theo|digital

Here’s the thing. I’m still the same political nerd I’ve always been, and while others are updating their brackets (poor Kansas) between commercial breaks, I’ve got my TV tuned to exciting late-night coverage by: C-SPAN. What could be more exciting than political 3-pointers (“kill this bill!”) tossed in buzzer-beating fashion (“The gentleman’s time is expired!”)?

So, it’s Sunday Night Congress for me… in another sports season it would probably include a theme song by a blonde country diva and maybe some rotating 3-dimensional logos.

And without getting into the real politics of the thing (full disclosure: I tentatively support the majority, especially disbelieving that we are somehow snapping the constitution in half with Marxist hands… but still concerned that the total bill as presented is marred by the process so much that it isn’t close to a great solution)… I have another more basic question.

Where is the part of health care reform bill that promotes and enforces digital health care information?

This was one of my favorite parts of Obama talking about reform as a candidate. He identified the problem with the antiquated information systems used by hospitals, and the lack of a common standard that allowed your medical record to be instantly and seamlessly accessible to any health care organization in the country.

The Recovery Act included money for this, but (and here I’m speaking from memory), not necessarily centralized standards and not tons of regulation.  Honestly, the best solution would be to create a robust central standard equivalent to IEEE anything… and then let private companies hack at that to create software packages that are usable, robust, and can interact with the standard.  This article, however, argues that more stringent oversight is needed because of potential safety issues in data management (“whoops, didn’t know she was taking THAT drug!  Did it just not show up on my screen?”).  Still, I’m a little more economically conservative on this one, thinking that competition between software houses is the best way to go:  you’ll get faster implementation of new features.

The single standard is important, because even if forward thinking doctors offices adopt new technologies now, if they can’t share with the hospital down the street, we’re giving up most of the benefit:  like the Personal Computer vs. the Internet.

But the key barriers are probably the practical ones.  When I did IT consulting for a large health system in Illinois, I discovered exactly what this article points out.

1. Doctors, especially older ones, can be surprisingly curmudgeonly about technology.  I realize this is a general overstatement, but even if it’s true for a few key doctors, it screws the whole thing up.  Plus, I’ve sat personally in doctors office trying to teach them how to use Microsoft Exchange… phew.  That’s tough work.
2. Hospital IT departments have the tendency to be staffed by… well, let’s say the system I worked for was mostly flowered-turtle-neck middle-aged women who didn’t know an API from a power supply.  A whole department of them attempting to support 4,000 employees. This is not a sexist thing, though I might be a little bit age-ist.  Seriously.  Hospitals need to hire some nerdy kids straight out of school, and fast.

Okay, rambling point done.