July 4, 2011

Implementing Information Technology In Health Care:  Real World Considerations

By  Michael D. Shaw

A few months ago, this column examined the big push to computerize health care documents. Given the incredible amount of paperwork generated in this field, and the dire consequences that can arise from the human errors connected with handling paper records, this effort certainly looks right.

What’s more, the Feds are fully behind it, setting aside $19 billion in stimulus cash for health care facilities that can prove that they are a “Meaningful User” of electronic health records. However, there have always been those who doubted the “IT equals the road to perfection” mantra, which started in the 1990s.

In an oft-cited paper from ten years ago entitled “Implementing information systems in health care organizations: myths and challenges,” author Marc Berg makes some interesting points. He observes that even defining whether or not an implementation of health care IT is successful is by no means straightforward. “Success” might mean that the project came in at or below budget, or that it started up on schedule.

Moreover, the supposed benefits of implementation, which were used to sell the program in the first place (such as cost savings), may change quite a bit as it is rolled out. As Berg puts it, “Success…is a dynamic concept, not a static one.”

It is worth noting that nowhere in Berg’s 6600-plus word article did he see fit to mention how health care IT (also called Health Information Technology—abbreviated as HIT) might actually improve patient outcomes. Perhaps, that’s because sometimes HIT can hurt patient outcomes.

The Register, a large online tech publication, based in both London and San Francisco, reported in May, 2005 that “Dirty PCs fuel hospital super bugs.” As the story details:

Scientists in the US have linked the spread of the hospital super bug MRSA to a sharp increase in the use of technology in hospitals. Researchers working in hospitals have found that the deadly bacteria clings to the keys of the computer keyboards used to update patient records and therefore can re-infect the hands of staff even after they had washed their hands.

Computers quickly become magnets for airborne dust and bacteria-harboring dirt, which builds up on their internal cooling fans. The fans represent a further health hazard because of their potential to blow that same dust around a ward.

Commentators with both an IT and medical background, such as Scot M. Silverstein of Drexel University, wryly note—in response to typical news stories describing (and probably whitewashing) HIT failures—that “Health care IT outages never, but never, adversely affect patients in any manner whatsoever.” For me, this is way too similar to the standard nonsense put forth by law enforcement whereby no suspicious activity they ever encounter is related to terrorism.

Silverstein and his colleagues speak of turf battles between medical personnel and hospital IT departments, with the hospital administrators and medical directors frequently siding with IT, despite rather obvious detriment to patient outcomes. They identify six key areas of concern:

1.    Resistance of some clinicians to rigorous information practices that support quality and safety (which is inclusive of, but not exclusive to, IT resistance).

2.    Resistance of the clinical IT vendors to high-quality user-centered design practices.

3.    Resistance of IT personnel within delivery organizations to user-centered design practices i.e., in customizations of vendor-acquired products, or internal development of specialized systems.

4.    A belief in IT solutions by many stakeholders as a “magic bullet” or panacea – i.e., build an IT system and miracles in clinical quality, operational, compliance, and documentation improvements will occur.

5.    Financial disincentives for many providers, especially community based clinicians, to adopt clinical IT.

6.    Knowledge that existing systemic organizational faults do contribute to errors in health care delivery.

Fortunately, HIT implementation at the level of the doctor’s office is not fraught with as many difficulties. Still, it pays to find the best consulting company for the job, ideally one that has plenty of experience in HIT. One such company is UIS Technology Partners, headquartered in the San Francisco Bay Area.

I spoke with UIS’ CEO Paul Dorian. I asked Dorian if we will achieve President Obama’s goal of full digital health records by 2014. He—along with many other authorities—doesn’t think we’ll make it. He recommends cloud-based applications, and suggests that competitors who argue against them are doing so simply because they think that it will cut into their business.

Dorian touts the fact that all of his staff is based in the US, which he says improves quality and eliminates any language barriers. Besides, the cost savings are often erased when poor support is factored in. Dorian’s attitude is quite refreshing:

Many times an IT person thinks that their job is limited to implementing the technology, but that’s not the case. Their job—really—is to improve the end user’s experience, improve their processes, and help them reach their goals. Fear is a big impediment to that, so a lot of our job is counseling, and reassuring the client that everything is going to be OK.

If we call their goals “outcomes,” then it all comes full circle:  Everything in health care should be focused on improving outcomes.