Tuesday, September 12, 2006

Medicine at war with ... the I.S. department?

Seen at the HISTalk web site, a site designed primarily for Healthcare's IT (computing) personnel, from an anonymous poster. I have been posting views on that site about the need for more clinician and medical informatics-based leadership of clinical computing projects:

From Anony-Mouse : "Physicians who haven't practiced often go right into sales or thought-leader positions expecting to earn the respect of their colleagues with their MD credential and 'been there, done that' claims, but they often develop overly complicated 'solutions' that no one uses. I enjoy Scot's perspective and find his articles thought-provoking, but I don't see anything in his credentials suggesting he's 'been there,' other than being involved in one EMR project. To imply that his skills or those of other informaticists are superior to those of lowly, undisciplined IT types is a fine example of his own rant, one whose tone and attitude furthers the narrow-minded and silo-creating thinking that plagues healthcare's social systems." (emphasis mine)

I had addressed the "you don't have enough experience" blocking-defense of the clinical IT world in this essay several years ago. Perhaps it is "insensitive" -- from that multi-culti socialist perspective - to imply that people with professional training and experience in two fields (medicine and computing) might perform better in clinical environments than those with training in one. (Patients, on the other hand, might favor the involvement of the former.) Perhaps IT personnel need to stifle their need for "sensitivity" where clinical matters are concerned as well as their argumentum ad hominem reactions to critique, which that posting had a touch of.

Another anonymous poster writes:

Scot - you are welcome to your opinion, wrong as it may be. I've been in this business for over 20 years and I've always said - give me someone with healthcare experience or IT experience...I'll teach him the other. You don't need someone with a PhD to configure an application.

I am not impressed by comments stating an opinion is "wrong" on the "argument from authority" ("I have 20 years of experience") alone. Concerning the "shrinkwrapped mentality" ... I'm not just talking about the tactical issues of installing a software application and configuring it, my concerns are about the strategic issues of clinical IT application design, development, iterative revision and other factors that give the installer something to 'configure.' The superficiality of the IT people wandering the hospital halls is sometimes startling.

Also, about the lack of 'need' for someone with a PhD or MD - I wrote about this attitude before as well at this page back in the late 1990's, partially in response to a large Healthcare IT recruiting company's written statement that "we don't believe a degree gets you anything."

Yet another anonymous poster writes:
... There are as many or more pretenders that are physicians who feign knowledge of the unbounded complications of the IT world merely because they are physicians. A medical degree does not imbue the owner of superior knowledge of IT initiatives, needs, systems, workflows functioning etc. but too often vendors and hospitals make an assumption that MD is identical to leadership and equivalent to information systems knowledge. The very opposite may be more true. Physicians are trained in diagnosing and treating patients but are often times the most unreliable in aligning business process with technology or the myriad of other issue that make up the Healthcare Information systems world.

While a few poster's views are clearly not indicative of a trend, I have more than one information point on this issue, e.g., here in observations from a few years ago, as well as observations by myself and other medical informaticists over the years in the field.

I am beginning - well, not just beginning - to suspect that:

1. In addition to the de facto warfare being conducted upon clinicians by payors, insurers, and various politicians and governmental agencies who control healthcare (not to mention the corrupt within healthcare itself), there may be another enemy: the hospital IT department and the EMR industry.

2. That there are those in hospital IT departments who are highly reactionary and unable to accept critique, and will guard their terroritory by any means necessary. To hell with patient care or clinicians as long as they "make their numbers." Medical informatics experts "don't have enough experience" (ergo, should not be hired).

3. There is a growing phenomenon of everybody and anybody in healthcare telling clinicians what they may say, do and think, what tools they need to practice, and who should give them those tools, and what form those tools should take. Now IT personnel think it's their turn.

This is a very bad trend.

-- SS


Anonymous said...

This is not a trend. Where you have large sums of money and the opportunity for control you will have those seeking to carve out a territory. In the old days we called this empire building. I have something you want, information, and you will pay homage to me to get this information.

My wife is an attorney. Several years ago the Feds ordered an integrated computer system be installed to allow access to various records. (Sounds kinda like EMR, doesn't it.) Very early on it was made plain to her she was not needed, the IT people could develop on their own all of the legal interpretations. Program was unimportant, only the numbers counted. Besides, she would just mess up their deal.

The "deal" was there were consulting contracts with some of the people supervising the installation of the system. (Pharma paying researchers and researchers not disclosing financial ties.) The deal also included cost overruns because they could not make the system compliant. All of this was paid for with tax dollars.

People resigned. People were demoted. Nobody was prosecuted or required to pay back any of the money received as part of their consulting contracts or for the inflated overtime. Billions of dollars were spent by every state for this system and every state had to comply.

IT is just the latest arena for those wishing to scam the system. Pharma's excesses have been so great they are now facing tough competition and more scrutiny. There will be a lag before enough people see the absurd cost, and who is making what, before they will respond with constructive control.

Many people do see an MD as the arbiter of all things good. I have to chuckle when I get solicitations from VOLPAK and the are signed Bill Frist MD.

Steve Lucas

Anonymous said...

People resigned. People were demoted. Nobody was prosecuted or required to pay back any of the money received as part of their consulting contracts or for the inflated overtime. Billions of dollars were spent by every state for this system and every state had to comply.

Perhaps a new approach to health IT dysfunction is needed: the lawsuit.

Periodically we read in the press about health IT malfunction and failure that could reasonably be due to the common errors people in Medical Informatics write about.

This may be a new area for litigation, as the money wasted is usually public money intended for healthcare.

These "IT malfunctions" in public hospitals come at taxpayer expense, after all. It's not like information on how to avoid the failures is a State Secret.