Technology in the Medical Industry

Now only to get some salesforce working on spreading it thoughout the land...

Budgets and politics are the two largest barriers. I know you said convincing people is key, but it's deeper than that. In a typical healthcare IT shop, the people who make the decisions aren't the people who know what the technology can do. So you get this barrier where IT has to first convince itself that it's a good idea, then convince itself it's a priority (most projects die in either of these two stages) and then finally work on convincing the outside world (this is where real politicing comes into play).

It's rare for a healthcare IT group to have any authority to change anything.

A perfect example is the last hospital I worked at. Our 3 year, "revolutionary" (for our province) plan? Standardize server OS and hardware. Move to a common directory services platform. Move to a common mail platform. Move to a common desktop management platform.

None of that changes patient care stuff. But without that type of foundational stuff you can't even get to the patient care opportunities. Then the problem becomes who pays for patient care IT upgrades. Not IT. And patient care budgets would rather spend money on more beds, more nurses, better analysis, etc than spend it on IT.

It's a far bigger conundrum than anyone who's never been there can understand.

If anyone is starting a company to do this, sign me up! I would love to work on this type of thing.

Less simple, less glib answer - that while video and technology holds a lot of value, there is a lot more going on with an in person visit and interaction than can be captured even by the best HDTV cameras. Smell, sounds, tones, subtleties of how someone reacts quickly, what their body is doing when they answer etc. I'm not a doctor but think about just within our own families - can't you tell just by looking at your loved ones when they are feeling pain or discomfort, even if they put on a good face, something subtle about their posture, face, tone of voice, little microgestures etc sends out a "not doing so well" vibe.

Plus, much like how a waitperson's tip has been shown to increase if they even briefly physically touch their guests (a brief pat on the back, brush of the hands etc), the physical interaction with a doctor goes a long way towards how the doctor is viewed. I know there have been studies which show that more than the actuality of whether or not a doctor made a mistake, the best predictor of who will in fact get sued has to do with how they interact with their patients - i.e. a doctor who makes a mistake but who seems nice and responsize gets sued less frequently than perhaps a "better" doctor technicaly but who is rude, abbrasize and seems not to care.

From a technical perspective I agree with the other commentors about the unlikelyhood of a "universal" solution getting traction. Rather, I would suspect that systems that "play nice" and work well with legacy systems while gradually moving data to a more consolidated and universially useful form will gain traction - but at the same time they face serious HIPAA (and other) regulatory requirements and restrictions.

(imagine what happens if a doctor's PDA holds 1000's of patients medical records and is stolen or lost. But at the same time while security is needed, what happens if a doctor needs to access a patient's chart in the middle of major crisis and forgets a password, miskeys something, is wearing gloves and other protective gear so biometric means are not available etc. Paper charts for all their failures have the advantage of not needing power, boot cycles, login times, etx. All they need is some form of illumination (generally available when a doctor has to work)

Shannon

P.S. How many Microsoft EULAs include the clause about 'do not use this product where failure could result in property damage or loss of life'?

You want a video of a doctor putting their finger in your butt? There are a lot, and I mean a LOT, of privacy issues regarding some of the things you are suggesting. How can you tell from a video tape if the clear liquid that a nurse injected into that line really is the correct drug in the correct dosage? All that a video camera is going to capture is the gross, and by gross I mean large, stuff. Like nurses smacking patients that they don't like and such.

Here's the thing, I agree that the technology has to get better and at a lot of hospitals it is. Who's going to pay for it? It's not just a matter of cost though. Hospitals are pretty rich. Look at the average patients chart, well you can't really. You can look at your own chart. HIPPA probably won't let you look at your wife or another family members, maybe your sons. Take a good, long look at all of the informtion contained in it. Now, count up how many people you see in the waiting room and think about how long it will take to enter in all of their data. Again, that's just the people you can see in that waiting room, on one floor, in one hospital. Imagine doing that for just everyone that works at Microsoft. And those people probably don't have anything all that serious wrong with them. We have entire file drawers dedicated to a single patients chart for some of our bone marrow transplant patients. A lot of that information is kept in an EMR, electronic medical record, but what happens if the patient is in a car wreck on vacation and they are seen at another hospital? How do you keep the information synchronized statewide, let alone nationwide or worldwide. If you say BizTalk I'm gonna smack you with a cluebat.

How do you convince machine manufacturers that it's in their best interest to make their data available in a standard format? How long did it take for Microsoft to open up it's Word format? Doesn't it make sense to have a standard format for information? So I can open up my Excel worksheet in Lotus 1-2-3 right? Every manufacturer is going to say, "our format should be the standard because we did the most research and determined that this is the best way to represent this data". What happens if their machine supports a very useful diagnostic feature that doesn't fit into the standard? Do you think there are standard data interchange formats for medical data? There's standard terminology, but what data points mean can vary from institution to institution and , most often, from physician to physician. How do you represent that in a standard format? There have been some attempts at medical information standards, but the problem is that there isn't one large guiding force in the medical industry.

I'm right there with you that things have to change. Heck, I'm one of the people working to make them change. It's a LOOOOOOOOOOOOOOONNNNNG uphill battle, but we are winning it somewhat. Look at the new ER in Issaquah, check out the system that Swedish hospital has in place. Tablet PC's and everything. I know a few hospials that my wife worked for in New Mexico were completely electronic. The Group Health hospital I was at just this morning (HIPPA VIOLATION!) has Dell terminals in every room and their EMR is synchronized between all GHC facilities. Is the system failproof, hell no. A nurse this morning couldn't enter some data because someone was "fiddling with the system.".

Lets look at your IV pump example. In either case, a blockage or out of fluid, a nurse is still going to have to check it and either clear the blockage or replace the bag. How does having a different beep really help? Isn't the idea behind the beep just to call attention to the machine? Which case is more important. How much does an MRI machine cost? What does a blood pressure cuff have to say to an IV pump? A malpractice lawsuit is much less expensive than replacing every piece of equipment in a hospital with a new piece that can talk to the others. You don't really solve any problems by making the machines smarter, in fact you create new ones. You still rebooting your Tablet PC every night? Imagine doing that for every piece of machinery in a hospital every night? If you don't, what happens when you are working a trauma case and you have to look up a patients chart only to have your Tablet lock up because it's been on for 5 days straight. Worse yet, what happens in a disaster? Think a lot of doctors were booting up their PC's during the Tsunami? A paper chart is never "down for maintainence".

Can you tell you hit a hot button for me? I deal with this EVERY DAY. We have to deal with data whose meaning changes over time even if the actual data doesn't due to advances in technology and knowledge. The amount of data and the complexity of the data is MASSIVE.

But really now, every time that surgeon pops his head in, he's charging your insurance $70 (or more). I wish I could do that.

I had the opportunity to do on-site usability testing with nurses and it was a serious eye-opener to see how they used technology, or maybe more accurately, didn't use it. Or tried to use it? LOL.

As well, I met with many docs, in their own environment and I was amazed at how far behind me tech-wise they were. It'll take time, for sure, but there is so much opportunity to help out there, it's well worth it is my guess.

BTW-- Blogging won't fix it. The solution starts at the CIO level.