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TECH: High tech in health care IT? Not exactly. by Roy Johnson

Roy Johnson is a Director of IS Applications at Children’s Hospital of Wisconsin in Milwaukee. He got a little hot under the collar after the piece I wrote on Monday about HISTalk’s post on how out of date technology was in health care IT. Here’s his take

Actually it’s worse than you think. Epic uses a Mumps back-end (the same technology IDX uses for the back-end) with a nice bright, shiny front-end and a spin-off of data to a SQL database for customer data queries (IDX is doing the same thing).  So explain to me why GE acquired that three legged, one eyed, octogenarian dog called IDX and hailed it as a great advancement???  Despite Cerner using current technology, they have interoperability and context management issues between their own modules because they were all developed separately and they seem unable to resolve them (and they have a terrible record for support).  So we’re down to Eclipsys.  Given the run up in stock price lately they are the “real deal”, at least as far as Wall Street is concerned.  But as soon as the next great software advance appears, I predict that they also will sink into the abyss of old technology because the cost of rewriting systems is too great for these companies (not just cost, time and migration issues, but also the inevitable “bugs” that they introduce and must expend efforts re-solving).Perhaps I am a bit cynical.

But we should also look in the mirror and realize that we in healthcare are also part of the cause for the lack of advancement.  After all, it isn’t as if there isn’t innovation in the world of IS. But healthcare in general is reluctant (to put it mildly) to try and to actively support anything really new and innovative in automation.  It costs too much and/or it takes too much time and/or they want someone else to lead the way.  There is no shortage of reasons why not to do something new.  For example I can’t get our finance people to seriously consider a different automated receivables system from the one they have been using for 18 years, because it works and they don’t want to risk having a new system cause a spike up in days receivable (though they would dearly love to have point and click features).

I am of the opinion that it will take a focused national effort to move healthcare out of the computing dark ages by mandate and financial support.  Without this commitment (and the current political speak commitment is meaningless) we will not find a way to achieve the envisioned national health initiative nor find a way to effectively manage costs in healthcare.

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  1. IT is not seen as a core function in healthcare, and so it gets treated like any other utility. The perverse incentives of the industry do not help matters either.
    > explain to me why GE acquired that three legged…
    Non cynical answer: To get the customers. Software is a subscription business, and GE probably figures 75% of them will “renew” with a different GE dog of a system when the time comes. Because it will be too risky for them to do anything else. Because they’re risk averse.
    Cynical answer: To make the headcount and top-line of the organization bigger in order to justify a higher salary for the division head, and of course, his boss.
    > But we should also look in the mirror and realize
    Another thing to realize is that the ad hoc, chaotic production processes in hospitals especially are not particularly amenable to automation. Unless or until the CIO and COO work together and have enough clout to force change on EVERYONE in the organization, nothing will get better. In my view, the problem of healthcare IT is not technical, it is social. And you have provided the example:
    > they don’t want to risk having a new system
    > cause a spike up in days receivable
    You are lucky you have found the objection. Can you eliminate this risk for them? What would it take? Do they trust you?
    > I am of the opinion that it will take a focused
    > national effort to move healthcare out of the
    > computing dark ages by mandate and financial support.
    Healthcare’s got about 20% of the US economy. How much more “financial support” do you think it needs? I am of the opinion that this is not a problem of resources: it is a problem of will, and of leadership.
    t

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