Health care and computers

[David Farber <dave () farber net>]

Begin forwarded message:

From: Ed Biebel <edward () biebel net>
Date: December 10, 2005 11:56:47 PM EST
To: dave () farber net
Cc: Michael.Kende () analysys com
Subject: RE: [IP] Health care and computers

Dave and Michael,

I can only share my anecdotal experience as someone that is part of the
healthcare system (as a pre-hospital EMT) and IT person who has been  
equally
frustrated by many of the same issues that Michael has mentioned below.

I think most of the issues can be attributed to a few root causes:

1.  Lack of appropriate and useful software that reflects an  
understanding
of the business processes of hospitals and the organizations that  
feed into
them.
2.  Lack of standards
3.  Government regulation or lack thereof.

One of the frustrating things that I have seen is that lack of decent
software available for the healthcare industry.  In the pre-hospital
setting, most software seems to be menu-driven, non-customizable and  
fairly
kludgy.  I've seen a lot of software missing basic components, such  
as an
easy-to-use report writer to address new reporting requirements.  My
organization was so frustrated by the search for a software package  
that one
of our members returned from college with his CS degree and wrote a nice
web-based application (which he is currently customizing and selling to
equally frustrated organizations in the area.).

I've seen the same thing in area hospitals.  Two of our hospitals have
recently replaced the triage process with a PC based system and the  
time it
takes to go through triage has increased dramatically.  The paper-based
system allowed the triage nurse to collect basic information specific  
and
relevant to the patient and then fill in the blanks later.  The nurse  
could
gather the medical information and have the demographic information
collected later.  Now, because the nurse is creating the computer  
record,
triage now must collect all of the demographic information before  
they can
begin entering any medical care information.  Or they must enter  
irrelevant
medical information to that patient (temperature on a heart attack  
patient)
because the system requires it to complete the whole record.  Obviously,
better designed software would allow a dynamic information entry  
process but
for whatever reason, it is not what we are seeing.

The second issue is a lack of standards.  In NJ, we have been  
advocating for
standardized pre-hospital care reports.  We are told that the state is
publishing a standard data set but no agreement has been  
forthcoming.  This
is likely one of the direct contributors to the poor software  
available as
no one wants to invest significant energy in a system that won't meet  
state
standards.  Pennsylvania adopted a state-wide standard a long time  
ago their
care providers have been using electronic data tools -- first  
scantron forms
and now tablet PCs -- since then.

Finally, government regulation plays a big part here as well.  We have
recently been told that new regulations have been developed that  
require ERs
to evaluate the medications of all patients as there has been a concern
about patients being over medicated.  As a result, a person's prior
medication information is less relevant is required to ask and review  
what
medications you are on today.  As well, you have government  
requirements,
such as the Ryan White act, which require maintenance of records (in the
case of Ryan White it is for 30 years) but without a clear standard  
of what
format and essential needs to be maintained.

As a counterpoint, I'll give brief example of something that I  
understand
was successfully implemented in Philadelphia and I think is an  
interesting
example of what happens when standards and solid software and business
analysis takes place.  Philadelphia Fire Department entered into a joint
agreement with the hospital systems in Philadelphia to develop an  
electronic
system for data interchange.  The system was designed and managed by  
a third
party company who oversaw billing and received a percentage of the  
billings
in return for providing the software and hardware.

The paramedics in the field complete their run report on a tablet PC  
during
the transport.  On arrival at the ER, the paramedics "dock" the  
tablet and
transfer all of the electronic information to the hospital system --  
past
medical history, medications, allergies, etc, history of the present
illness, etc speeding creation of an accurate hospital chart.  The  
tablet in
turn receives an ID number for that patient's record.  This is a  
benefit to
the PFD because frequently they get poor address information and lose  
the
ability the bill.  When the paramedic returns to base and docks  
again, the
call information is uploaded to the PFD's record and billing system.
Because the hospital typically collects good insurance and identity
information, the third party company links the fire department record  
to the
hospital billing record.  My understanding is that successful PFD  
billings
went from $200-$300K to several million.

However, Philadelphia is able to do this because Pennsylvania has
well-developed standards, a large regional (the city) area which they  
serve
and several large hospital systems (Penn, Tenet, Temple, Jefferson,  
Catholic
Health East) which make up the majority of the ERs.

-Ed




-----Original Message-----
From: David Farber [mailto:dave () farber net]
Sent: Saturday, December 10, 2005 6:07 PM
To: ip () v2 listbox com
Subject: [IP] Health care and computers



Begin forwarded message:

From: Michael Kende <Michael.Kende () analysys com>
Date: December 10, 2005 4:17:41 PM EST
To: dave () farber net
Subject: Health care and computers

Dave,

If you see fit for IP, I have a question about the computerization, or
lack thereof, of hospital health care.  Having spent more time than I
would care to have in the past few years around hospitals, there is an
obvious reformulation of Robert Solow's quote, that one can see
computers everywhere in the hospital except in productivity.  I wondered
if anyone had any thoughts why this is (or why my perception is not
correct)?

For those of you fortunate enough not to have recent experience in
hospitals, these are some observations from some of the big hospitals in
the Washington DC region including Georgetown and Sibley:

- check-in is painfully slow, even if they have previous records, even
in the emergency room.  Georgetown actually photocopies drivers license
and insurance cards each time for even for regularly scheduled visits.
- although all information is input into computers, it comes out as
papers onto clipboards and gets carried around that way from then on.
Several weeks ago one of my relatives was at the emergency room and no
Doctor came to see her because her clipboard was not in the triage
slot (I had to
find it).
- no records of previous medical information seem to be (readily)
available.  This
same relative had been multiple times in the same hospital for the same
reason, but when they noticed that her blood pressure was low they had
to ask us if this was uncommon, rather than simply check records.
- not sure how Doctor's orders get passed through the system, but I know
that they start on paper in cupboards outside each room (at least at
Sibley)

So the question is, why can the Hilton check someone in faster than the
emergency room, even for a repeat visit, and keep and use information
abuot previous visits such as newspaper preference (whereas the hospital
has to find out each time about a penicillin allergy)?  Why does a
Doctor come into the room with less computer power in his/her hands than
the UPS delivery person?  What am I missing?

I guess possible explanations include:

- budgets, except that the hospitals all do have computers everywhere,
it is just not clear what goes in and what is available afterwards.
- privacy, but could that explain the same hospital not having easily
available records on the same person?
- others?

Given the size of health care in the economy, and the potential impact
on lowering costs, not to mention better diagnosis and prevention of
mistakes, it would be interesting to learn both what I am missing in
terms of what the existing computers are used for and why the whole
process does not seem more computerized,

Thanks in advance,

Michael


Michael Kende

Principal Consultant

Analysys Consulting

Tel:  1 202 349-1114

Fax: 1 202 349-1113

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