Loading ...
Sorry, an error occurred while loading the content.

Re: [Hardhats] Re: What do you keep explaining about Health IT

Expand Messages
  • fred trotter
    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
    Message 1 of 5 , Sep 2, 2010
    • 0 Attachment
      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]
    • hungerregnuh
      When I first got into healthcare I had tons of those huh? moments... - The failure rate in HCIT seemingly being higher than other industries, by failure i
      Message 2 of 5 , Sep 2, 2010
      • 0 Attachment
        When I first got into healthcare I had tons of those "huh?" moments...

        - The failure rate in HCIT seemingly being higher than other
        industries, by failure i meant project failures
        - The dozens and dozens of ways to accomplish the same thing depending
        on type of coverage, practice etc. It seemed to me that every specialty
        or section in healthcare had their own process to accomplish the same
        things, which of course vary by organization too.
        - The separation between clinical staff and IT, kind of like the
        phrase, the left hand isn't talking to the right, in HC it seemed like
        the left hand didn't even know the right hand existed.
        - How far behind HC is, in terms of technology from other industries,
        to put this in perspective, one of my clients, a major hospital well
        respected hospital uses hardware that i think may predate myself (i'm in
        my mid 20's). Also ran into some software that was almost as old as i
        was too.
        - Hardware procurement got me, it seemed to take forever to get
        anything, it took us 1 month to provision resources to buy a 100$ NIC
        card, in the end we bought it for the client cause after a month the
        request was still in limbo. In a nutshell healthcare seems to move
        significantly slower than other industries...

        that's all for now

        On 09/02/2010 08:13 PM, fred trotter wrote:
        >
        > 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]
      • Philippe Ameline
        My 2 cents (or my 2 billion $ :-) ) They are all doctors, but in the same way people building a house are all workers... there is the same distance between a
        Message 3 of 5 , Sep 3, 2010
        • 0 Attachment
          My 2 cents (or my 2 billion $ :-) )

          They are all doctors, but in the same way people building a house are
          all workers... there is the same distance between a gastroenterologist
          and a radiologist or a cardiologist than between a painter and a plumber.
          "Health IT" has always been about dedicated, specialized, systems ; it
          is born to diverge (and fail).

          When I started working with knowledge management research teams, I
          discovered fundamental concepts like "concurrent engineering" and
          "viewpoint oriented systems" : the issue being something like "how can
          different skills work on the same project/process?"
          It is a genuine reference frame shift: the starting point is no longer
          each specific job, but processes and the way they demand heterogeneous
          viewpoints to interact.
          I hope it can converge ;-) but you will eventually told me that doctors
          seldom think in a "process oriented way"!

          The other issue to address is twofold:
          - health IT is governed by "non clinicians": most standard and norms
          were built by radiologists and pathologist... simply because they were
          first to ask for information systems
          - University Hospitals are in charge of research... even if it is the
          most distant point from people health (I mean health, not fighting
          against diseases)

          These points are crucial when it comes to Public Health Information
          Systems (PHIS). Having University Hospitals in charge of such projects
          is pretty much like dealing with public security issues from the bridge
          of an aircraft carrier!

          I could conclude in the same way I ended my previous post: a paradigm
          shift is needed... and, at the end of the day, you may conclude that
          doctors will not be the initial customers of new systems.

          PA

          Le 03/09/2010 05:35, hungerregnuh a écrit :
          >
          > When I first got into healthcare I had tons of those "huh?" moments...
          >
          > - The failure rate in HCIT seemingly being higher than other
          > industries, by failure i meant project failures
          > - The dozens and dozens of ways to accomplish the same thing depending
          > on type of coverage, practice etc. It seemed to me that every specialty
          > or section in healthcare had their own process to accomplish the same
          > things, which of course vary by organization too.
          > - The separation between clinical staff and IT, kind of like the
          > phrase, the left hand isn't talking to the right, in HC it seemed like
          > the left hand didn't even know the right hand existed.
          > - How far behind HC is, in terms of technology from other industries,
          > to put this in perspective, one of my clients, a major hospital well
          > respected hospital uses hardware that i think may predate myself (i'm in
          > my mid 20's). Also ran into some software that was almost as old as i
          > was too.
          > - Hardware procurement got me, it seemed to take forever to get
          > anything, it took us 1 month to provision resources to buy a 100$ NIC
          > card, in the end we bought it for the client cause after a month the
          > request was still in limbo. In a nutshell healthcare seems to move
          > significantly slower than other industries...
          >
          > that's all for now
          >
          > On 09/02/2010 08:13 PM, fred trotter wrote:
          > >
          > > 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]
          >
          >


          [Non-text portions of this message have been removed]
        • Ian Martin
          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
          Message 4 of 5 , Sep 4, 2010
          • 0 Attachment
            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. 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).

            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. 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...


            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.trotter@...>
            To: hardhats <hardhats@...>; 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]
          • fred trotter
            ... The speed to use effect. Several mentions of this... seems like it really is central. ... Great example on how simple issues impact time. ... Good point.
            Message 5 of 5 , Sep 5, 2010
            • 0 Attachment
              On Sat, Sep 4, 2010 at 11:14 PM, Ian Martin <ian_martin65@...>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.trotter@...>
              > To: hardhats <hardhats@...>; 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]
            Your message has been successfully submitted and would be delivered to recipients shortly.