

Ask HN: Why is healthcare IT so screwed up? - va_coder


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ahi
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...](http://www.vcstar.com/news/2010/jul/10/records-show-about-half-of-
ventura-countys-and/?print=1)). 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.

------
veb
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)

------
ryanteo
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.

------
euroclydon
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.

------
hparra
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>

------
va_coder
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.

------
mgkimsal
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.

~~~
va_coder
That's what I was thinking but my doctor entered her information into a
netbook.

The data is stored digitally. For some reason or another her office only sends
the data to the customer through snail mail.

I've heard on a few web sites that they still do it the harder way, as opposed
to email, to get extra money from the healthcare companies.

The system, as it is today, does not encourage players to be efficient.

~~~
mgkimsal
I didn't say it wasn't happening, or impossible, but you don't see more of it.

Most doc offices aren't tech savvy - they'll get something that has some
approval from colleagues or professional bodies, and go with that
recommendation. The few products/services that can break through that seem to
be set for a while.

------
tallanvor
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.

~~~
va_coder
As tech guys, is it really safer? What's to stop a shady postal service worker
from making money on the side by looking at peoples mail?

~~~
krallja
Postal service workers take an oath that they won't do that, with severe
penalties if they break that oath.

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

