Thursday, August 20, 2009

Why Siemens Healthcare Fails

I have written numerous times on this blog about the blind-man ignorance displayed by many healthcare IT and biomedical companies regarding Medical Informatics expertise.

As a graduate and postdoctoral-level Medical Informatics educator with considerable applied expertise, as well as talent management experience, I teach students of a variety of healthcare backgrounds that the only way to overcome the sociotechnical complexities (i.e., issues at the intersection of people and their interaction with technology) of HIT is via education and considerable experience.

Once students become aware of the nuances and complexities of HIT in real-world clinical settings (if not already enmeshed in such environments), they find the lessons learned from substantial and rigorous immersion into a wide corpus of literature, overseen by someone with expertise, profoundly important towards advising their own organizations in avoiding pitfalls and achieving success.

I note that I used to admire German engineering rigor, but after seeing ill conceived, misguided position ads like the following from Siemens Healthcare, I am having sincere doubts about that country's current prowess in that domain.

I refer to a recent ad (here at the moment) for a Physician Consultant:

Job Description

Siemens Medical Solutions is the industry leader in Healthcare IT technology and Clinical workflow solutions. We are seeking to hire an experienced Physician for our Professional Consulting Services Organization. In this highly visibly position, you will support the implementation of Siemens products (such as Soarian ) in hospitals nationwide. To be considered for this position, qualified candidates must have the following credentials and experience:

• U.S. based Medical degree with at least five years of post-residency experience in large multi-specialty practice or hospital-based facility in the United States.
• Currently practicing medicine, or must have practiced at least 1 week per month within the last 3 years
• Leadership experience with at least one CPOE implementation in a large, multi-facility health system, Integrated Delivery Network (IDN) setting
• Extensive public-speaking and executive presentation experience
• Medical informatics credentials or advanced degree preferred, but not required [Medical Informatics not required? - ed.]
• Prefer some experience in public-health related projects

Here are the obvious major problems:

One CPOE implementation or even several does not by any means qualify a person to counsel other medical organizations and clinicians as a representative of a company citing itself as "the industry leader in Healthcare IT technology."

Further, the criteria "Medical informatics credentials or advanced degree preferred, but not required" suggests the crafters knows little about Medical Informatics, or hold it at a low level of esteem, considering it an optional "gift" that might add slight extra value to the incumbent's ability to travel the country and give good advice and support in clinical IT implementation. What might substitute for such knowledge and expertise?

This J.D. might better be described as "glorified salesperson." It might be a good exit route for a "techie doc" (usually, someone who knows just enough about HIT to be destructive) who hates the current practice environment. It might also be good for managers who don't want knowledgeable experts pointing out their bad decisions and mismanagement, but I think a global company like Siemens should be setting its sights higher in such a crucial area as electronic medical records and clinical IT consultants.

I would not want such a physician advising or supporting complex HIT projects at my organization.

I spent time at Siemens Healthcare headquarters in Erlangen in 2000, and was offered gracious hospitality and a position overseeing the Soarian cardiology suite. The people I met in Erlangen then seemed extremely competent and informatics-savvy, but I turned the offer down through no fault of Siemens. I'd received a near-simultaneous offer (FAXed to my hotel in Erlangen, in fact) from pharma that involved a much stronger management role.

I understand through conversations over the past few years with current and ex-Siemens personnel that most of the Siemens personnel I'd met in Germany in 2000 are no longer with the company. I was told they'd performed suboptimally after the acquisition/merger with Shared Medical Systems (SMS) in Malvern, PA. (I do not find that credible, and would find it far easier to accept that the problems were on the American side, but that is a personal opinion.)

Questions raised by these observations:

  • What manner of ideology about education and expertise does this job description represent?
  • Is there nobody left in Germany with a realistic sense of the education and expertise required to advise on and support HIT implementations in a competent manner, I ask?

Allow me to answer question #1. It represents the IT designer-centric, data processing and tabulator punch card culture-based (and antithetical to medicine and science) view that with enough generalists and sufficient "process", any problem can be solved. By this logic, Bach and Beethoven would have had symphonies written for them by low level musicians in the name of "efficiency" and cost savings.

Wanted: consultants to write my Ninth Symphony, according to the Acme Symphony-Writing Process Manual. Musical experience not essential. Must be team players.

Shareholders, take note. I emailed this post to the Siemens Healthcare CEO Hermann Requardt, who I note (almost predictably) lacks a biomedical background other than having been a research assistant for aviation medicine once, and having worked on MRI:


  • Secondary school (baccalaureate)
  • Studied physics at the Technical University of Darmstadt and University of Frankfurt (Dr. phil. nat., Dipl.-Phys.)

A lack of response is therefore not surprising.

-- SS


Anonymous said...

I was initially concerned about Hermann Requardt's lack of a biomedical background. However... Last summer, John Glaser took the Siemens Healthcare CEO position. He has a doctorate in Medical Informatics, a long legacy of success as former CIO of Partners Healthcare, and recently served as advisor to the ONC-HIT (formerly Dr. Blumenthal). And Mark Overhage will be officially starting his new role as Siemens Healthcare's CMIO March 28. These leaders are well known in the medical informatics field. Still, it would be wonderful to require every Siemens Healthcare software developer to have some kind of medical informatics education, so that user interfaces for doctors and nurses can be developed with more of a medical practice-based mindset. It doesn't make sense for clinicians to develop the code and packaging (alongside software engineers) for health information systems, unless they're formally trained to do that.

Scot M Silverstein MD said...

Re: Anonymous March 25, 2011 1:34:00 AM EDT

I do not know Mr. Glaser, but I do know Mark, and wish his efforts well.

-- SS

Scot M Silverstein MD said...

...and, while probably of little consequence, who knows what contribution my posting and email to Siemens Healthcare CEO Hermann Requardt might have had on those hires?

-- SS