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Why don’t connected healthcare information systems work?

In a perfect world, connected healthcare information systems would be easy to use, offer doctors a way to effectively communicate with their patients without any barriers or restrictions and give patients a secured means of keeping track of their electronic medial records (EMR).  Today’s healthcare information system doesn’t do this.  


According to last month’s New England Journal of Medicine, 17% of U.S. physicians use some kind of electronic medical records system and only 9% of U.S. hospitals are adopting EMRs. What’s the holdup?


Some say it’s a case of misalignment of incentives. At this week’s MIT Sloan CIO Symposium, Dr. John Halamka, CIO of Harvard Medical School, talked about how implementing connected healthcare information systems comes at a high price in terms of cost and productivity to doctors and medical facilities, with little return on their investment. Halamka talked about how doctors are presented with this great new technology for electronic health records. But the doctors initially have to put their own money up to fund the technology investment. They then see an immediate loss in productivity due to the setup time and management of the system. Finally – their staff ends up quitting or complaining about all the extra work involved in the new process. What are the incentives to this? Extra hours, lack of productivity and no additional compensation. And how is that supposed to improve my healthcare experience?


Or maybe it’s a workflow issue that’s holding up the progress of connected healthcare information systems. Fellow panelist Gregory Veltri, CIO of Denver Health and Hospital, blamed the lack of progress on workflow. Veltri gave a great example of his CEO telling him, ”Nurses chart today the same way they did 30 years ago. You need to fix that.” This was a wake-up call for Veltri, who realized that doctors and medical facilities have a major workflow issue. They have been using the same systems and workflow processes for years and literally haven’t had the time to make changes.


Could the holdup be blamed on the technology? Does the technology behind connected healthcare information systems do a good enough job in meeting the needs of doctors, patients and insurance carriers? Connected healthcare information systems are very complex and involve doctors constantly codifying data for flows, reminders and alerts. Most doctors don’t think in terms of codes. Moreover, a lack of standards means the system your primary care doctor adopts might not be the same as the one a specialist or hospital has, making your record unusable by anyone but the facility that created it.


The goal of connected healthcare information systems should be “to push the right data to the right provider at the right time,” said Veltri. I’m not sure about you, but I’d rather have my doctor use a system that will allow him to spend more time figuring out my diagnosis, not just the right codes to enter.  

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It is not the question of technology or even work flow but rather the arcane method for identification of diseases/treatments devised by the "international standards body" which produces the ICD Codes. Ten revisions so far and probably working on version 11 or 12 when the doctor/nurse graduated when there was release 7 or 8. Who needs to know these codes? Why not work on Body Parts and Health Effects? I guess there is too much baggage in the ICD promoters to look at simpler solutions. The other drawback is the blind adoption of the HL7 standard which is nothing more than a glorified typewriter. Why would anyone want to put in the effort in that area? The Health Care practitioners are and have been doing a very good job so far. The issue is the that the IT folks have got involved and like the Peanut Package vendor, the accounts want to make the selling price to be $7 while the small vendor was making money at 25 cents!
We have spent half a mil, (this is behavioral health) - and are in pain every day, the vendor charges if you just call their number and are not motivated to satisfy our acute care inpatient needs. Dragon naturally speaking , best hardware and younger MD's are gonna make this IT we bend over backwards & train, train, train
I was a part of a very large medical records project back in the 90s, and the list of "challeges" to adoption are legion... Yes, work flow is a problem. By itself, it's a legacy of the golden age of paper and pen (sometimes with hospital standards for what colors of ink may mean). In addition, what do you do with the previous 'n' years of paper charts? As alluded to in the article, many doctors and hospitals add transcription to their normal staff's workload with the predictable consequences. As the comment noted, ICD codes and other nomenclature in the field have changed repeatedly over time. So, it's not nearly enough to hire a skilled typist to "help out." Perhaps this is the temporary solution to the unemployment problem? I'm forced to disagree about the efficacy of the HL7 standard, though. My work centered on the HL7 2.x standards that were a bit less international in scope because of character set issues but were quite efficient in terms of network bandwidth. HL7 3.x has adopted XML and its underlying layers to address those problems at the cost of bloating every message. But, that's beside the point. HL7 is nothing but a means for expressing information about patients and their treatments/medications/insurance in a form that aims for interoperability. It prescribes nothing in terms of applications, GUI or character front-end design, etc. It is entirely possible for such things to be very friendly. The other big technological pain point is how to represent all of that data on disk (or tape) and layer in hierarchical storage management to keep from blowing the budget. The repository for my project took the "a few key fields plus BLOB" approach with predictably bad results. There was an entire, separate database just to describe and decode the BLOBs. But, that's one of the most efficient storage techniques... Once you've conquered some of the back-end technology challenges, the widespread adoption of Web-based technologies, cross-platform-capable Java applications, HL7, DICOM, etc. could make the entire "investment" for individual doctors drop to paying a provider for access to their software and storage and entering the data. That's a tough nut to crack, but it's far easier than buying the hardware, software, disk space, tape drives, off-site storage, etc. for every doctor's office...
I don't view the healthcare information systems dilemma as one that’s going to be resolved by technologists alone, or by workflow managers alone, or by information workers alone. The path most likely to lead to success is an equal partnership between all of them - information workers, information consumers, technologists, applications designers and business process managers (maybe more). The collective efforts of these smart, energetic and dedicated people (dedicated to the cause), actively working together, hashing out ideas and possibilities, listening openly and contributing to ideas, getting creative and serious as a team – that’s what it’s going to take. Furthermore, goals and measurements of the project should be defined as business objectives and not technology objectives. That is, what matters most to the people consuming and providing the information. Then it’s up to everyone on the team to contribute their ideas and feedback on how to efficiently and creatively address those goals. I don’t know about others, but I would like to see goals such as healthcare providers being enabled to focus on providing me healthcare while easily receiving and capturing information, with or without workflow changes. I’d like to see my information be very reliable in terms of accuracy and completeness, with or without the codes. And the technology should have its own quality measurements addressing performance, security and connectivity with other healthcare information systems, with or without standards. And the software facilitating human interaction with the information should have usability guidelines so it's fast, easy and intuitive to work with. The challenge (and solution) is getting the various functions to come together and do the best possible work they can defining the right goals and then designing and implementing an efficient and innovative future healthcare information system.
Yet another lack of risk management, planning, change management, etc. ad infinitum. Anyone ever done an SAP implementation from scratch? /*Of course*/ there are workflow issues!!!!! Duh!!!! /*Of course*/ there is an initial hit on productivity!!!! Duh, again!!!! And, unfortunately, /*of course*/ there is going to be a less-than-user-friendly UI design. There's nothing new under the sun. Is this the first time the user interface was designed by some techno-nerd with no domain experience? Is this the first product that has been sold as the best thing since peanut butter which will solve all of the world's problems and insure world peace? Is this the first instance of a new software system being introduced into a paper-based, bricks-and-mortar, carbon-based system with no change management process in place? I was in the IT business for over 25 years and worked in many industries and in companies large and small. Only once in that time did I see an implementation in which there was up-front risk assessment and end-user involvement in the assessment/design/acceptance process, a comprehensive change management process put in place that accounted for and managed the disruption of ongoing operations, and one in which all parties agreed on and signed off on expectations and timetables. This is not a technology failure. It is a typical, consistently-repeated management failure . . . with at capital FAIL.
One perspective: Health practitioners are still using pen-and-paper; a means of recording information that hasn't change for decades. Let's see, what would our everyday personal banking/financial activities be like if the recording and tracking of those transactions were still in paper format?
oh, the finger pointing is boring. Why can't people just come together for the cause?