Thursday, October 04, 2007

Medical Informatics still round peg in square hole?

As I have written in many prior posts, medical informatics specialists often face significant challenges in leveraging their expertise. At a time of a national EHR initiative and ample documentation of costly difficulties in healthcare IT projects (e.g. here), this is somewhat of a paradox, but that's the way it is.

Several years ago I took a position as Asst. Professor of Healthcare Informatics at Drexel University in Philadelphia, based in the College of Information Science and Technology. Drexel, an engineering school, had acquired the Hahnemann/Medical College of Pennsylvania medical school which was orphaned and nearly bankrupted as a result of the huge AHERF scandal of the late 1990's (Pittsbugh Post-Gazette newspaper article series on AHERF is at this link).

Unfortunately, the Hahnemann Hospital (where, ironically, I'd acquired my interests in both computing and medicine via NSF programs for high school students in the early 1970's) was not acquired by Drexel. It was acquired by Tenet, and has been having a hard time in the difficult Philadelphia medical market, which made applied informatics collaborations in the (private) hospital harder to organize.

As a result, to stay involved in applied informatics at the time I came to Drexel I sought an advisory role in the Drexel College of Medicine Faculty Practice Plan's (DUCOM FPP) EHR initiative, which was under the aegis of the university.

The DUCOM FPP desired an EHR for the usual reasons - improved efficiency, better care quality, reduction of errors, decreased costs, and so forth. The CIO of the DUCOM FPP was quite happy to have me as a consultant based on my informatics knowledge and experience as a CMIO at a nearby regional medical center, Medical Center of Delaware (now known as Christiana Care Health System) several years prior, although I did not hold an appointment at the College of Medicine itself. That is a story for another time. I started attending the DUCOM FPP EHR planning committee meetings, which were by invitation only.

Unfortunately, for a number of reasons of which I am not entirely aware, the CIO left the organization a few months later. There had been some issue with a crash of email that clinicians were quite bitter about and blamed, fairly or unfairly, on the CIO, although clearly more must have been going on. A new CIO was hired.

Even more unfortunately, the new CIO no longer invited me to the EHR implementation planning meetings. I asked on a number of occasions to attend, but invitations were not forthcoming. Having the attitude that when people do not seem to want my help, I respect their wishes, I put my involvement in the EHR project on the back burner.

Fast forward two years: the result is this multimillion dollar lawsuit by Drexel against the EHR vendor AllScripts and Allscript's partner Medicomp Systems, a "corporation specializing in the development of point-of-care tools for Electronic Medical Records ... to help overcome physician resistance to adoption." The Medicomp financials component of the EHR system was malfunctioning, requiring much manual labor to assure accuracy, prevention of billing mishaps, etc. - and negating the cost advantages of the EHR.

Here is a link to civil complaint in PDF for breach of contract. The E&M coder was incomplete and did not function properly, among other issues, resulting in major, unplanned increased costs, delays (to avoid just the situation linked to above), and clinician frustration and loss of confidence. The vendor was accused in the complaint of unresponsiveness. The suit went from local civil to federal court, and I do not know the outcome.
Ironically, I had experience with regard to this type of issue. The following story reflected my observations regarding a FPP billing system fiasco at Yale University a decade prior:

Insufficient IT Management Depth Results in Justice Dept. Investigation, Millions of Dollars in Fines

The billing system deficits in this case led to a Justice Department investigation, massive fines, and the scrapping of a multimillion dollar IT investment (although the story is 'anonymized', it drew on publically available sources such as the New Haven newspaper and other media reports, so there are no secrets being revealed here).

Perhaps this experience might have informed the acquisition and/or testing phase of the DUCOM FPP system ... perhaps not. I will never know, since my involvement within my own university was apparently deemed nonessential by the project leads.

Medical informatics is not a strategic priority at Drexel at this time. It may be a truism that without strategic prioritization, and with many other priorities competing for resources and faculty time, medical informatics will just "not happen" in any organization.

I am now seeking new applied medical informatics opportunities, although am remaining an adjunct in the College of Information Science and Technology, an excellent college with excellent people that I have found the antithesis of the toxic Ivy academic environment I'd experienced in the past. I will be writing about the sometimes surprising, annoying, or simply stunning experiences I am having in seeking to return to an applied medical informatics role, some of which have already proven worthy of study.

Here's a short one that is self-explanatory with regard to the issue of IT complexity and difficulty of use, sent to the CEO of this healthcare organization. The online eRecruiting system I encountered is so intrusive and time consuming, one wonders if anyone in this organization's HR department considered human factors, or has a clue as to what that phrase means.

From: MedInformaticsMD
Date: 10/04/2007 11:17AM
Subject: Chief Medical Information Officer position

Dear Dr. Royer,

I am a medical informatics specialist and am the author of the well-known site on healthcare information technology difficulties at . An electronic alert informed me of a posting for a Chief Medical Information Officer (CMIO) at Christus Health.

I am perhaps doing your organization a favor by informing you that your online application process is so intrusive (e.g., entry of a Social Security number into a faceless system of an unknown organization is mandatory) and so arduous (requiring the applicant to go through a multiple-step electronic building of a "resume" rather than submission of a document) that it simply discouraged me from applying. I am certain it will be found discouraging by others in this field as well.

As a clinical computing expert, I can only hope your EHR efforts pay more attention to interaction design and good first impressions.

-- SS


anonymous M.D. said...

Your story is, unfortunately, not surprising to me at all. Similar events occurred during my 21 years at a faith-based hospital system in the Mid Atlantic. For some reason, hospital administrations have some kind of almost willful blind spot when it comes to IT. They consistently fail to consult the right people, fail to listen to advice or warnings coming from their own rank and file while a new system is being built, and throw money at consultants who know less than their own people. It's very puzzling. I am wondering if it will change when my kids' generation, who grew up with computers and associated technology since birth, come to run these organizations. I hope so, because if not, there is a REAL problem.

Anonymous said...

The problem is you guys are smart. This is not what people want.

CIO’s do not want someone who will be able to take over his or her job in six months.

CIO’s do not want someone who knows the system better than they do.

CIO’s do want power.

They want to control access to their system. They want to control who gets what functionality, regardless of need.

They want no internal oversight. They want the vendor to report to them, not a board, so they control the flow of information. They also want a great deal of sucking up with paid business dinners and conferences.

They want a big dollar project to pad their resume when they go looking for a new job. They will not stay around to clean up the mess they made, instead, they will be making an even bigger mess at another institution, for a bigger salary.

We have reached a very strange place in American management. In the old days people stayed with a company for years, if not decades. Those who were incompetent were shuttled aside. Today the game seems to be stay one jump ahead of your last mistake. Now, being promoted to you level of incompetence, usually means being so bad you are only fired when a criminal act occurs.

Like I said: You guys are smart. You just want to get the job done. The vendor is looking for a big payday. The CIO is looking for a bigger salary at another institution. Getting the job done is not the object. Making money and controlling the process is the object.

Steve Lucas

MedInformaticsMD said...

They will not stay around to clean up the mess they made, instead, they will be making an even bigger mess at another institution, for a bigger salary.

Yes, they leave that for people like myself. And clean up I did ... e.g., dirt-infested, pathogen-colonized PC's on the ceilings of medical ICU rooms, anyone?