Sunday, August 15, 2010

EPIC's outrageous recommendations on healthcare IT project staffing

"Critical thinking always, or your patient's dead" - Victor Satinsky, MD, NSF-funded summer science training program (SSTP) for high school students, Hahnemann Medical College, early 1970's.

Health IT projects are incredibly complex undertakings in equally complex, mission-critical medical environments. They are definitely not an area for novices.

From conception to design to implementation, faulty systems can endanger patients.

Further, one astute author of an article entitled "Faulty Construction" in the journal ForTheRecord.com (link) observes that:

Critics wonder what good it is to invest in EHR technology if it fails to engender itself to users who feel betrayed by its lack of intuitiveness.

Inexperience is a critical factor in creating and implementing HIT that "betrays" users in many ways (see, for example, here on mission hostile HIT).


With these issues in mind, here is how the major HIT vendor, EPIC, recommends hospitals staff their clinical IT projects. It also follows that they staff their own development teams in the same manner.

The recommendations are largely outrageous, especially in the context of medical environments where uninformed, unconsenting patients are subjected to IT experimentation in clinical matters.

From this link at the "Histalk" site on staffing of health IT projects, Aug. 16, 2010. Emphases mine:

Epic Staffing Guide

A reader sent over a copy of the staffing guide that Epic provides to its customers. I thought it was interesting, first and foremost in that Epic is so specific in its implementation plan that it sends customers an 18-page document on how staff their part of the project.

Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say.

The guide suggests hiring recent college graduates for analyst roles. Ability is more important than experience, it says. That includes reviewing a candidate’s college GPA and standardized test scores.

I bet many readers were taught by their HR departments to do behavioral interviewing, i.e. “Tell me about a time when you …” Epic says that’s crap, suggesting instead that candidates be given scenarios and asked how they would respond. They also say that interviews are not predictive of work quality since some people just interview well.

Don’t just hire the agreeable candidate, the guide says, since it may take someone annoying to push a project along or to ask the hard but important questions that all the suck-ups will avoid.

Epic likes giving candidates tests, particularly those of the logic variety.


While there's some good here, the part about "not worrying about relevant experience" and about "hiring recent college graduates as HIT project analysts" is downright frightening.

Medical environments and clinical affairs are not playgrounds for novices, no matter how "smart" their grades and test scores show them to be. These practices as described, in my view, represent faulty and dangerous advice on first principles.

The advice also is at odds with the taxonomy of skills published by the Office of the National Coordinator I outlined at the post "ONC Defines a Taxonomy of Robust Healthcare IT Leadership."

One wonders if these recommendations are simply the idiosyncratic opinions of EPIC's leadership. They certainly deviate wildly from medicine's culture (e.g., of rigorous domain-specific training, and certification where the test cannot even be taken without prerequisite, very specific experience).

One could also look at these recommendations from an economic perspective. The word "cheap" and a corollary concept, "age discrimination" come to mind regarding a stated preference for recent graduates over experienced personnel.

Finally, from a personal perspective, my grades and test results out of high school and college were very high, e.g., a perfect 800 in math on the SAT, high grades in advanced courses in the 'hard sciences' - not to mention, advanced computer courses such as in IBM mainframe assembly language programming.

Yet the ‘modern me’ (after medical, further IT and informatics education and hard earned applied experience) knows that I would not have wanted the ‘young me’ to have been involved in critical clinical IT functions on that basis.

-- SS

10 comments:

Anonymous said...

It is cheaper for Epic to employ undertrained workers. Since there is not surveillance of the adverse events, injuries, and deaths from defective HIT and defective deployment, they can get away with it.

Another one to ponder: Since the US Government can not afford to take care of all of these old sick people, flawed HIT is a clever way of lessening the burden. No one will know.

Continues to Search for a Job said...

I see the same thing over and over Scott. I'm not heartened by the EPIC advice that it "may take someone annoying to push a project along."

Add pushy and annoying to inexperienced and you don't get "ask the hard but important questions" you get the company party line shoved down the throats of MDs that get no respect from a nerdy youth now empowered by better than the geek squad at best buy.

If you simply look at this from EPIC's money-making point of view a) cheap and pushy will make them more money and a faster implementation and b) pushy and annoying in the user companies will give them someone else to blame for failure.

What I can't understand is why the people who run these hospitals are so daft as to buy this crap.

Anonymous said...

I had the opportunity to speak with a college grad of 2009, working for a DC inside the beltway consulting firm. This newly minted consultant is advising hospitals how to alter function to dunction with the law of health care reform.

I almost wrecked the car.

Multi-million dollar compensated hospital CEOs are relying on these "experts" to recommend the changes needed in the care of acutely ill patients.

paulboal said...

Inexperienced workers have the benefit of coming into situations with limited predefined expectations. In an industry undergoing change the appears dramatic, that can be a real asset. That said, I agree with most of the other comments. Inexperienced means inexperienced. They either need to be lead by someone who does have a righteous mission and/or need to have the sense to question what they're told. You can't see that in a test score. Good listener and analytical thinker is the opposite of pushy and annoying in my book, but you can find both right out of college.

Anonymous said...

This has been going on for a long time. My attorney wife, with years of experience, was called in her boss’s office years ago and a 20-something geek dressed her down stating she would not participate in an upcoming project because she would ruin their deal.

Later people would resign to avoid legal action, people were demoted, and the whole thing was swept under the rug.

Today everyone worships at the tech alter. I am neither a computer guy nor doctor, but do remember from years ago: Garbage in, garbage out. Somehow this idea has been lost.

Steve Lucas

MedInformaticsMD said...

Today everyone worships at the tech altar

We need to leave the Boy Genius idea where it belongs - in the comics.

Cetona said...

Nicely done, Scot. Your account helps understand what we've called the anechoic effect--annoying people by definition make noise, docility is the keynote.

It also helps us understand the fundamental distinction: IT in our society isn't part of health care. It's a business vendor to health care. So these directives are business decisions. Once that is taken as a given, a lot falls into place.

This was driven home to me in a flash a few years ago while listening to the then-and-now CEO of a major competitor of Epic. We were a small group of would-be "leaders" sent to this company's home town to become evangelists for our incipient EHR roll-out.

What they guy said, precisely, was: "EHR isn't about good software quality. It's about change management."

That stuck with me. What did he mean?

In essence, he was saying: "don't come back to us for modifications based on lessons learned. Ram it down your people's throats."

Stop and think about it: this is very good business. His job is to add to his bottom line. Unruly customers detract from it. Docile ones add to it.

It's good business. But it's lousy health care.

MedInformaticsMD said...

Cetona said...

What the [HIT CEO] said, precisely, was: "EHR isn't about good software quality. It's about change management."

My expression "cross occupational piracy" by the IT industry has real meaning.

-- SS

Cliff said...

I appreciate members of the medical community utilizing critical thinking when new concepts are presented. But in reading this post I have to question the veracity and accuracy of the factual information presented when the article was posted at 9:16am on August 15, 2010 but excerpt of Epic's hiring recommendations highlighted by SS were of an event that did not take place until August 16, 2010. Some people are just afraid of change or differing opinions and practices. Did anyone besides me note that Epic did not say send untrained novices to take over EHC, but merely suggested alternative hiring practices to get quality people who can be trained. Innovation never occurs when everyone follows the status quo. Innovation and change (yes, even change for the good) only happen when someone takes ownership of a new concept and won't let the established 'powers that be' defeat them because they want to protect their positions and the status quo. I certainly hope that the established experienced experts in health care continue to question new ideas, but do so based on objective and not subjective analysis.

Scot M Silverstein MD said...

"Cliff"-anonymous (unavailable blogger profile) writes:

in reading this post I have to question the veracity and accuracy of the factual information presented when the article was posted at 9:16am on August 15, 2010 but excerpt of Epic's hiring recommendations highlighted by SS were of an event that did not take place until August 16, 2010.

"Cliff"-anon,

My HC Renewal post was indeed posted Sun. Aug 15 while the linked HISTalk story is in the "Monday Morning Update 8/16/10".

HISTalk posts his updates the day before, i.e., the "Monday Morning Update 8/16/10" usually appears on Sunday. Or perhaps earlier that week as the URL is http://histalk2.com/2010/08/14/monday-morning-update-81610/.

In fact, I'm not even sure what you're questioning; you're certainly not thinking critically. How could I have accurately posted something about "an event that did not [yet] take place" unless I was clairvoyant?

Regarding the rest of your message, "innovation and change" through preferential selection of young, inexperienced novices for life-and-limb critical healthcare projects is foolish on first principles. There is nothing to debate and nothing to discuss on that issue.

On the other hand, your unavailable Blogger profile suggests your bias is towards EPIC. I wonder if you're an EPIC employee or media consultant.

We've had HIT industry sockpuppets here before, such as the fellow here.

-- SS