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.