If hospitals were run like startups
omarmetwally.wordpress.com
omarmetwally.wordpress.com
11. If hospitals were run like startups, 10% of emergency patients would be turned away ('not the target audience'), and any medical staff who complained would be labeled "insufficiently pragmatic".
12. If hospitals were run like startups, 90% of them would close their doors within the first year of opening.
13. If hospitals were run like startups, patients' medical information would be used to sell them ads. The databases storing this information would also be leaked within the first 10 years of opening, since details like security are rarely a priority in a startup.
14. If hospitals were run like startups, junior medical staff would be overworked, underpaid, and burnt out. Actually, this is already the norm (at least in Canada).
15. If hospitals were run like startups, patients who went in to have their appendix removed would find that their tonsils and wisdom teeth had also been removed, and an RFID chip with their patient ID had been implanted "to serve them better". This would be OK because it would be covered by the blanket consent form referred to by the sign at the entrance that reads "by using this facility, you agree to its terms and conditions (available upon request; may change at any time)". Patients who had read it would know that they could opt out.
It is illegal because it was a frequent occurrence, and, while less frequent, it (patient dumping) remains a serious problem.
It is a major problem (both independently, and as a symptom of other major problems) today.
Its less of a major problem today than it was before it was outlawed.
Now you can trace a direct link between passage of EMTALA to the over utilization of the Emergency Department.
http://www.dispatch.com/content/stories/local/2014/12/30/ohi...
Sad, but true.
Forced by who? The management? Or did they do it themselves for their own benefit?
I have worked IT in hospitals. I agree with the actual point the original article is trying to make - hospitals are not doing technology well at all. I don't want to bash the article too much, because that point is correct.
But there is an extremely important factor here - patient health. No technological improvement is worth risking the health of a patient.
This is a core business principle at work - the point of most businesses is not to have the best technology. Technology is a tool that often helps them achieve their actual goals better. Just a tool. Technology for its own sake is usually a mistake, and very much a mistake if it risks the health or life of any person.
Basically there's a ton of room for improvement, and the reason the improvement never happens is that the people who evaluate the systems are never the same people as the users. Moreover, the people who evaluate the system have no idea how to do anyone else's job, and so they have no idea how much inefficiency they're saddling their underlings with.
They probably also don't care.
What about the time spent on 350 clicks? Do that 20 times a day. How many hours of sleep did that intern lose to clicks?
As a physician who writes code, and is on the hospital's informatics board, his main point is a massive drag on medicine. And the problem is very much on the IT side. The hundreds of clicks are the problem.
People who write this code really should be made to write that code, at least sometimes, maybe one day a week, on the floors. Just sit at the nurse's station and try to do abstract, thoughtful work in a near panic. Oh, sounds terrible? Yes, yes it is.
The people who buy this software, quite frankly, I have no idea what to do about them. It makes me sick.
I disagree, least of all because the health of the patients should be put ahead of the health of a patient.
The fact is that this unreasonable fear of harming patients has caused everyone to be completely blind to the routine fuckups and inefficiencies which, when taken together, doom the industry and patients as a whole.
Let's look at EMRs. Epic, for example. Integrating with Epic is pretty hard--unless the client really twists their arm, they basically won't say anything to help you with their software or access their piles of shitty databases (mumps lol). They get paid tens or hundreds of millions of dollars a year (per hospital!) to handle the task of not losing patient records, a task at which they semi-succeed. They have no incentive to change. Oh, and one more thing...hospitals are deathly afraid of having data duplication anywhere, so they freak out if you start looking like you're a sibling system to their EMR instead of just blindly consuming it.
Moreover, they--like many smaller vendors--do extreme customization work that basically guarantees a new learning curve everytime somebody moves to a new system. And the software looks like garbage, and is hard to use, but at least lives aren't on the line and nobody was risked being harmed by some ~crazy new startup EMR~. Hah, oh wait, they are on the line, and people die due to bad medication decisions that aren't flagged or are flagged and ignored by the system.
And this whole system? Most of the mess is geared towards solving the billing problem. It isn't geared towards the patients records problem, towards the "what did this patient's body do at this time" problem. It isn't geared towards the "hey, that's odd, all my lab messages have the same jank-ass free-text formatting instead of an interface from the 90s".
The fact is that the vendors and hospitals have conspired in their fear and greed to basically raise the barrier to entry so high that iterating on new designs to help is quite hard, and instead just a good way of giving yourself an aneurysm. And you don't want that, because by that time you'll want to step nowhere near a hospital.
A better model is aviation, i.e. an industry where failure is often catastrophic. Look at the success of jet engine manufacturers in producing product that does not fail. Trans-oceanic flights on just two engines is something that would have been considered folly 30 years ago. It's all well and good for Southwest Airlines to have super-perky flight attendants that innovate by singing songs during post-landing announcements, but the real core of their business is safety, just like the real core of medicine is treatment outcomes.
For instance, in the US, if someone hacks your user's credit card data there will be some penalties involved, but life will continue. But if someone hacks your patient's records in your healthcare system and you didn't follow the rules regarding security? Up to $25k per infraction. If you did it willingly you're in criminal territory and the fines get much larger.
And that's just the regulations in the US. Every other country has it's own regulations you must follow.
Fortunately things are changing. Politicians are clarifying and updating laws to accommodate new technology. The tools are getting better. And startups like Dr. Chrono are slowly chipping away at the entrenched enterprise. But it's going to be a slow process. After all, it's a very serious business.
The main point is that hospitals are political organisations. And like political organisations, large scale change only comes after deepening crisis, or leadership overhauls. Those are the only two ways. Efficiency and speed are not even on the list of things a hospital is trying to optimize.
Man, that is quite impressive, must be some kind of a world record? I would really like to see that app :)
Paging systems are absolutely archaic and I've had important pages simply never be delivered many times. Bed tracking software at my current hospital has multiple full time employees whose job is 90% looking over things and sending support staff to their next task via a page. Callback numbers that take priority over any other task but then they won't pick up which just wastes time for short concise directives. Manual charting that's made incredibly tedious by poor UIs.
Hospitals shouldn't be run like startups, but they desperately need better integration with technology.
That is a perfectly logic statement that I'm sure most folks would agree with.
However, a blog title like that wouldn't get many clicks, would it?
Not sure of a fix. The best I can think of is rankings.
dlitz and others are playing the Waldorf-style heckling from the sidelines "doh ho ho, hospitals-as-startups would shave ads into your scalp". That's real cute. The fact is, hospitals as they've evolved are super gnarly behemoths. They have this insanely conservative culture at all levels...nobody wants to lose their job, and especially in IT, the successful ones have basically made it their life's mission to prevent physicians (who are, generally, pretty smart and freakishly stubborn people) from being overzealous and doing stupid things like spewing patient data over cell phones. They still do this.
Any change whatsoever in their operating environment takes months, because they are completely optimized to prevent systematic change from occurring. There is paperwork and lawyers and billing the likes of which you've never seen. Sales cycles are over 18 months. 18. Months. You could conceivably have two full children at a hospital before they have approved the project you'd use to pay for same.
The technology in hospitals is a bad joke. They cannot reliably tell you the status of a patient, what department they're in, or where in the hospital they've been. Frequently, updates to patient details will come out saying "Oh, whoopsie...this patient? They really are this other patient...wait, shit, those are the same patient." Nurses and docs will occasionally just horde equipment in their offices to guarantee that their department has what it needs, and the hell with the rest. It's absurd. They thought, for a long time, that no nurses would ever be interested in texting results around--and now, guess what, in the handful of places rolling that out, it's been like the best thing ever.
The people? Hoo boy. The nurses are awesome, but turnover and burnout tends to be large, least of all because of how shitty the alarm management situation is in certain ICUs. The docs? Some pretty great people, but getting product feedback from them is basically like calling rand() over and over. They also basically are in fire-fighting mode all the time. So, they'll do nothing to help you until they need something yesterday, and then magically their bitching will open up administrative doors that previously you didn't even know existed.
And that brings us to the administration. Some folks "get it". Mostly, though, especially in IT, they don't. They started their careers as machine operators, and with the awesome application of seniority, they rise through to their maximum level of incompetence. Things like billing 10K for 10gb of network storage on a VM. They only buy big name software, and that's how the deathgrip of Epic happens.
And if you could just bribe these folks to get shit done that'd be one thing--but hospitals (correctly) tend to have these super draconian gift policies, to the extent of not even being able to buy like a ham sandwich for a client. The hospital systems sometimes employ technically incompetent people, but always also close the backdoors we'd use to work around them.
Let's assume you find some docs and nurses on your side. Let's assume you find some IT folks that know how to Get Shit Done, or at least stay out of your way (you know, instead of taking two months to open a fucking port to let something work). Well, now, it's off to the fucking races with legal and billing.
Why? Because legal will have somebody look at a contract, go over it, send it back, and then have somebody else look at it, back and forth and back and forth, take vacations, sometimes just fucking lose the contracts, and then if anybody anywhere made a revision, the process resets. We've had some SLAs and MLSAs held up nearly years because of this. And you can't get them fired, and nobody cares, because of the magical fucking pixie dust of "We're saving people's lives here".
Billing and money, that's the real magic. Why? Because you've got to figure out which buckets of money you're going to get paid from. Is it going to be a grant? Is it going to be funding for some initiative? Is it going to be operations? Will maintenance fall under normal service budget, or will it be some setaside from a budget normally earmarked for new construction? Did legal fuck you and make you miss a quarter's budget freeze?
And that's just the clients trying to buddyfuck you. Like, actually worse than gamers as customers.
I'm increasingly convinced that healthcare needs a SpaceX style makeover. Someone with a few billion dollars that can fund the top to bottom construction of a new state of the art facility and fund the software and medical equipment development to get things running how they ought to.
Thread over.