Healthcare is NOT Ready for Innovation

Healthcare is NOT Ready for Innovation

Sean McCown, contributing editor for InfoWorld describes why healthcare is not ready for innovation and why he is leaving the healthcare industry for the second time.

I just left the healthcare industry for the second time and it’s sad the level of ignorance and superstition that exists around computers… and SQL especially.  The entire industry treats computers like big electronic pieces of paper.  They print things they can easily email, they manually enter in things they could easily write a form for, and they perform repetitive manual tasks they could easily script.  It’s pathetic how far behind the industry as a whole is and the people who work in it are so close-minded I don’t see how they ever get anything done.

Part of the problem is the doctors.  Doctors think that because they’re doctors that they know everything.  Several times I’ve had one doctor or another tell me specifically how they wanted me to do something in SQL.  They didn’t know the first thing about it, but they heard a few terms here and there so they decided to run the show.  And here they are in meetings insisting that I follow their HA architecture that was just ridiculous.  I got a reputation in my company for being difficult to work with because I always called them on it and told them to let me do my job.  Then they would complain and my boss would be at my desk the next day.  It’s just incredible ego to think that you’re an expert in all fields because you’re an expert in your own.05

However, doctors aren’t the only problem.  Vendors are also a huge problem because they’re very slow to adapt to new technologies.  And by slow, I mean 15-20 years too slow.  We’ve had so many vendors who only code against SQL2K.  Their support personnel are pathetic to say the least as well.  These vendors know nothing.  And they’re guiding hospitals in their implementations.  And of course now you’ve got the blind leading the blind because while there’s nobody at the vendor who knows what he’s talking about, there certainly is not anyone at the hospitals to call them on it.  And when they do get someone in there who knows what they’re talking about they can’t keep them because what really good IT person wants to work with an entire floor of people who don’t know the first thing about IT?

The biggest issue we had with staffing was that everyone who does the hiring thinks that you have to have hospital experience to be able to work in IT at a hospital.  So they end up hiring ex nurses or other clinical people and give them jobs as programmers, system admins, etc.  These people don’t know the first thing about being in IT or about C# yet they’re given positions based off of their hospital tenure.  So someone who wanted a career change could come in as a Sr. Programmer yet they have never even had a simple online coding course.  So now they’re in there trying to figure this stuff out.  They’re architecting solutions that they could barely qualify as end users for.  And anyone in IT who knows what they’re doing has to put up with this idiocy.  And make no mistake… it is idiocy.

The industry itself has too many older managers in it and they need to bring in some fresh blood that actually knows something about IT and how to actually get things done.  As it stands they’re just too scared of the change, too scared of the data, too scared of being sued, too scared of pissing off the doctors, and too scared of technology in general.  Oh sure, they’ll bring in iPads for the doctors to carry around, but big deal.  They’re not doing anything cool with them, and everything they put out there costs tons of money in support because they were not put together correctly.  Want a perfect example of how far behind they are?  Whenever you go to a new doctor you still have to fill out all that damn paperwork by hand don’t you?  You have to put your name, address, SSN, DOB, etc. on like 9 forms.  Doesn’t that sound like something they should be able to get past by now?  And there’s more to that specific story than just being afraid of computers.  That particular one is caused by the system itself.  I won’t go into specifics though.  I have also seen plenty of people print online forms, fill them out, and then scan them back in and store that into the DB in a text column.  Seriously dudes?

So what can they do to change?  How can healthcare move into the 80′s?  For starters they can hire some younger more hip managers who understand how IT works and the benefits it brings, and give them the power to do what they need to do.  Next they can stop hiring from hospitals, C# coders, or SQL guys don’t have to know crap about your business.  They have to know their business, which is IT.  And they’ll have to pony-up the money for some real IT folks.  IT folks aren’t going to work for peanuts… not when they can go somewhere else and get $20 to $30K more.  Oh yeah, and you’re also going to have to start treating them like they’re professionals.  IT guys don’t want to hear how much the doctors know about IT.  They want you to let them do their jobs.  So seriously, stop treating them like they’re nothing compared to the doctors.  Doctors are essential to hospitals, but your IT staff is too.  It’s getting so that hospitals are crippled without IT.  So why do you still insist that all IT guys are the same?  Hell, even all janitors are not the same.  I can easily tell the difference between one who cares about what he does and one who doesn’t.

Here’s a scoop for you.  Healthcare is going to need to get their act together or else.  The government is mandating that everyone have their health records in a meaningful use format by 2015 so the time of getting by on the idiots you’ve got is over.  You’re going to have to get some real talent and do what it takes to keep them.  If that means paying them a good salary, and listening to them, then all I can say is ‘you poor baby’.  Hospitals jump through hoops all the time to attract some new doctor because of what he brings to the network.  If anyone in healthcare is reading this then you’d better start planning now.  Start gathering some talented IT guys and let them do their jobs.  And NO, before you ask, you don’t know what IT talent looks like.  Get someone to help you find that talent.  And I’m not talking about recruiters either.  Go to the Microsoft MVP site and Google someone in the field you’re looking for and start emailing them.  Ask them to help you interview a few guys.  I’m sure they’ll charge you a little, but it’ll be more than worth it.  Then once you get these guys on staff don’t treat them like second-class citizens to the doctors.  You’ve got no choice anymore.  You have to do something.  You can’t keep this up.

My guess is that it’ll probably take about another decade before this starts really turning around though.

Sean McCown is the contributing editor at InfoWorld and the sole database expert for InfoWorld Magazine. Sean blogs about SQL server and other tech topics where this was first posted.

(Image courtesy of iStockphoto)

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  • http://twitter.com/bart/status/308941151648485376/ Bart Collet (@bart)

    How can healthcare move into the 80′s? http://t.co/uzv0C5UiE5

  • Barry

    He’s 1000% correct. Between the omniscience factor, the government ineptitude, and vendor reliance on automating paper, HIT is still too immature for patients to be getting their money’s worth. Oh, and the patients, who foot the bill ultimately, aren’t even considered in the designs. Other obstacles to throw into the mix, HIPAA, which is a scandalous waste of bureaucracy created with noble intentions (aren’t they all) and oblivious to the unintended consequences and the unforeseen issues. I wouldn’t give up though, voices such as ours are needed to call the get rich quick guys and save the patients.

  • WilliamK

    I would add one thing. MIcrosoft is not the answer either. Windows is so 1980 it is pathetic.

  • http://twitter.com/infotechmike/status/308961013032685568/ Michael Stanton (@infotechmike)

    Healthcare is NOT Ready for Innovation: Sean McCown, contributing editor for InfoWorld describes why healthcar… http://t.co/90erRgEEnB

  • http://twitter.com/healthstartup/status/309001664722001922/ @healthstartup

    How can healthcare move into the 80′s? #innovation http://t.co/MGpxBWWJ0g

  • http://twitter.com/NurtureAsks/status/309037894503387136/ @NurtureAsks

    Counterpoint: Healthcare is NOT Ready for Innovation http://t.co/a2jaBWhhi9 @hitconsultant @MidnightDBA Is #healthIT in trouble?

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    You are the arrogant one. SQL to get data out of an EMR? Trouble getting data into an EMR? Doctors don’t know Scheiße from Shinola? Blaming the individual practices for lack of an HIE? Stuck on SQL Server when that is a lousy database compared to Intersystems’ Cache – know what I’m talking about hot shot? Know what HealthShare is? Know what a network database is? Know how to store and retrieve hierarchical data? Know what a concept parser is? Know what a clinical note is and how to use Dragon Naturally Speaking to enter a note with the help of voice macros and a 22 dollar Radio Shack microphone with 99.9% accuracy? Know the difference between menu & template driven drivel and concept driven expedited workflow? Know what a concept processor is? Know what form filled hypertext is? Know how to graph in a browser the relationship between clinical issues and pertinent RDF stores? Know the pertinent RDF stores for health care providers wanting to practice evidence-based medicine?

    You are out of health care IT. Good riddance because you don’t know HIT from SHI_!

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Know how to handle multi-valued variables concurrent to the visit? Ever program a drug – disease interaction program so that when a physician orders a new medication (e.g., for a tremor) that clashes with the patient’s past medical history (e.g., history of melanoma) the doctor gets a warning on attempted order entry that there might be a significant drug – disease interaction? What language would you choose in your infinite wisdom to program that list – list interaction so that it is so robust it could be used for clinical reminder feedback right when the physician is attempting the order? Have you ever programmed a host of clinical practice reminders and figured out how to intergrate those CPG’s with multiple sources of data WHILE the patient is being seen? And how would you organize data in an HIE so that it could be used for concurrent monitoring of CPG’s during the visit? Know any HIE’s that greatly facilitate the process of concurrent monitoring and feedback? What is your experience in programming clinical prediction models so that clinical prevention is facilitated? Know how to program branching logic questionnaires so that disease classification can be facilitated by patient – computer interaction? Know any examples of where this has been done so you can recommend it to your physician customers? You are as valuable or even more valuable to the delivery of health care than physicians are you not?

  • http://twitter.com/DruryDHC/status/309285011335544832/ @DruryDHC

    RT @Saif_Abed: Healthcare is NOT Ready for #Innovation – http://t.co/w9cFM77ugV via @hitconsultant #DigitalHealth #HIT Powerful article.

  • http://twitter.com/TimAllenMDJD/status/309292806835429377/ @TimAllenMDJD

    RT @rvaughnmd: innovation in health care? “It’s pathetic how far behind the [health care] industry as a whole is” HT @Saif_Abed http://t.co/aRlP3iPYjw

  • http://twitter.com/LjkMModal/status/309308650084777984/ @LjkMModal

    wow. Harsh..but maybe some truth to it. RT @sarah_mmodal: #Healthcare is NOT Ready for #Innovation http://t.co/7PWmelUOAg #HIT #HealthIT

  • Observer

    Charles, your attitude is exactly what is wrong with HIT. The fact that you don’t think there are some major systemic problems in HIT shows that you are part of the problem and are highly resistant to anyone from the outside coming in with any criticism and call for change.

    Anyone can go off on a tirade of things like you did, but it just makes you look like a 4 year old.

    The fact of the matter is that HIT is broken and most everyone involved is highly resistant to change. It isn’t just HIT though, its healthcare in general. I don’t think you’ll ever be able to see these problems though because you’re a part of the broken system and that’s why its necessary to get people in with new perspectives.

    “Death Is Very Likely The Best Single Invention Of Life. It Is Life’s Change Agent.” – Steve Jobs

    How true in this case, I think we’ll only see real change once the existing old guard of healthcare either retires or dies.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Observer, you are not a very astute observer. I wish you the best and hope that you do not die too soon.
    My maxim is: “I never interacted with a patient from whom I did not learn a lot.” I hope to be doing so as a primary care general internist for the next ~20 years, having proudly done so for our veterans for about 30 years..
    “What this patient needs is a doctor” – Eugene Stead MD
    I agree with you: what this country does not need is 99.0% of its current HIT folks.
    Charles Beauchamp MD, PhD
    primary care general internist in solo practice delivering high-quality, evidence-based, physician-customizable, cost-effective primary care to people in some of the poorest counties in North Carolina.
    And, I have interacted with a fair number of HIT people in the VA and have learned a lot from them. They truely do not make HIT folks like those who were in the “underground railroad” of the VA.
    They pioneered or help to foster much of the “innovations” to which I referred.
    “There is nothing new under the sun.” You just have to be able to observe the light that is there and not curse the darkness.

  • Thomas Lukasik

    @Sean

    I’m not sure that your attitude towards a doctor (who’s not a DBA) wanting to be involved in their IT decisions is any more defensible than that of a doctor who resents a patient (who’s not an MD) wanting to be involved in their healthcare decisions.

    TJL

  • http://twitter.com/MidnightDBA Jen & Sean McCown

    Charles,

    I wrote the article you’re commenting on. I’m not really sure what the point of your rant was though. PIcking a bunch of random technologies and thumping your chest like I’m supposed to know everything in IT. I’m a DBA. I’m a good DBA. And I manage huge enterprises worth of data on different platforms. And picking me to be the author of some of those solutions is just as dangerous and stupid as it is to let the doctors do it, or to insist that I have to have some serious medical training to make it happen correctly. Medical training isn’t the same as IT training and despite having industry knowledge, that’s what BAs are for. A good BA should be able to bridge that gap between IT and doctors. But having medical personnel write code or architect enterprise solutions just because they have industry knowledge is just asking for trouble and it’s why technology is so far behind in healthcare. You can make examples of the 1in 10,000 doctors who are also very studied in IT, but any intelligent argument knows not to include those supermen.

    Healthcare is in trouble IT-wise. They’ve refused to change their thinking to stay up with the times and they’re suffering for it. I don’t know much about healthcare because I don’t need to. I’ve worked in healthcare for years and I’ve seen and dealt with the results of these horrible decisions. I’ve worked with the vendors, I’ve talked with the doctors, and I’ve sat with “Sr. Developers” who didn’t even know the basics of their language, but they were nurses for 5yrs so hey, they’ll make great programmers.

    And how much you get out of interaction with your patients means absolutely nothing in this debate. I’m sure each one of them takes you to a place you’ve never been, but if you may recall, that was never even mentioned that in the article so it has no place in your reply. I’m sure healthcare is very rewarding for you. And I’m happy for you. But your happiness with your profession isn’t in question.

  • http://www.hitconsultant.net/ Fred Pennic

    Great points Sean.

  • Jan Oosterman

    Sean McCown´s observations are
    correct. The profession is afraid to loose control over their personal domains
    and income. My experience, however on the sales side in ophthalmology sw, match
    the observations of Sean. Doctors are here to help patients, that is what they
    have chosen to do and what their training is for. IT is a service to collect,
    interpret, manage and move data secure and very quickly. IT not only helps in getting
    the right images of the sick and wounded patients or a good insight in costing,
    it is of a much more interesting dimension when in addition to all that it is
    also assisting medical staff in diagnosis and treatment fulfillment. Doctors
    could do miracles if they would embrace IT as a friend, rather than an enemy,
    an extension of the tax office and/or bean counters. IT is, next to technology
    and engineering, prime in helping to put equipment and people on the moon or
    mars and … back! My advice, doctors should start trusting and better ..
    testing the stuff, it is really great, also in scheduling!

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    I did not pick a bunch of “random technologies” – the fact that you do not recognize these technologies and how they go together to facilitate the use of HIT by clinicians shows your gross ignorance of what HIT technologies are worthwhile.
    And my “rant” succeeded your RANT.
    My happiness in my profession is directly related to HIT when HIT interferes with my interaction with patients.
    Sean, bottome line is that they do not make “HIT DBA’s” like they use to in the “underground railroad” of the VA in the 1980′s. Almost all the technologies that I cited stem directly from the HIT technologies created by the “underground railroad” folks. Again, the fact that you cannot recognize these technologies as integrated, you can cite no HIT innovations of your own and you rant against healthcare folks who are striving to further these technologies points out that you are suffering with an HIT thought disorder and do not qualify to write a rant on this website.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Sean since you spent years in healthcare as a DBA you undoubtedly are aware of the existence of FileMan – created by the “underground railroad folks” and HealthShare – created from FileMan / Cache as a commercially viable spinoff.
    Here is a true and sad story about how lack of knowledge about HealthShare (and the other innovations) causes loss of money, loss of good patient care oppotunities and loss of money:
    In 2009 the State of North Carolina let a contract with CSC to build an analytic database for Medicaid administration in North Carolina. It turns out that the lobbyist for CSC was appointed as the director of HHS by Gov Bev Purdue at the same time the contract was let. Originally the contract was to be 55 million dollars a year (258 million dollars total cost) to integrate the data on 900,000 Medicaid patients for the purpose of Medicaid reimbursement analysis and NC clinician feedback of the data collected on Medicaid patients. Now the contract has been upped to ~500 millions dollars total cost AND still is not ready for implementation. These money expenditures have contributed to NC being 1.4 billion dollars in arears in its federal debt for Medicaid.
    Before 2009 the country of Sweden paid 20 million dollars to Intersystems Inc to integrate all of its healthcare data on all of its citizens – 9,000,000 people about the same as the population of all of NC.
    The state of NC just rejected the Medicaid expansion allowed by the ACA because of the “inefficiency” of the Medicaid program in NC
    In 2009, I asked Brian Lord (a super DBA derivative of the “underground railroad” , one of the gurus of the WorldVista program and originator of a WorldVista support open source derivative of VA’s VisTa) what the cost of implementing WorldVista + HealthShare technologies (WorldVista = EHR & HealthShare = HIE) in North Carolina. He is in Durham NC, knows the North Carolina clinical site EMR/EHR situation wel AND he did own a company that installed Medscape like VisTa derivatives into large and small practices. He estimated that it would cost 145 million dollars to implement BOTH WorldVista AND interface it with HealthShare-NC in ALL 10,000 clinical sites in North Carolina including hospitals as large as Duke U Medical Center.
    About 15 years ago the Durham VAMC HIT leaders went to Duke U. and offered to intall VisTa into Duke U. Hospital AND train ALL of its personnel in its use. The VA DBA at that time Connie Raber was in very close touch with the “underground railroad” of the VA. He had the expertise to do what the Durham VA promised. The Dean of the School of Medicine at Duke at that time, Sandy Williams MD on the advice of the Duke DBA rejected the VA’s offer and said that: “Anything that costs 250 dollars cannot be worth it.” For five of the subsequent six years Duke changed its Pharmacy module because it did not integrate with the rest of its health care data at the cost of 10′s of millions of dollars. Subequently, the Durham VA HIT folks met up with the Duke U. DBA folks at a national HIT meeting. When asked if they were willing to accept the VAMC’s offer the Duke U DBA folks said: “We have the money and we are going to spend it for our own solution.” Now years later and ~500 million dollar wasted effort to install Duke’s “own solution”, Duke is engaged in installing EPIC at a cost of 100′s of millions of dollars.
    The above is one example of the tower of babel that is USA HIT that causes enormous waste, fraud and abuse of the use of health care dollars.
    All because of gross negligence and ignorance on the part of HIT DBA’s such as yourself.
    Ever wonder why the cost of health care per patient way outpaces the cost of inflation?
    One answer (there are other partial answers): the HIT thought disorder of HIT “professionals” in the USA as exhibited par excellance in your RANT and most of the other articles on this web site.

  • Curatio Technologies

    Sean Mc Cown I am writing this comment after having read this article. I am a doctor by profession and my son Varun Jain who is the CEO of Curatio Technologies is an IT professional. While working for http://curatio.in I have similar kind of conflicts which you have with medical professionals.

    My son has a feeling that since he is an IT professional so he should be calling the shots. On the contrary my view is that an IT professional is no more than a mimicry artist whose principal task is to mimic natural course of events in IT domain to extend reach and improve efficiency which is unattainable by man made systems without IT. Since a doctor shall always have a better understanding of natural course of events, so he will decide what is to be done and an IT professional will decide how the same is to be done and will actually implement it in a user friendly manner and to the satisfaction of various stake holders. An IT professional is not supposed to be teaching doctors the way they are supposed to be practicing their science and art. Neither an IT professional is supposed to resent doctors’ ignorance about IT. I admit that information technology can greatly benefit healthcare but only if correctly applied and for this medical schools are probably a better place to initiate the change so that young doctors are culturally comfortable with information technology and its ways.

    So we father and son have our own share of conflicts and contradictions, and are able to keep the relationship going.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Here is a suggestion for remedial DBA training for you.

    Contact Intersystems Inc and ask for training on the administration of HealthShare. It has API’s for many more languages than MUMPS.

    Contact Franz Lisp and ask for training in setting up Allegro STORE and the Gruff Browser.

    Combine HealthShare with a customized Allegro Store, Graph database and the Gruff Browser and you will be an HIT Hero who will deserve an prize for HIT innovation.

    If you have fears about learning Lisp programming look at the Beowolf site for a Lisp program generator that will assist you in learning Lisp programming – http://www.beowolftech.com/lispgen/ It will teach you AutoLisp of AutoCAD fame and hopefully the company will come out with a Lisp program generator that will allow you to learn how to control HealthShare and Allegro STORE like a champion.
    But, my guess the above is below or above your cognitive radar.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    You could be a “clinical DBA” who has an understanding of where data are in the clinical database of the EHR how those data can be combined with data from a state-wide HIE that is as robust and “concurrent” as HealthShare from Intersystems, along with the data collected during the patient-physician and patient-nurse encounters can be combined, parsed, fed into differential diagnosis, treatment clinical decision support, intervention ordering, referral making and database publishing software for the purpose of dx, rx, cds, OERR, referral, after visit summary (in part via optimization of smart database publishing) with patient education, instructions and self-care advice.
    Just remember Sean:
    The physician prescribes smart solutions when the clinical DBA assists the physician (in general) to subscribe to the right data at the right time.
    Believe it or not, Sean if you want to know how to do this you have to know how data relate to clinical concepts and how those concepts can be processed with the help of the clinical DBA to further the goals of high quality, safe, evidence-based, cost-effective care.
    Sean you are more than the keeper of the data you are also the one who assures that all the data that are pertinent to the care of the patient are available WHILE the patient is being seen and WHILE the physician is completing her clinical note and entry of orders into the computer.
    Two other aspects of the job of a “clinical DBA” are very important:
    1) Know the psychology of your customers
    2) Have a sense of humor and don’t take yourself too seriously or make fun of your customers without making like fun of yourself also
    The later two points were made to me by the “keeper of the bullets” (Japanese title) – Captain in charge of Phillipines munitions (US title) when the Japanese invaded and occupied the Phillipines during WWII. I asked him how did he survive the Batan death march, torture to sign a statement that the US had munitions in the Phillipines that exceeded International treaties therby justifying the Japanese invasion, having to disassemble US cannons, and send them back to Japan (when he spiked um so that when they fired they exploded), smuggling handguns into prison camp so fellow POW’s could have them to escape AND fooling his captors into letting him stay in the Phillipines rather than get on the last POW transport ship back to Japan before the American military returned where that ship had a 20% survival rate of US POW’s by the time it arrived back in Japan.
    His answer:
    1) I knew the psychology of my captors
    2) I kept a sense of humor.
    AND at the age of 96 he said: “Doc I don’t need them anymore – referring to his Levitra prescription. I can do it without them”, with a twinkle in his eye.

  • Marie Haggberg

    I’m disappointed that an otherwise good article was marred by ageist comments to hire “younger more hip managers” since “(t)he industry itself has too many older managers in it and they need to bring in some fresh blood that actually knows something about IT”. Knowledge of current trends and older age are not mutually exclusive, nor does relative youth bestow a magical ability to choose the best mix of IT services in a healthcare environment.

    I’ve read many of your posts via Midnight DBA and very much respect your technical knowledge and service to the SQL community. Help maintain my high opinion of your work by canning the stereotypes.

  • http://twitter.com/MidnightDBA Jen & Sean McCown

    Curatio Technologies– I feel your pain and I understand. However, realize this. Nobody in IT is beating down your door and making you hire us. You must feel we bring something to the table otherwise you wouldn’t spend so much time and effort on us and our servers.
    IT can’t solve every problem, and I’ve never heard anyone say they wanted to replace a doctor with IT. Humans will always be better at some things than computers. That said though, give us some credit for doing what we do well. We can retrieve records faster than a nurse, we can store, change, move, arrange, aggregate, etc all faster than any human. Our processes, typically even when they’re not optimized, can work faster than a human.
    And there have been some amazing discoveries made by mining data. These are things that mere doctors could never do on their own because the human effort is just too great. So don’t spend too much time harping on the shortcomings of IT in your field. We do what we can do and we tend to know our limitations. Well, I do, I suppose I can’t speak for everyone you’ve worked with.
    And that’s part of the problem isn’t it? Healthcare is so poor at IT they don’t even know how to hire competent IT. And if they happen to find someone really good it’s either by luck or by a manager who came from outside of healthcare how knows how to hire smart IT. Hell, I’ve seen healthcare managers trip over themselves to hire a C# programmer they thought was really good. And the only questions they asked him were about how to do basic things in excel. It’s all the manager knew so if someone came in and knew those basics he was considered a great IT find. When I tried to stop the hire I was told to mind my own business. And sure enough the C# guy came in and barely knew the 1st thing about .net. We would have been better off not hiring for the position at all.
    So the good ones know their limitations and try to make the doctors’ job easier. Technology should be in the background. You should use it without even really realizing it. But the way healthcare does it, it’s in your face constantly because it’s always breaking or just not working right to begin with.
    I really do feel your pain.

  • http://twitter.com/MidnightDBA Jen & Sean McCown

    Hey Thomas…
    I really have nothing against a doctor wanting to be involved in his DB decisions. What I have an issue with is doctors who know very little about it and still insist on IT doing exactly what they’re told. As a doctor, let’s say you don’t know as much about HA/DR as I do since it’s my business. And when I make a recommendation and you tell me no that I’m going to use this other technology because you say so, then that’s when we’re going to have a problem. You may suggest and we can discuss it, but don’t tell me my business.
    A patient who comes in can give his opinion about his condition, but when he insists that the doctor do something stupid because he thinks that reading an article on a website makes him an expert, then that’s when the doctor will get upset. It’s not the mere matter of having made the suggestion, it’s forcing the will of an amateur onto a professional.
    I’ll discuss the options and even explain them in as much depth as you like, but in the end it’s my decision what we do. And as a doctor why do you even care? You should only be concerned with the results.

  • http://twitter.com/MidnightDBA Jen & Sean McCown

    As much as I would love to debate the finer points of your comments with you, you’re just hostile and there’s really no point. I’m glad you took the time to read the article and I’m even more glad you guys are out here discussing it. If my post serves no other purpose than to get the industry started in discussion then I’m happy.

  • http://twitter.com/MidnightDBA Jen & Sean McCown

    Marie, see my reply to Curatio Technologies above. I address them there.
    thanks.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    And YOU were not “hostile” in your article?

    And YOU do not want to “debate the fine points” because “there is no point”. Wow!

    YOU, in my opinion, did “contribute to the debate” by having some define what a “DBA” in HIT should be responsible for knowing and doing.

    Thank you for that.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    “mere doctors” – ? – what an attitude YOU have Sean.

    It is very true that doctors can overlook essential details of patient care but that can be corrected by concurrency of being reminded, not data mining.

    Both your writing and thinking need some serious work.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Sean your SQL skills are nearly vacuous in HIT compared to those of the NoSQL developers using SPARQL, if you know what I mean?

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Tell us Sean, what great truisms have be revealed by “data mining”?

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Sean you are the personification of the truism that “knowing about IT” does not mean you know about HIT.

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    Sean, you might want to look at the following peer-reviewed articles for your education about becoming a “better DBA” even if you do not care to venture into HIT again except to hurl verbal bombs:

    Improving residents’ compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders.

    Demakis JG, Beauchamp C, Cull WL, Denwood R, Eisen SA, Lofgren R, Nichol K, Woolliscroft J, Henderson WG.

    JAMA. 2000 Sep 20;284(11):1411-6.

    PMID: 10989404

    The above feedback-focused RCT is related to the following:

    A managed care workstation for support of ambulatory care in Veterans Health Administration medical centers.

    Levy C, Beauchamp C, Hammond JE.

    J Med Syst. 1995 Oct;19(5):387-96.

    PMID: 8613713

    A clinical database management system for improved integration of the Veterans Affairs Hospital Information System.

    Andrews RD, Beauchamp C.

    J Med Syst. 1989 Dec;13(6):309-20.

    PMID: 2636966

  • http://www.hitconsultant.net/ Fred Pennic

    Charles, I understand you are extremely passionate about your views on this topic as most of us in healthcare, but you cannot beat up the author about your viewpoints.

    I also understand that Sean was extremely passionate in his thoughts in the article; however, there is a better way to have an engaging discussion about this without having an “e-shouting match”

  • http://www.facebook.com/charles.beauchamp.52 Charles Beauchamp

    What goes around comes around Fred. I am a “mere doctor” “beating him up” in his own territory. How much damage can I do? He shouted first and I believe the “shouts” in return are important for all HIT-wanabees to hear.

  • http://www.hitconsultant.net/ Fred Pennic

    Touche Charles.

  • David Fulton, MS, PMP

    What I see in Sean’s article and the resulting comments is a disconnect between technology and clinical expertise. One common thread is that everyone seems to feel that their unique perspective is not understood. This kind of discord is not uncommon in many industries when essential communication and project leadership is lacking. Having built businesses, departments and markets, I speak from experience when I say that innovation is rarely easy or pretty. Ideas are nice, but making them work is where the rubber hits the road.

    Having recently earned my Master’s in Health IT and entered this field as a “new professional” I perhaps view the challenge of HIT adoption in a different light. What I’ve observed is that the mindset seems to be that Technology is the panacea that will provide the healthcare reform solution. The reality is that technology will constantly change. When you put your money on technology, you’ll loose. Technology is a tool. Some technology is more stable i.e. the wheel while other tech is less so… anyone still use a VHS recorder? The talent to use the technology to MEET NEEDS is the most critical factor. Todays issues will be replaced by tomorrows. Similarly medical knowledge will also change… is the use of leeches on or off this month? Are eggs good or bad now?

    What remains constant? R&B artist Aretha Franklin gave us the answer in 1967 with the song, R.E.S.P.E.C.T. No, I’m not suggesting that we all go out and start hugging trees. Project Management Institute considers communication to be 90% of what a project manager does. I have had the pleasure of directing the work of some extremely talented people in several industries. Each one was a true artist whether in technology or subject matter. Problems arose, but as long as I could respectfully clarify and communicate, projects stayed on track because everyone was pulling together to make it happen. What I find frightening is the lack of attention given to the communication function. Countless peer reviewed articles cite failures due to poor assessment of user-need and lack of adoption due to user dissatisfaction. This is not a technology failure, but rather change management problems directly tied to poor needs assessment and communication.

    The next several years in healthcare are going to be fraught with confusion as workflows are altered, processes are replaced and technology is applied. Expecting stressed healthcare professionals to find time to understand technology is unrealistic. They need to focus on their core competency, treatment and prevention. They are already overwhelmed with information overload. Technology must be seamless in it’s application so as to not increase distraction and error. It only takes 3 seconds of distraction to make someone lose their train of thought. The interface function is of staggering importance.

    Similarly technology experts should not be required to learn medicine or read minds. This gets back to RESPECT. It takes years to master various aspects of technology as it does to master medical knowledge. Leaving egos at the door and coming together as partners for change will do a great deal to make the inevitable transition far less painful and save more lives. I don’t want an engineer or programmer doing my surgery and I don’t want a physician safeguarding my network. The third and perhaps fourth piece to bind with technology and clinical expertise is the communication and project management professionals who are essential to bridge the disciplines and respectfully clarify needs, requirements and limits. These professionals can focus on making certain that all parties involved are able to make informed, respectful decisions based on their knowledge-base. This allows the IT and the Clinical to not suddenly be required to also develop new skills in project management, human behavior, marketing, communication, etc. Then and only then can everyone effectively pull together for the best possible outcomes.

    To conclude, I think it is not necessary or realistic for health care professionals to become technology experts. They shouldn’t be expected to do so. I don’t use my car with the expectation that I can run diagnostics on it. All I want is for it to start, drive and stop. Physicians want technology to help them to be most effective in their practice. Similarly most mechanics don’t have the driving skills necessary to win Nascar. However, try winning a race with a poorly designed car or one that you don’t know how to operate. It takes the users and the developers working with project development experts to reduce the tension and make sure that outcomes meet expectations. I’ve been amazed by and considered it an honor to guide incredibly talented individuals to achieve outcomes that I and they are proud to own. The talent to respectfully bridge technology expertise with clinical knowledge and requirements will be an essential piece to advance HIT development and adoption to achieve the ultimate goal of health reform.

  • http://www.hitconsultant.net/ Fred Pennic

    Great thoughts David and I agree with your concluding thoughts on how it is not realistic for healthcare professional to become technology experts. Thanks again for posting.

  • howie

    retro SQL server? huh? maybe HIT should start to hire NoSQL pros!

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  • http://www.linkedin.com/in/leecashpmp Lee Cash

    Yep, been there, suffered from that. One word, ego. The arrogant
    CDC psychiatrist I was working with did not know crap about IT, yet
    cost me my contract. I thought psychiatrists listened; she must have
    been delusional.

  • Jim Reimer

    I find it interesting that in the vast volumes of articles written about the shortage of Health IT professionals they get close to the real issues but from my perspective, never really attack them head on. While I think this commentary is a bit skewed by emotion there lies in it some basic truths about Health IT and the self imposed “shortage”.

    First, they never seem to take the basic personality of an IT professional in mind. In my experience they tend to see things in black and white but not in a limited way. There are infinite combinations of black and white to choose from. They are problem solvers in a “check in the box” world of healthcare compliance. To truly get the best from your IT staff let them solve real problems and the checks will automatically fall into the boxes. I agree with most of the literature that promotes non-healthcare IT professionals for work in healthcare but as a Clinical Requirements Analyst in R&D I can say from first-and experience it is critical that they have availability to experienced clinical analysts and informaticists to keep their work relevant to the tasks at hand. I would also hope that the Clinical IT staff not fall in the typical Health care “Check-in-the-box” mentality that regulated industries are so well known for and understand they have a very specific skill set different from the IT folks. Leverage the strengths of each team member!

    Second: Hospitals continue to seek staff familiar with their particular HIS when reports say that most organizations are seriously considering changing their vendor. Does this make sense? Hire someone who knows the system you are going to replace? I suggest going for core knowledge and skills. Someone who can adapt no matter which way the wind blows. Who knows? Life as the “Detroit style Big Boys” of EMR’s may end as more agile and clever systems are replaced by open and nimble start-ups.

    Third: At least for the clinical IT folks, I see a lot of open positions out there, but the pay is often less than they can make as a staff nurse. Sure, they get off those terrible shifts and have the weekends off, but this is a specialty and should have pay commensurate. If you can’t find a local candidate, pay for relocation (keeping my first point in mind). If you already have strong Clinical IT folks consider an internship program. I recall a decade ago creating an internship program for OR Nurses because of the shortage. There’s no difference here. As Clinical IT folks, we need to step up to the plate and develop the folks that have an interest in our specialty. Let’s forget about certification and formal education at least until the crisis is over. We don’t have to be programmers. I’m not saying that certification and education isn’t important. I’m just saying the shortage won’t wait for everyone to get credentialed.

    I could go on forever, but we have a real-world problem that requires practical solutions. As a last thought to ponder: When we were in the race for space against the Soviet Union, we spent millions of dollars to develop a pen that write in zero gravity. The Russians used pencils. Let’s just keep the ultimate goal of improving patient care and health in mind.

  • Muneera

    Spot on, great article. I love your candor.

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  • Stratguy

    I wouldn’t spend a minute more on FileMan / Cache. These are 1970′s technology that should have died a long time ago and would have if HIT wasn’t trying to keep them on life support.

  • Kimberlein

    Love this real talk. It’s time someone admitted that the emperor’s not wearing any clothes. I only work peripherally in health care (as a digital marketer with clients across the health care spectrum, among other industries). My main perspective is that of a patient, and one who spent the last year in countless clinic and hospital settings while enduring a high-risk pregnancy.

    The number of times I had to fill out paper forms supplying the same basic information, despite attending appointments within the same health system and usually with the same provider was shameful. Also shameful is the volume of paper I received in return, in the mail, related to my care. Let’s not even talk about how much I pay for this embarrassing inefficiency. It makes me want to pull my hair out. This is 2014!! Step onto the information superhighway, people. The patient base is only getting younger, which means the expectation for functional IT infrastructure is rising, and fast.

  • Jon Lewis

    Everything in your post is true! I’ve seen it first hand working in the HealthCare IT field for a large provider. Good post!

  • PokeyMeansBusiness

    @Sean – Beautiful article! This seems up my past six years working for a Health IT company.