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Medical programmers are just as bad as the doctors.

Posted Nov 03 2009 10:01pm

GuildMasters_250

Programmers of medical information technologies (IT) seemed to have learned from the Renaissance Guild Masters. In at least one way, they are just as bad as doctors.

For centuries, doctors have been accused of maintaining their power by keeping their arcane knowledge close to the vest and not sharing. To some extent, the charge is true. Even today, many doctors reject online medical information, patient education, and comparison-shopping. They claim that the average person cannot understand the data and that much of it is irrelevant, erroneous or at least ambiguous.

If the average person cannot understand the data, then the data should be organized so that this person can understand it. Doctors should not release erroneous, ambiguous or contradictory data. If the medical profession truly accepts the principle that the patient is responsible for his or her health, then they need to act accordingly.

If patients should make decisions for themselves and be informed shoppers, then the information systems should be geared for their easy use.

Convert Doctor–patient into Programmer–doctor
Take the discussion above, substitute the doctor for the patient, and make the computer programmer the person having the special knowledge. In other words, make the doctor the end-user and the programmer the one who organizes the information. With most medical IT systems, doctors experience the same frustration and user- un friendliness as patients do when they try to get medical data.

Medical IT systems are designed by the holders-of-arcane-knowledge. They like to show off what they and their systems can do. The result is an overload of options and information. The screen on which I am supposed to sign my letters to other doctors has 74 (!) icons or data packets. Medical IT systems are the antithesis of the easy-to-use iPhone.

The systems are all independent, that is, they are not inter-operable. The patient scheduling program does not communicate freely with the scheduling program for the ultrasound lab and neither talks to the X-ray Dept scheduling program. Does the patient become a different person when she or he moves from one Dept to another?

I cannot look at an X-ray done at another hospital. MRI, echo, and angiography use three different programs entirely even though there are many patients on which all three modalities are used.

The systems keep changing and the change is always to greater complexity.

Security comes first and always trumps information sharing. I cannot email letters to referring doctors. I am not supposed to share information or discuss patients over the Internet. (We all do but heaven forbid we get caught.)

Last excuse: the providers do not know what they want or they all want different things. The truth is exactly the reverse. We all know what we all want and need. We all want computer systems that make it easier and safer to care for patients. That’s it.

Medical IT systems, just like all IT systems, should facilitate decision-making, improve efficiency, and make it easy to share information. They do exactly the opposite.

Before we conclude, we need to mention health care costs, since they are everyone’s lips. I bet you did not know that fully functional medical IT system could save over $330 billion during the first ten years and $78 billion per year thereafter. This was shown in a 2005 academic paper (by Walker et al) that made no attempt to quantify the gains in outcomes and satisfaction. Talk about a win-win-win scenario: saving money with better results and more professional satisfaction. It is a shame we do not have this.

  • Medical IT systems could reduce costs and improve efficiency but do the opposite.
  • Medical IT systems could improve medical outcomes but are prevented.
  • Medical IT systems could improve provider satisfaction but do exactly the opposite.
  • Medical IT systems could make patients more informed shoppers but do not.

Medical IT systems fail at all the tasks they could and should be doing.

System MD

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