On Sat, Sep 4, 2010 at 11:14 PM, Ian Martin <ian_marti...@yahoo.com.au>wrote:
> Hi, > I'm an Emergency Physician, and program (badly) for the fun of it. > > First of all, there is a paradigm shift between medicine and IT. Medicine > has a > veneer of science, but once you dig a little, there's a truckload of touchy > feely stuff that the science depends on, and that makes it very hard to > tick > boxes on a screen. This ranges from the really complex individual with > multisystem problems who really went to ED because their granddaughter went > away > for the weekend, and they're not mobile enough to manage (unable to cope is > not > an allowed choice) to the elderly person who trips over because their > eyesight > is bad and breaks a hip. The hip is the reason for admitting them; the > underlying problem will almost by definition be secondary (if at all > recorded), > but fixing that is the real long term solution to the patient's problem. > Or how > do you code possible drug seeking? Yes, you can write a database complex > enough; I've used it. There were about 100 options at each of 5 levels > (OK, I > exaggerate, but that's what it felt like); what happens is the most common > generic case becomes a catchall, and IT blame the medical staff because > they > aren't getting good data. > > In part because of that, we're a bit cautious about the black and white > approach > IT has to health care. > > > Without any question, the most common problem we have with IT in healthcare > is > time. The speed to use effect. Several mentions of this... seems like it really is central. > For an IT person, individual logins are a must; for me, it means I'm > logging into physically shared PC's, probably on average about once every > 5-10 > minutes given all the different usernames/ passwords are taken into > account; one > for radiology, one for labs, one for the internet, one for toxicology > database, > one for drug database... and of course autologouts are set so short that in > a > complex case you may have to relogin if you get interrupted (in my job, > interruptions average 30/hour). > > With every new program, it's "only a few seconds to log in". I can fill > out a > paper XR request in 1/4 the time I can do it on the PC (could the people > programming for Kodak please have to use their system for a day? I have 2 > separate usernames entered in 4 locations, two passwords... one Xray > request. > Autofill got invented a few days back). > Great example on how simple issues impact time. > > In my job, sometimes I don't have that time. Doctors don't "get" why we > should > have to go to court and explain why patients die because management > replaced a > paper based system that is efficient at the front end with a computer that > causes up front delays, even if there are significant back-office benefits. > We > are also being held to ransom by lawyers, and cannot afford poorly worked > out > processes- it's our career on the line when bad things happen because the > PC > takes forever to load/ we can't get results because its patch Tuesday/ our > login > died on a weekend and we're useless for an hour or more. We also go home > and > use programs that "just work", so we know we shouldn't have to tolerate bad > design on the job. > > Another major hurdle yet to be overcome is data entry. Doctors are, in > general, > not touch typists. Good point. Typing and data entry. The corellary is that doctors should be suscipcious of any UI that does not get close to keyboard-only control... but do not consider this often enough. > Voice recognition software is still a work in progress. > Until the barrier to entry for getting data on the system rapidly has been > lowered, IT will be seen as a problem, not a solution. Also, most medical > record keeping software also has issues with graphics; a picture may take a > thousand words, but it seems to take at least a million bytes, and I've yet > to > see or hear of a good implementation that allows graphics. And who's going > to > enter it all? I trained for 10 years to... do data entry. Slowly. Most > other > health care workers don't understand the nuances enough to enter accurate > data, > and I don't have the time. > > The data storage issue is bigger than what you've noted. Health care > records > often have to be kept- and be accessible- for the life of the patient, and > more > than once I've found information from the 70's that relates to the problem > I'm > trying to address at the time. In IT it may be acceptable to update your > database/ language occasionally; in my job, accessing old data is more > important > than riding the cutting edge. Don't forget it's not just a court case and > a > truckload of money off to your local litigation leech; it's potentially > lives > lost, and an doctor respecialising in tractor driving. And lawsuits aren't > rare > events: someone once told me the average American doctor spends more time > in > court than the average American criminal... > If you can find me that study I would be impressed... I am a big fan of lifelong records. I have argued for the seven generation test. Now some peope call it the "Trotter Test" contributing to my already big fat head. > > > Finally, local to you the USA has a huge problem with fragmentation due to > the > private health care system, and I'm willing to bet not even the President > of the > US will be able to shout down all the private interests making money out of > your > ill- health. The billing problems you mention are only the start; given > that > healthcare is about 18% of GDP, don't bet on being able to inject any > common > sense. There are too many vested interests making money on it staying just > the > way it is, and unless greed starts to be seen as a negative attribute, the > status quo is bound to continue. > > Ian > > > > > ________________________________ > From: fred trotter <fred.trot...@gmail.com> > To: hardhats <hardh...@googlegroups.com>; openhealth > <openhealth@yahoogroups.com> > Sent: Fri, 3 September, 2010 2:13:03 PM > Subject: [openhealth] Re: [Hardhats] Re: What do you keep explaining about > Health IT > > > I really appreciate the wonderful questions and answers that I have gotten > on this question so far. > > However, many of them have been focused on Doctors not understanding > fundamental IT notions. > > This makes sense. Our community is often trying to convince various groups > of doctors to make good leadership decisions, and focusing on the problems > with that process makes it easier to answer "what do doctors not get". > > But I had two parts to my question. The other part was "What do > (non-health) > IT people not get about Health IT. > > To get us started I will start with the most shocking Health IT reality > that > I learned about when I first started in this community: > > The degree to which medical billing impacts the health IT process. I was > shocked by the need for clearinghouses, that X12 was the "new" standard > (dates me, I know) rather than a sensible choice like XML. I was shocked to > see the arms race between insurance companies reasons for not paying and > doctors justifying expenses... Then the degree to which that process locked > us into billing ontologies that prevent more reasonable ontologies from > flourishing. > > For those of us on the IT/Programming side, what was a > painful/dramatic/profound lesson that you needed to learn about the way > health IT operates? > > -- > Fred Trotter > http://www.fredtrotter.com > > [Non-text portions of this message have been removed] > > > > > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > Yahoo! Groups Links > > > > -- Fred Trotter http://www.fredtrotter.com [Non-text portions of this message have been removed]
