Harvard Says Computers Don't Save Hospitals Money 398
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by
kdawson
from the always-jam-tomorrow dept.
from the always-jam-tomorrow dept.
Lucas123 writes "Researchers at Harvard Medical School pored over survey data from more than 4,000 'wired' hospitals and determined that computerization of those facilities not only didn't save them a dime, but the technology didn't improve administrative efficiency either. The study also showed most of the IT systems were aimed at improving efficiency for hospital management — not doctors, nurses, and medical technicians. 'For 45 years or so, people have been claiming computers are going to save vast amounts of money and that the payoff was just around the corner. So the first thing we need to do is stop claiming things there's no evidence for. It's based on vaporware and [hasn't been] shown to exist or shown to be true,' said Dr. David Himmelstein, the study's lead author."
Re:Transferability (Score:3, Informative)
Your records belong to you. You can request them (and depending on the hospital / doctor's office, they may claim you can only receive copies or that they will only send them directly to your new healthcare provider) at any time and take them with you.
Re:Transferability (Score:5, Informative)
Nope. The current Electronic Medical Record systems are not capable of exchanging information freely. There is no standard data format that everyone can exchange.
There are a few standards that can package data, but they are not adequately specified for seamless interoperability.
If you request records, they can print them out quickly for you though.
Re:Transferability (Score:3, Informative)
One would wish. Doctors either spend more time with electronic systems than with paper systems... or if it is a good system... about the same time.
The current systems haven't made doctors more productive. There may be an exception or two though in select settings where considerable grant dollars were poured in to build a locally optimized system.
Building good clinical systems is hard.
Re:Well (Score:5, Informative)
I work in a hospital as an interpreter, so I see a lot of how people use computers... and how they don't. Generally in the ER, the patient first sees the triage nurse, who asks a series of questions. The answers all get entered into the computer. Then the patient sees their actual nurse, who asks many of the same questions again. This information may or may not get entered in the computer. Then the PA comes in and asks the same questions a third time. This time, the information gets written on a piece of paper, or maybe a tablet computer. Eventually, the attending physician stops in just long enough to ask the same questions a fourth time, and doesn't enter the info anywhere. If the patient is admitted and sent to another department, the process starts over.
Re:Transferability (Score:5, Informative)
The systems aren't put in help the doctors. They are put in by the non-medical managers to help their jobs. And they fail at that. A system designed for doctors with the goal of reducing error and improving care could work. But that's not what the systems are. They should start working now to have all records be electronic, X-rays, MRIs, personal history, etc. should be in formats that can be directly shared between doctors. Then processes and systems that are designed to help the medical care should be used to put that information to good use and let patience get improved care for a lower cost. But the systems are all billing systems first, and care second. And that's why they fail, and always will. Improving billing doesn't help care, and can often make it worse, as having a doctor or nurse putting in billing codes will only slow down the process.
Remote access to specialists (Score:3, Informative)
The ER doctor looked at the X-rays, then called the fracture specialist at home, who looked at the X-rays on his home computer, and passed on his advice to the ER doctor.
Let's see them do that without computers.
Re:I would also guess... (Score:3, Informative)
That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.
This is exactly what I witness. I am working as a Software developer in a University Hospital in Europe. Just an example:
It often happens here, That some one enters data into a system. Then another devision needs said data and guess what they do? Data is printed out, faxed internally to another devision and usually a subset of the data is entered manually into another system again. Despite the fact that all involved users have access to both systems and if they'd use the systems appropriate, data would be exchanged automatically between theses systems (data exchange doesn't always happen automatically for several logical or obscure reasons).
As it looks like (from talks with IT stuff from other hospitals) we are not a special case. Especially non academic employees in a hospital are really resistant in learning how to use these "new" technologies (it works much better with younger employees).
Re:Parkinson's laws (Score:1, Informative)
One thing that always amused me is the jaw-dropping amounts of money spent by bureaucracies, especially large government, on enforcing rules designed to increase efficiency.
For some large government projects, it gets to the point that it would be cheaper to simply hire 10 different companies to all produce the software product that you wanted, and then simply pick the best one.
Meanwhile, in the supposedly efficient government system, the actual project is done by 1 software team that is red-taped to death, it ends up costing 20x more than it should have, and then still fails.
Even if in my hypothetical scenario of using 10 different companies it turns out that 9 of them produce a rubbish product, you'd still be better off than spending 20x the sane amount and failing. You could literally have some huge fraction of your suppliers simply pocketing tax payers' money and walking off with it and still save money by firing all the paper-pushers.
Posted as AC as currently I'm a subcontractor to an outsourced supplier providing services to a branch of a department investigating... you get the idea.
Re:Transferability (Score:3, Informative)
"The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld."
That's not the problem, and doctors aren't going to make money-saving decisions anyway (what planet is this guy from). The real problem is that hospital administrators are uninformed and powerless. For example, most hospitals use Group Purchasing Organizations (GPOs) that actually don't save them money, yet the administrators are convinced that everything's just fine and that they're all set. And most hospitals don't intervene in the purchasing decisions made by doctors -- they think, "zomg what if our Star Doctor leaves us and goes with Hospital X" -- so it's hands off on anything the prima donna decides to do. The result is that the hospital will not buy software that could save them money immediately on every purchase decision, and it will not second-guess any purchasing decisions made by its doctors.
Bottom line: they have met the enemy, and he is them.
Re:Well (Score:3, Informative)
But it has to look pretty, or the folks with access to the bank account will never buy it! It also needs animated sliding panels, customizable positions for all controls, and must fit the graphical style of Windows, so the office staff don't get confused. When the programmers are done with those important goals, then they can work on the petty stuff like speed and usability.
Oh, don't worry about that part, the system Smith and Feied are talking about is their own product, that they sold to Microsoft [bizjournals.com].
Re:Transferability (Score:3, Informative)
Cool story bro, though that probably wasn't an EMR: just some DICOM images. Of course I can't say that with full certainty, just with what I know from working IT in a hospital. But it's still cool that it helped save his life.
Re:Transferability (Score:3, Informative)
But, those records weren't available to be sent over when required. Your mom did it. If she hadn't, regardless if they were paper or electronic, they would have gotten there too late.
That's a change that has to happen. I'm starting to build my own patient file on myself. Every time there's a test, or anything more interesting than "I have a cold, gimme some antibiotics", I get my own copy of their records. Unfortunately, I didn't start doing this years ago. I've tried to track down some records from 8 years ago, and they can't be found. It's not just that it fell outside of their document retention policy, but the doctor is no longer practicing. The lab was a mobile unit, who I don't know the name of. So, those records are lost, even though they'd be great for identifying change over time.