I would love it if the health­care indus­try adopted CCR for every­thing and it was all stan­dards based and inter­op­er­a­ble, but the fact that we aren’t there now doesn’t mean health­care hates tech­nol­ogy, or is avoid­ing it to keep their costs high. I just want some real­is­tic dis­cus­sion that isn’t based on the IT sit­u­a­tion at some tiny doc­tors office.

1. “Health Sys­tems Resources” (Excel). World Health Sta­tis­tics 2008: Global Health Indi­ca­tors. World Health Orga­ni­za­tion. 2008. http://www.who.int/entity/whosis/whostat/4.xls. Retrieved on 2008-08-30. *Note: It is on the tab marked “4” on the bottom.