Harvard study: Computers don't save hospitals money

I've been an ER/Critical Care nurse for 15 years. I've worked/contracted at over 30 hospital, and I've worked in a number of different specialties. I recently went back to school for a CS degree, and I'm working 3 days a week as an ER nurse, and I code the other 3 nights a week on my social news site for economic and financial news, http://Newsley.com.

I get asked all the time by people at Hackers and Founders meetups as to why I'm not going in to Health Care IT. And, the short answer, is that the computerization of healthcare is wrong. I currently work at a hospital that's consistently named one of the nation's "Most Wired", and the more I work at a "Wired" hospital, the more of a luddite I become. As much as I love computers, I think that their role in Health Care should be limited to a very few places.

Why? Here's the long answer:

- Culture. When a physician graduates from med school, they take a vow to "First, do no harm." The culture of safety, is everywhere. Physicians change their practice slowly based on research that often takes years to vet. Medications take years to pass FDA approval. This is all because of the very strong culture of safety in hospitals. Now, try and meld that with an IT culture where a generation in technology is 18 months, and user's heads explode. I've seen CardioThoracic surgeons who makes $750 thousand a year cutting into beating hearts struggle for an hour trying to put orders into a new computer system . A lot of physicians trained in the last 40 years never learned to type, and really don't use computers much. It's simply not cost effective to force physicians to make the huge adjustments in their practice to fit the needs of the IT department.

-Disasters. If any organization has to run in a disaster, it has to be a hospital. There aren't many disasters that can prevent me from writing a note on a paper chart in a disaster. But, every computer system that I've worked on in hospitals crashes. When that happens the whole hospital is crippled. Fault tolerant, reliable systems are essential for hospitals, and frankly, they just don't have the money to spend to build them or buy them. Paper is much more forgiving in a disaster than a huge distributed computer applcation running on 1000 Windows PC's with a datacenter back in New Jersey.

-Time. More often than not, I've seen software systems slow patient care down by a factor of 1-4x. We have to spend a lot more time looking at the computer rather than looking at my patient.

-Money. I've alluded to it above. But, when hospitals actually are running in the black financially, they tend to run a 1-2% profit margin. Software systems to run hospitals usually tend to cost tens or hundreds of millions of dollars, and a large support team to manage them. Hospitals generally don't have the money to pay top notch talent to maintain a really complex IT system.

-Bugs. Bugs are a fact of life for programmers. Bugs happen all the time. But, when a bug happens in a healthcare setting, people die. I've seen in happen, and it sickens me.

-Proprietary data formats. Every application that I've ever worked with in a hospital has been proprietary. That means proprietary data formats. A typical hospital will use dozens of different systems that all have their own proprietary data formats from automated lab systems, EKG machines, vital sign monitors, billing systems, inventory tracking systems, etc... All those systems have to be integrated, and for that data to be available across systems is really hard. (see Bugs and Money above).

After years of thinking about this, and working in this environment, I've come to the conclusion that paper is simply a much better technology for the industry. Really. Paper is cheap, portable, fault tolerant and easy to change. I don't have to wait for months for a work order to go through IT to change a database schema when I want to adjust the data that I'm gathering at Triage for instance. I can just have someone print up a copy of the new form. I'll stop now, but if you want to hear more of this rant, feel free to stop by our next meetup and buy me a beer. By the time we're done we'll both need it. As you can see, it's a hot button issue for me. :)

He said that problem is that American private hospitals already are highly computerized, it's just that the computer systems are focused entirely billing and not at all on medical records management.

When they decide to get an EMRS, hospitals turn to their billing software vendor to provide them with something integrated with their billing systems. The vendors tack something on to the billing software without adequate requirements gathering amongst the actual nurses who will use it, so the result is a system that simply does not have the proper workflow for managing patient medical records.

While EMRSes like the Veterans Administration's VistA program exist and are well-liked by nurses and doctors, they provide no functionality to ensure that you get billed $20 for each tongue depressor used. That functionality is, of course, of primary importance to private hospital administrators. So effective EMR software gets passed over unless it integrates with hospitals' existing billing infrastructure, and the hospital billing system vendors build terrible EMR software.

Oh, but it has. Outside the US, a number of countries have used computers very effectively in health care. In Taiwan, my medical records are linked to my national ID number and follow me wherever I seek care. Furthermore, doctors can regularly do pull up my chart from a laptop when I meet them in their office. It's also easy to make appointments online, and they go straight to the doctor in question, without any need to go through human administrators at the hospital. It's been a huge time saver for the patients, and the doctors achieve a turn-over that would be unheard of in N. America.

I can only speculate about the money savings, but it's overwhelmingly likely they are large. Most visits have a co-pay of about 3-10 US dollars, my one emergency room visit was about 40 and the highest tax bracket is only 20 percent. Most people are only taxed at about 7-8 percent, so it isn't simply a case of a health care system flooded with public money.

US hospitals just need good computer-based systems, or if it's a national one then a single good system.

For example, RIS/PACS(Radiology Information System/Picture archiving and communication system) systems may (and do) save millions euros a year only in radiographic film. I've seen figures stimating the ROI and its only 3-4 years. That without mention the advantages of having radiological data instantly accesible from anywhere, which opens the door to telediagnostics and telemedicine.

That's a very clear example. In other cases it may be harder to calculate real savings(if any), but not the improved care level.

So the software works for the only interest group in the hospital that actually has the power to spend five- and six-figure amounts on infrastructure. The system works! :-/

"The problem 'is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients,'"

There are plenty of products out there specifically to help doctors and nurses, and an increasing amount are being installed in hospitals. If it is in fact true that a majority of hospitals only have billing software, I would say it is the fault of the hospital/institution in that they chose to go that route.

"Implementing e-health records nationwide would cost between $75 billion and $100 billion, Brailer said, adding that individual hospitals "will have to make sizable, potentially multi-hundred-million-dollar budget commitments." Still, he said a fully functioning national electronic health system could reduce U.S. health care costs by $200 billion to $300 billion annually by cutting down on duplicate records, reducing record-keeping errors, avoiding fraudulent claims and better coordinating health care among providers. Himmelstein called those claims "unsupported.""

The dollar amounts I don't know where come from, but the advantages of a universal health care record aren't too difficult to see. Supposedly 50+% of faulty diagnoses are due to a doctor not having the information they need (that is available elsewhere).

"Finally, we believe that the computer’s potential to improve efficiency is unrealized because the commercial marketplace does not favor optimal products. Coding and other reimbursement-driven documentation might take precedence over efficiency and the encouragement of clinical parsimony. The largest computer success story has occurred at Veterans Administration hospitals where global budgets obviate the need for most billing and internal cost accounting, and minimize commercial pressures."

It seems like hospitals hyper-optimize single actions at the expense of efficiency of pipelined actions. sort of like... An addition takes a single clock, a multiplication takes a single clock, but a multiplication followed by an addition takes 100 clocks. Except tongue depressors and temperature taking instead of arithmetic; money instead of time.

I doubt you could build a more cost effective system to have a doctor walk in, take your temperature and leave.

http://www.infoeconomics.com/squandered.php

If organizations aren't following Strassman's recommendations for technology implementation, then it's not really that much of a surprise that they're still wasting money. The costs of technology are basically the same today as they were ten years ago, and it's not like human behavior has magically changed.

As I think about my friend with the Oracle system I wonder if the problem is technology or the companies implementing the technology?

I think one of the important things to note is that the true benefits of healthcare reform are going to come with IT in the form of payment/reimbursement reform legislation and a restructuring of Health Insurance. As this article also notes, greater public benefit of IT comes from the data exchange pieces which are being put in place, big news this week with Kaiser sharing data with the VHA, I expect this to be a trend that snowballs more information into the NHIN.

Other pieces of Healthcare IT that will benefit outcomes and burden on the system that this article doesn’t mention is Telemedicine for greater collaboration around providers, that is a sample among other emerging technologies that it will take government funding to really skyrocket.

Taking a massive IT project inside the four walls of a Hospital can be tricky since you have to account for some soft metrics like time saved, reduced LOS’s, and other non direct financial rewards. The other piece that does not have widespread adoption is the analytics piece, mining the data and being able to use for process and efficiency improvement is HUGE, doubt that was taken into account either.

They save lives..