The Healthcare IT Guy

There was an interesting article in the Portland Business Journal a few weeks ago which intimated that as physicians increase their use of e-mail with patients, their incomes may decline:

For physicians’ offices, e-mail between patients and providers may prove a mixed blessing.

Patients who use e-mail to communicate with their medical providers are apt to visit the doctor’s office less and are also less likely to phone the doctor’s office, according to recent data from the Kaiser Permanente Center for Health Research.

Technology usually means higher productivity and less work all around; if you run a business such as a help desk or service center email is great since each call you receive means extra expense. But, if you’re a doctor and you’re getting paid per patient visit it helps to have more patients coming into the office, not fewer.

the Portland Business Journal cites a report by Kaiser Permanente Center for Health Research which indicates that patients who consult with their physicians via e-mail are less likely to visit their physician and less likely to call their doctor’s office. Kaiser reported a decline of almost 10% in office visits for patients who use e-mail (the bad news). The good news is that also report that patients who use email did not call their doctors’ offices as much (as we all know docs don’t get paid for phone calls so a reduction there is a good thing).

Of course patients making fewer doctors visits is great for insurers and employers but for docs who depend on office visits to help maintain their incomes it’s actually a wake up call to make sure they give due consideration to whether or not e-mailing is such a good thing. If they care only about their patients, it’s a great idea; however, if they also care about their income, well, that’s another story.

There’s been plenty of discussion in both literature and general media about how most software projects fail. There are plenty of reasons for failed projects: from inadequate requirements gathering to poor project management to plain incompetence. Some of the problem starts at the C-Suite where projects are actually identified and initiated — for asking to automate (presumably with software) something that maybe has no business being automated.

My simple advice to most CEOs and CIOs about project management starts with a question: can you methodically and manually repeat the thing you are trying to automate? If the answer to that question is “no” then no PMO, no project management technique, not even the smartest most talented people in the world can help automate something that can’t at least be repeated consistenly manually.

This advice of asking a simple question about repeatability might sound so obvious as to not even bother asking it but it becomes perilous not to do so. At the heart of most failed software automation attempts is a failure to understand the workflow and gather the right requirements. That’s pretty easy to figure out. What’s not so easy to figure out is: why is the workflow so hard to gather requirements for? It’s probably because the workflow, while it seems consistent at the high level, isn’t repeatable enough consistently to describe in software. Perhaps parts of it are, but maybe the entire workflow isn’t.

So, as a senior executive that may not be leading the project, but may be green lighting it, what you need to do before making a decision is have your project managers describe that they can clearly repeat (manually and consistently) what they are trying to automate. If not, get the process engineering guys in there to work on the process before the geeks get in there to work on the technology. The rule is simple: if you can’t repeat it manually, don’t bother automating it.

I’ve been researching service continuity for patients in Healthcare organizations recently. I ran across a company, Marathon Technologies, who focuses on fault tolerance in IT infrastructures and I found it interesting that they were targeting tools necessary to provide care for patients. I invited Mr. Joost Verhofstad, Director of Healthcare Solutions at Marathon, to talk a bit about what they do and how they safeguard critical patient information. I requested that he help prescribe preventative high availability solutions to ensure that unplanned system failures never come between patients and their healthcare needs.

What is the single most reason given by Healthcare IT Administrators for improving IT infrastructure? Without question, Patient Care tops every list, followed closely by federal regulations and costs. With the rise in government mandated regulations such as HIPAA, identifying ways to encourage widespread use of electronic data interchange has resulted in a surge of activity within healthcare organizations from hospitals to pharmaceutical organizations looking for ways to streamline processes that improve patient care and reduce risk. In today’s world, it is imperative that no patient ever has to wait to receive care; especially not as a result of paperwork or technology issues.

As Healthcare organizations adopt new technology to improve their efficiency, their dependence on that technology increases exponentially. Today, third party vendors handle physician paging and delivery of alert codes. Government Agencies provide call center and online assistance to potential patients in need of care. Pharmaceutical companies track critical drugs. All of these tasks are handled by an intricately designed IT Infrastructure. However, what happens to all of these critical applications if a failure were to occur? What about the integrity of the caregiver’s data in the event of a disaster?

If the IT Team implemented a high availability solution, then downtime (planned or unplanned) won’t be an issue for the patients who depend on these services. In the event of a disaster, critical patient information, including insurance information, can be accessed from alternative locations. A well planned “high availability” approach can protect critical applications and data from unplanned events ensuring service continuity to patient.

When considering an upgrade to a current healthcare IT infrastructure, many organizations will utilize complicated and complex systems like clusters which require increased staff and enormous cost while increasing failure points. In contrast, there are software solutions currently on the market that provide the highest reliability for Healthcare IT systems and maintain availability with limited administration and installation costs.

With so many different approaches to achieving “availability,” understanding not only what is best for your hospital or organization, but the solutions your partners and vendors utilize will ensure that every patient receives exceptional care when they need it. Integrating “high availability” should be at the top of organization’s list of requirements for “Improving Patient Care”.

A buddy of mine, Bob Burns at 5th Quadrant, sent me a couple of links questioning the clinical effectiveness of EMRs; the links were just adding to several others reports that I’ve seen recently. I’m not sure I agree with all the findings, but the direction in which the winds are blowing is clear: be wary of EMRs that promise better clinical outcomes.

• Electronic Health Record Use and the Quality of Ambulatory Care in the United States (from the Archives of Internal Medicine).
• Electronic Records Fail To Enhance Care, Study Finds (from iHealthBeat).