Health care I.T. is one frustrating mess. There are lots of reasons: One huge problem is the government incentivizing people to buy really lousy technology, and trying to force-feed standards from a lofty perch in Washington to an industry that’s craving for innovation. But the biggest issue is the qualifications and lack of experience of I.T. people in government, at provider organizations, and at HIT vendors. Fortunately, or unfortunately, depending on your perspective, the payers (except the government agencies) have oodles of I.T. experience and use it to their advantage--but more on that in a future posting.
My central point for this blog is that I constantly hear all sorts of pie in the sky uses of "technology" that will somehow drive down costs and improve care. As I’ve argued in the past, I don't think so. At least most of what’s talked about by government bureaucrats or M.D.s-turned-systems-architects is pretty high up the improbable scale. This is exactly what one should expect when re-inventing the wheel.
It doesn’t have to be this way. There are a few industries that have been down this road and know all the potholes and speed bumps. It’s a shame that we hardly ever see these experienced I.T. experts in health care.
This lack of experience shows up in three major areas where HIT is really horrible: user interface (easily fixed by not hiring Microsoft .NET/ASP programmers as architects and technology strategists); interoperability; and analytics.
For the latter two, HIT really needs to hire I.T. pros from the financial services industry. All the interoperability and data sharing problems facing HIT, and then some, have been solved in financial services. The practical limits of decisions support, analytics, and data mining have been stretched to the max in financial services –there’s still a sliver of pie in the sky on data mining but nobody is betting the farm or tossing around the hype the way we see in health care. In financial services, data sharing, transaction processing, analytics, security and privacy (while not perfect) is a generation ahead of what we see in health care. Plus no bank teller on earth has to suffer through the horrible user interfaces we expect doctors to use all day, and all evening, long.
If for some reason the financial services industry does not float your boat, maybe look to transportation and logistics. The parallels between what a UPS driver, or a mom-and-pop shipper, has versus what health care needs in terms of I.T. infrastructure (data communications, user interface, and analytics) is astounding. Or there's retail -- scanners, tracking, direct store delivery, product planning and placement, collections, hiring, ---all lessons learned that would be more useful in HIT than 10 years of college learning medicine. Of course all this technology needs adaptation, but basic principles, certainly at the sorely lacking infrastructure and UI levels, would boost productivity and abort I.T. projects doomed to failure before they get started.
The ultimate pie in the sky is the goal to replace a doctor's common sense and experience with computers, and that’s not going to happen no matter how many financial services pros (or doctors, nurses and Ph.D.s who think they can design computer systems) you throw at the project. A better approach would be to find operations managers who can plan and design branch office automation, and have the skills required to implement real-time credit checking and fraud detection. They would go a long way to make sure HIT projects and I.T. products are realistic and successful. Of course, this also means teaching the industry to doubt the hype cycle we're now in.
Rob Tholemeier is a research analyst for Crosstree Capital Management in Tampa, Fla., covering the heath I.T. industry. He has over 25 years experience as an information technology investor, research analyst, investment banker and consultant, after beginning his career as a hardware engineer and designer.
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