Ask HN: Why is healthcare IT so screwed up?

I used to work IT for a College of Pharmacy and had to occasionally deal with the IT for the enormous health system: http://med.umich.edu. There are pockets of competence and the occasional really cool project, but "screwed up" is a good descriptor.

The people who have decision making authority or political weight, doctors and administrators are completely clueless. While typically highly intelligent, their training tends to turn them into savants.

These people making decisions, and the users in nursing all ask their kids for help at home with this type of stuff. IT staff have to support a userbase that is much older than most other industries (http://www.vcstar.com/news/2010/jul/10/records-show-about-ha...). IT cannot assume competence.

There is absolutely no incentive to get this stuff right. Most healthcare systems are rolling in money, so IT staff levels are typically huge. The correct way to protect these fiefdoms is to not screw up and not get noticed. Admin will keep throwing money at you so long as they don't have to think about you.

In the health system, IT has no political weight. It's regarded slightly better than janitorial staff. Which affects (non-monetary) resource allocation and recruitment of IT talent.

A brief anecdote. The College of Pharmacy had a contest requiring some of the hospital's pharmacists to score videos of student-patient interviews. They had to do it at home. There are departments at the hospital that do incredible work and research with imaging tech, but their pharmacists can't view a 5 minute video clip in any format.

I work in healthcare IT as a software developer, and I only have one thing to say: Bureaucracy.

Honestly. When you have 12 managers for ONE project, that has ONE developer, nothing gets done!

Outsiders think the reason it's so hard is because of dealing with 'sensitive data' - they don't deal with it, they pretend they do.

If you want to make software for healthcare, have lots of cool graphs, lots of amazing "management" features and features to cut-down on paper-work (i.e. do referral forms automagically) you can sell it for A LOT -- but only if you're really good at sales, and know exactly the right people. :)

p.s. in healthcare IT, you can sell promises (oh, my humanity)

Just a comment from Asia (Singapore). It's rather difficult to get doctors or medical personnel to adopt new technologies. The nature of the industry selects people who are trained to behave very cautiously, as it concerns life and death. The healthcare industry is also very fragmented geographically due to necessary regulation. This makes it difficult to scale, as each location may have its own set of legal, medical, safety and privacy requirements. Doctors are also used to pen and paper. An example we saw when visiting our clients is the use of a touch screen tablet for taking patient's notes. Basically, it just replaces a paper notepad with a digital notepad. The doctors fundamentally do not change their behaviour or actions. However, there are changes happening with the advent of electronic medical health records and the integration of the internet to connect the various systems.

Another point would be the costs involved. Everyone seems to charge some insane multiple once it's healthcare-related, even though it's just the same hardware/software.

I guess there's a lot to talk about and discuss, drop me an email if you are interested. I'm also pretty sure the DrChrono guys (I've seen them post on HN before, I think) can chip in with a few insights from their end.

When designing systems for doctors, you really need to talk to them and watch them use your product/platform/software/website. There are a lot of idiosyncrasies/terminology involved which an outsider is unable to grasp easily.

I used to develop solutions for clinical trial management. The problem set is similar to EMR. I noticed that the data schema requirements were incredibly flexible by necessity. A health practitioner is basically gathering ad-hoc information from their patient. "How do you feel?" "Where does it hurt?" "When does it hurt?" The schema to store that information, when it's formalized, resembles the gramar rules for a spoken language, and is challenging to code, and even more challenging to query.

I'm not saying this is why health care IT is so screwed up, but it's something that drove me away. There are standards for data storage, like HL7 and CDISC.

Now, add on the fact that you have to formally test the living crap out of anything healthcare related, or people can die. The bureaucracy can be a lot for some people to put up with. It's difficult to attract good developers, when there are so many other fields to work in that are more free-wheeling. Also, healthcare IT is not very conducive to a lean startup culture, because of the domain expertise and labor involved to get a product out the door.

Healthcare IT is screwed up only because our healthcare SYSTEM is.

I recently left my job at UC Irvine, where I worked in telemedicine research and IT. I can only repeat what ahi and veb have already said, bureaucracy, specifically bureaucracy on all levels, departments, organizations, insurance companies, state and federal bodied, regulations, and fear, are the cause for stagnation. I've seen too many innovative solutions squashed because someone in management was convinced it wasn't "HIPAA-compliant".

If I had to choose one reason, however, it would be insurance companies. Why? Insurance companies choose what to reimburse, and they're not reimbursing for technology-based preventative and/or virtual care. My first response on HN was on this exact subject: http://news.ycombinator.com/item?id=2256119

I just got a physical and the dr's office told me the only way to get the results was through post office mail. So I called Anthem, a huge healthcare company, and asked if there was a website that allowed me to select doctors that email results to the patients and they said no there is nothing like that.

It would be so easy to require dr's to give a little information about how they cut costs and Anthem could deliver that information to consumers online.

Instead Anthem does nothing. Why is Anthem such a big player? They suck.

Few companies can afford the up-front CYA that comes with dealing with 'sensitive' information, nor the initial investments required to integrate with even a few legacy systems out there. The continued requirements and restrictions serve to keep established players established, while the barriers to entry get larger.

Most doctors work in small offices. They don't have the resources to come up with a good electronic infrastructure and make sure it is properly secured. It's much easier to use the mail than to risk exposing patient information online.

The way doctors think is radically different from the way engineers (who build the tools) think. We need somebody like Steve Jobs in healthcare.