The Dark Side of Doctoring

Innovation in Health IT happens usually because CMS (Agency that administers Medicare, Medicaid etc) looks at the landscape and comes up with a carrot / stick rewards system to force Hospitals and practices to update their software. They generally do things like:

* Hey you need to store records electronically. If you do this by X, you will get Y$. If not, you will be penalized Z$ every year after X.

* Hey the system you built - It needs to actually be able to talk to other systems. If you do this by X.. you get the point.

* The data you're collecting in your system is stupid. We need X, Y and Z reports to ensure you're actually using the system as we meant for you to use the system. Do this by X.

Several other misc things I noticed:

The industry by itself is extremely complex with business requirements that vary between hospitals, practices, labs and so on. This makes connecting systems together a nightmare. Even when you manage to integrate systems, each hospital and practice has a set of business practices (forms they collect, the way they organize information etc) that make rolling software out very hard. Configurability is king. Making everything configurable and having configuration engineers set things up makes automated testing very hard at a UI level. This leads to some sharp corners and contributes to bugs and general UX clunkiness.

UX design isn't generally valued and suits / "business requirements" / timelines are prioritised over usable, stable, secure software. This is a typical UI: http://uxpajournal.org/wp-content/uploads/2014/07/smelcer3.g...

Standards are out of date and the only thing pushing innovation here is CMS doing its best. The problem with this is that they're a govt agency, so they're generally slow and they're an insurance company, so their primary motivation is to cut cost of care.

Doctors are generally smart, and you can sometimes get good feedback from them, but they're already overworked and can't really vocalize what they find frustrating about software.

I hate to generalize, but in my experience atleast, all other people (middle management, front-desk staff) are useless. By that I mean they just don't understand how software works.

There are some smart CIOs, but they care about their position and the hospital bottom-line, so trying to sell them something that doesn't exactly line up with the CMS carrot / stick model is basically impossible.

The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents.

As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commodities in this complex industry. It’s no longer about the patient. It’s about the business of hospitals."

If doctors were viewed in their industry the way software engineers are viewed in ours -- as specialized skilled labor with extreme leverage and limited time -- then we would have well-supported, well-rested, and well-compensated doctors.

But as it stands, we have overworked and overtired doctors buried under a mountain of clerical work, who need to slot their patient in to 15-minute "encounters" in clinic to keep the profit machine running. Meanwhile, administrators, health insurance executives, and medical equipment CEOs work 9-to-5 and earn millions. It really boggles the mind and infuriates me, as a technologist.

p.s. Don't listen to any of the comment threads here that say long hours are required to reduce patient handoffs. Yes, it's true, patient handoffs cause some danger. But tired doctors make mistakes. Period. And, as this post indicates, a perpetually tired doctor burns out and either quits the profession or (worse) commits suicide, which is the worst possible outcome for the system.