Critics Urge Lawmakers To Tread Carefully With Health IT Proposals

i read the article. let me give you my view. i have more than a decade as an IT developer/project manager at one of the major oil companies before i became an RN. This man's view is very common with most IT management. The issue is that most people who manage IT don't actually know how the business is run and take a template of "Best practices" to apply to the industry that the are working in. I understand what he is saying about the need for project management and cost savings.

What i have experienced is that there is a major disconnect between the IT and clinical side. either nurses move over to IT and try to make it work or IT tries to understand nurses' needs. The problem is, unless you have the right understanding of the big picture and how the development lifecycle workers, the nurse turned IT person is going to be limited. The same with the IT person, unless they know what questions to ask, how the care flows and what sort of "step outs" exist, they too will fail.

The biggest difference and this is the part that worries me the most about this push into healthcare by IT and our government is that, we deal with people. we deal with people on the worst days of their lives, we deal with people who are not able to advocate for themselves, we deal with the elderly and infants. Unlike every other industry, we are in the "people" business. you can't just boilerplate practices that worked in one industry and expect them to work in healthcare. The CIOs and leaders don't have a good understanding of this. They walk the rarified air of upper-management. The question is, how much time have they spent on a floor, watching, listening and learning? i bet very little.

These consultants and "experts" talk a good game but i have seen them from Arthur Andersen-Andersen Consulting (now dead), KPMG, Cap Gemini, IBM services, BAH and even McKinnsey and Co folks. They have a superfical understanding, they learn the right lingo and then bam "they know more than the people who the day to day work". I watched these folks come into the oil industry and grab contracts and muck about. At the end of almost every engagement, we (the employees) still were not sure what they even were supposed to do as well as what they actually did.

well, that is not entirely true, they always wanted to help us outsource our IT. God help us if that happens to healthcare. Now your entire personal history could be stored in a country, where bribes are common and the rule of law is more thought than practice, by subcontractors who get paid less than the folks that do the housekeeping in the hospital.

And that is the dirty secret, most of the cost savings promised around IT is around sending the work to a cheaper source. notice i said cheaper, not better, not safer, not more secure. Ask yourselves this, if your hospital buys into the idea to outsource some of their IT and support somewhere, do you feel comfortable knowing that someone's life may depend on support of systems that are half a world away who has no real stake in the situation as well as 10 to 16 hours time difference. All the associations, state regulatory boards and JCAHO is meaningless on another continent...

Excellent post, horus.

Offshoring is such a huge risk... just look at all the contamination coming out of China.

Procedural boilerplates are ridiculous but standardized algorithms certainly have their places.

To me, the potential benefits of well-done EMR isn't with regard to cost savings... it's with regard to improved efficiency (which doesn't necessarily reduce costs) and reduced potential for errors.

I agree completely, though, with your characterization of the difficulty of integrating IT folks and nursing folks.

I am an ex-programmer who served as a short time as the informatics nurse in a small CAH. The IT folks got annoyed that I wasn't a Windows help desk tech and the nurses didn't believe that I was, you know, a nurse. Clinical hated corporate and corporate viewed nurses with terrible disdain.

I got in big trouble for trying to teach the nurses about simple things like, you know, cut and paste and right-clicking. Corporate got mad because they were supposed to know these things. How? They weren't hired with that in their job descriptions.

Health care will nickel and dime itself into the ground in implementation. They'll pay a bazillion dollars for a system and then not want to pay the nurses to learn it.

what i saw that bothered me the most around the consultants was with an SAP implimentation. we ended up having to change the way we did some of our business practices so they would mirror the way the system worked. the promise was the system would work with our processes,we ended up changing our processes so we could work with the system.

from what i have seen is the promise with the addition of IT to healthcare is cost savings but they are vague as to how that will happen. i doubt that most hospitals are so inefficent that there are millions in cost savings just waiting there. as with the oil companies, the savings will be sending the work to a cheaper location.

i offer what needs to be done is a type of activity based costing analysis first (i know this was in vogue in the mid 90's) but if a hospital can identify how much it costs to do each task in patient care, they can then look for ways to make it more efficient. if they just want hospitals to slam IT in without really carefully looking at what drives the cost and figuring out ways to fix that first, they are not going to save any money.

finally, they need to have total buy in from the people using the new systems. i have seen things fail because the users refused to use them, you can spend 50 million on a system but if the users sabatoge it, then what?

Here's what I've noticed about EMR: Compared to paper charting, it's much harder to scan the record for information or patterns. In the hospital where I took my students (last year, maybe things have changed), physicians no longer look at nursing notes; they expect the nurse to give a verbal report to them now.

If they wanted to read yesterday's nursing notes, they would have to bring up the patient's record, go to yesterday's date, then click on the nursing records: the assessment section, the separate I&O section, the separate nutrition section, etc. Then within each section, they might have to click on the heading for what they were looking for to get the complete entry. For example, if the nurse has a detailed comment about the patient's response to teaching, only the first few words would show up at first.

It seems to me that the info is there, and the documentation is there, but the system is unwieldy. Plus, as an instructor, I'm troubled that it is possible to change an entry or change the time of an entry.

Sounds like a very poorly designed system.

Also, a system that's worth a darn will time-stamp and user-stamp any changes. It's much more reliable than paper charting where anybody can make the change anonymously (sure, you know it was changed, but you have no idea who or when) or can even rip a page out altogether.

i would give the software the benefit of the doubt and bet there is a timestamp that just may not be visible to users with certain "rights". i would bet if you looked at the tables of the database you would see something that would document changes in the records.

I do not doubt that it is embedded in the software that changes can be tracked. None the less, it is not obvious to the reader.

Again, sounds like a poor implementation. Changed fields should be readily identified as such and have a simple means of summarizing the change... something like a roll-over tool-tip that at least shows the user ID, date and time of the change, and perhaps the original value, as well -- not something that requires a bunch of clicking or special admin rights.