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. :)