Sunday, February 22, 2009

Informatics, or Infomagic? Health IT Cannot Flourish When Everybody is an Expert

I recently saw a hospital ad for a surgeon in my local newspaper:

Professor of Surgery

Must have 5 year post fellowship exp as Thoracic Surgeon, fellowship in advanced minimally invasive surgery of lung & esophagus, & fellowship/post-fellowship exp in thoracic oncology, radio frequency ablation, & airway, esophageal & endoluminal techniques. Board Eligible/Board Certified in General & Thoracic Surgery. Fax resume to James Diehl, MD, Director, Thomas Jefferson University, 215-955-6010.

There is nothing at all unusual about this ad. It calls for someone who has completed premed (4 years), medical school (4 years), internship and residency training (4 years), one or two postdoctoral fellowships (~2 years each) in highly complex subspecialties, and at least five years of experience beyond the fellowship(s). Plus board certification after a grueling series of exams. This is what it takes to be a medical specialist.

Compare this to an ad for a "VP of Global Strategic Informatics" for a large medical consulting and practice management company (in another highly complex medical subspecialty I will not name to protect the organization's identity). I received this:

Vice President and General Manager, Global Strategic Healthcare Informatics

This new position reports to the Chief Executive Officer. Its primary responsibility will be to serve as an architect and builder of a newly formed healthcare informatics business. We seek a seasoned and polished professional with a minimum of 20 years of experience in positions of significant authority and a proven track record of building and leading highly dynamic businesses. Significant experience in the delivery of healthcare services or products is highly desirable.

You must have a proven track record as an entrepreneur, architect, builder, and driver of a successful organization. We prefer a strong leader with a solid general management, planning, business development, financial or marketing background. You must be experienced at working effectively with the investment community, stock holders, and Boards of Directors.

Notable are the domain neutrality of the ad. A VP of healthcare informatics has as a "desirable" requirement experience in "delivery of HC services OR products?" A "solid general management, business development, financial OR marketing background"?

Most notable of all: there is no mention of a true clinical background or formal medical informatics background whatsoever.

Now imagine an ad for a thoracic surgeon that does not call for thoracic surgery experience, just general skills such as chiropractic.

It's as if Medical Informatics is simply Infomagic, to be led by a domain neutral individual who knows something about healthcare, maybe through selling toothbrushes, acupunture supplies, or marketing diet pills and vitamins and "alternative medical products."

Compare this ad to the ad seeking a surgeon.

Several questions come to mind:

  • Do the people who composed these requirements know anything about medical informatics?
  • Do they know that it is a formal, highly specialized field whose training is supported by the NIH at major universities in the U.S., as well as by foreign governments and universities, and that has been called a critical subspecialty by the National Research Council? If not, why not?
  • Do the people who composed these requirements know what they are doing?
  • Did they consult experts in the field in composing these requirements? If not, why not?
  • Do they think there may be value in making knowledge of medical informatics a priority in the candidate requirements? If not, why not?
  • Do the stockholders in this company know what is going on?

I was asked if I knew of any hospital executives I could recommend for this position.

I explained to the sender of this ad that I did, but would not recommend them to pursue this position of "Strategic VP for Healthcare Informatics." I explained that the ad shows the crafters were themselves not thinking strategically (or perhaps simply not thinking at all!), and were setting up the incumbent and the company itself for failure in this highly specialized field, especially compared to competitors with more modern views about medical informatics and IT.

I did not receive a response nor do I expect one.

I've personally seen and commonly heard from my colleagues of this scenario - leadership of medical informatics-related activities by novices - causing expensive IT debacles, patient injury and death, severe elevated risk of injury or death, impaired pharmaceutical R&D, distracting infighting between clinicians and management, and other flavors of mayhem.

I've seen and warned against pharmas whose CEO's were engineers or lawyers for fast food chains and whose heads of research IT lacked any biomedical background whatsoever, impairing R&D, hospital CIO's who put contaminated computers over patient's heads in an ICU or whose ineptness in medicine created mayhem in a cardiac cath lab, HIT vendors whose lack of medical experience causes their products to provide a dangerous, mission-hostile user experience (more on that issue to come).

At this point, after my many postings on similar topics about informatics hiring practices here at HC Renewal, my HIT difficulties website, and other writings over the past decade, I can no longer get upset at this. I've fulfilled my medical obligations, such as in reporting on these issues in prominent places, and then some.

I can, however, take a perverse pleasure in knowing my valuable advice, given absolutely for free at a time when leaders of many of our business organizations have been proven incompetent (at best), will likely be ignored as the ramblings of a know-nothing or curmudgeon (or worse). Is this an instantiation of the saying "pearls before swine?"

I can also take perverse pleasure in knowing what companies to take a bearish position on, long term.

I take no pleasure in the harm being caused to patients by these attitudes, however, which I will be reporting on further.

Finally, one day one of those patients being harmed might be ... you.

-- SS


Anonymous said...

The answer to each question thta you pose is likely to be "NO", but if you asked if this consulting outfit "contributes" to CCHIT and HIM$$, the answer is likely to be yes. Tragic that patients' lives depends on such consultants.

calvin jablonski said...


There are still questions that need to be answered regarding the Certifying Commission for EHR's . I apologize if this if this is the wrong location for this post but CCHIT needs to answer the questions.

OPEN letter to CCHIT, Ms Reber,
In light of the current economic reality , there are some questions that need to be answered.
1. Why haven't you addressed the reasonable question of why CCHIT was Involuntarily Dissolved ?
2. Now that CCHIT attorneys have managed to get downtown and stuff the State of Illinois corporate registration file with fresh papers, we would like to know when CCHIT plans to purchase a business license for operating within the City of Chicago?

3.We would like to see public reporting on how the $7.5 million form the Office of the National Coordinator was spent, who received money and how much money. Additionally how much cash does CCHIT have on hand at this time and where its accounts are held.

4. We would also like to know how long CCHIT has operated in Chicago without a business license and does CCHIT plan to purchase a business license for its business operation in Chicago?

5. What is CCHIT's connection to the Government Health IT publication deal that CCHIT' parent organization, HIMSS, is trying to conceal? What was given for to acquire the publication and what are the terms of the deal? Who are the new owners of the publication?

1. The writer believes Mayor Daley of Chicago is authorized by the tax payers of the City of Chicago to collect licensure fees and that the self proclaimed non-profit status CCHIT brandishes does not relieve itself of this obligation.
2. Therefore if CCHIt refuses to purchase a business license from the City of Chicago immediately, on behalf of the tax payers, the writer is demanding CCHIT get out of town , out of Chicago, our good city. We don't want you here.

The write also states that if CCHIT operates the way it has to cheat the City of Chicago on advice from its parent organization,, it too should pack its bags and get the h*** out of Chicago.

2. Considering the fact that CCHIT operated in bad faith without a business license and without a certificate of good standing from the State of Illinois it is highly unlikely that CCHIT can substantiate any claim to issuing valid certifications in exchange for money they have taken from vendors.

Calvin Jablonski

HIT said...

On another note down the same line, it has been an interesting journey for myself both looking to hire, and looking for a new job.

Some of these requirements that are out there are ridiculous. Some of the requirements I see are.

1. Bachelors degree
2. Experience translating data
3. 2+ years in healthcare (no mention of what capacity)

which is interesting when I look back on my own short career, 2+ years? That's not enough that's dangerous, some places don't even require 2+ years in health care, just 2+ years doing analysis of anything!

We've also hired along those guidelines and its cause us many headaches, many fixes and many bad situations (let your imagination go wild here).

The reason for all of this? Those who say what the minimum requirements are often have to battle to bet the budget to hire people who do fit. Then after awhile it becomes a battle of we just need people who cares how much they know or how *competent* they are. Bodies are what we need.

It seems to have been a battle of qualified vs budget or 'just need someone' vs nothing. Its a shame that there are these trade-offs.

MedInformaticsMD said...

Then after awhile it becomes a battle of we just need people who cares how much they know or how *competent* they are. Bodies are what we need.

There are numerous posts on HC Renewal about the absurdities of HIT hiring and exclusion of the most experienced specialists.

The work of Professor Norm Matloff at UC Davis on the IT industry "hiring cheap" is worth reviewing. I may do a piece on it here.

MedInformaticsMD said...

Calvin Jablonski writes:

The writer believes Mayor Daley of Chicago is authorized by the tax payers of the City of Chicago to collect licensure fees and that the self proclaimed non-profit status CCHIT brandishes does not relieve itself of this obligation.

I know my dad's business in Philadelphia was required to so do.