Healthcare isn’t ready

I just left the healthcare industry for the 2nd time and it’s sad the level of ignornace and superstition that exists around computers… and SQL especially.  The entire industry treats computers like big electronic pieces of paper.  They print things they can easily email, they manually enter in things they could easily write a form for, and they perform repetative manual tasks they could easily script.  It’s pathetic how far behind the industry as a whole is and the people who work in it are so close-minded I don’t see how they ever get anything done.

Part of the problem is the doctors.  Doctors think that because they’re doctors that they know everything.  Several times I’ve had one doctor or another tell me specifically how they wanted me to do something in SQL.  They didn’t know the first thing about it, but they heard a few terms here and there so they decided to run the show.  And here they are in meetings insisting that I follow their HA architecture that was just ridiculous.  I got a reputation in my company for being difficult to work with because I always called them on it and told them to let me do my job.  Then they would complain and my boss would be at my desk the next day.  It’s just incredible ego to think that you’re a expert in all fields because you’re an expert in your own.

However, doctors aren’t the only problem.  Vendors are also a huge problem because they’re very slow to adapt to new technologies.  And by slow, I mean 15-20yrs too slow.  We’ve had so many vendors who only code against SQL2K.  Their support personnel is pathetic to say the least as well.  These vendors know nothing.  And they’re guiding hospitals in their implementations.  And of course now you’ve got the blind leading the blind because while there’s nobody at the vendor who knows what he’s talking about, there certainly isn’t anyone at the hospitals to call them on it.  And when they do get someone in there who knows what they’re talking about they can’t keep them because what really good IT person wants to work with an entire floor of people who don’t know the first thing about IT?

The biggest issue we had with staffing was that everyone who does the hiring thinks that you have to have hospital experience to be able to work in IT at a hospital.  So they end up hiring ex nurses, or other clinical people and give them jobs as programmers, system admins, etc.  These people don’t know the first thing about being in IT or about C# yet they’re given positions based off of their hospital tenure.  So someone who wanted a career change could come in as a Sr. Programmer yet they’ve never even had a simple online coding course.  So now they’re in there trying to figure this stuff out.  They’re architecting solutions that they could barely qualify as end users for.  And anyone in IT who knows what they’re doing has to put up with this idiocy.  And make no mistake… it is idiocy.

The industry itself has too many older managers in it and they need to bring in some fresh blood that actually knows something about IT and how to actually get things done.  As it stands they’re just too scared of the change, too scared of the data, too scared of being sued, too scared of pissing off the doctors, and too scared of technology in general.  Oh sure, they’ll bring in iPads for the doctors to carry around, but big deal.  They’re not doing anything cool with them, and everything they put out there costs tons of money in support because they weren’t put together correctly.  Want a perfect example of how far behind they are?  Whenever you go to a new doctor you still have to fill out all that damn paperwork by hand don’t you?  You have to put your name, address, SSN, DOB, etc on like 9 forms.  Doesn’t that sound like something they should be able to get past by now?  And there’s more to that specific story than just being afraid of computers.  That particular one is caused by the system itself.  I won’t go into specifics though.  I’ve also seen plenty of people print online forms, fill them out, and then scan them back in and store that into the DB in a text column.  Seriously dudes?

So what can they do to change?  How can healthcare move into the 80’s?  For starters they can hire some younger more hip managers who understand how IT works and the benefits it brings, and give them the power to do what they need to do.  Next they can stop hiring from hospitals.  C# coders, or SQL guys don’t have to know crap about your business.  They have to know their business, which is IT.  And they’ll have to pony-up the money for some real IT folks.  IT folks aren’t going to work for peanuts… not when they can go somewhere else and get 20-30K more.  Oh yeah, and you’re also going to have to start treating them like they’re professionals.  IT guys don’t want to hear how much the doctors know about IT.  They want you to let them do their jobs.  So seriously, stop treating them like they’re nothing compared to the doctors.  Doctors are essential to hospitals, but your IT staff is too.  It’s getting so that hospitals are crippled without IT.  So why do you still insist that all IT guys are the same?  Hell, even all janitors aren’t the same.  I can easily tell the difference between one who cares about what he does and one who doesn’t.

Here’s a scoop for you.  Healthcare is going to need to get their act together or else.  The government is mandating that everyone have their health records in a meaningful use format by 2015 so the time of getting by on the idiots you’ve got is over.  You’re going to have to get some real talent and do what it takes to keep them.  If that means paying them a good salary, and listening to them, then all I can say is ‘you poor baby’.  Hospitals jump through hoops all the time to attract some new doctor because of what he brings to the network.  If anyone in healthcare is reading this then you’d better start planning now.  Start gathering some talented IT guys and let them do their jobs.  And NO, before you ask, you don’t know what IT talent looks like.  Get someone to help you find that talent.  And I’m not talking about recruiters either.  Go to the Microsoft MVP site and google someone in the field you’re looking for and start emailing them.  Ask them to help you interview a few guys.  I’m sure they’ll charge you a little, but it’ll be more than worth it.  Then once you get these guys on staff don’t treat them like 2nd-class citizens to the doctors.  You’ve got no choice anymore.  You have to do something.  You can’t keep this up.

My guess is that it’ll probably take about another decade before this starts really turning around though.

8 thoughts on “Healthcare isn’t ready”

  1. I agree whole-heartedly with this post.

    I’m fortunate that the medical clients I work with tend to be much farther along on the technological curve by the time they want/need our services since we primarily do medical claims data warehousing and analytics so we do tend to get listened to a bit more than an in-house IT staffer would.

    That being said, you hit the nail on the head: “Doctors think that because they’re doctors that they know everything.” This is so incredibly frustratingly true. I mean look Doc, I respect your position and admire the skills and experience you gathered while achieving it. Now you damn well better do the same to me or we are going to have problems.

    The 2015 mandate is definitely going to make for some interesting times between now and then but based on the current state of the industry I would have to agree with you – We will see more and more health care personnel going unprepared into 2015.

  2. Damn.

    I know how frustrating working in healthcare is. That’s one reason I’m not going back.

    Alternatively, I feel that the IT people DO need to learn the healthcare business, but because IT people are always learning, like you said, it’s better to get good IT people and then let them learn your business.

    Another BIG problem is that people in ANY industry fool themselves into thinking they are good at it the longer they are in it. So a business-person (or a doctor) will insist that they are the best at business decisions. But businesses are always failing (and doctors are always making mistakes), so you still have to remember that SOME of these business people ARE NOT as good at business as you are at IT, and they may not be as good at business as you can be (once you figure it out).

  3. And that’s sad isn’t it? Here we’ve got an entire industry that has scared away talent. And that means to get us back would require something pretty awesome to happen… it’ll cost them more than promises, and definitely a very pretty penny initially. They’ve got more than their own BS to get past… now they’ve got a bad reputation.

  4. Just because people have work to be done doesn’t mean they deserve to have it done.

    With all the startups and businesses in need of personnel because of all their wonderful ideas that they want built, I’ve learned that a lot of time these people think that just because they want something built, they will then just go find someone to build it and it will be done.

    They think that everyone will just jump at the chance to go ahead and carry out their evil schemes because they have the next facebook or whatever.

    And frankly, that’s very very naive.

    All these kickstarters that are delayed indefinitely as they get people in China to figure out how to build their great designs!

    There is no substitute for talent.

    Your grand plan needs to include talent all the way down to execution.

  5. The know everything attitude affects more than just the medical field. Try being a developer being managed by someone chosen because they are multilingual in spoken languages, even though they have no IT background beyond Photoshop. Try working with an airline pilot. Or work on a database project with a manager chosen solely due to their military background and Ivy League connections. 😮

  6. I have heard your rant and I have a rant back! I am a RN and have been working for HIM, which manages a lot of data for their constituents, helps to educate and integrate the clinical, reimbursement requirements and the myriad of home gown departmental sources of clinical information. They hired me because of my clinical, compliance, quality, research, coding, HIPPA, and IS systems/software experience in a variety of healthcare settings. Of course I worked with know it all MDs who don’t know it all! But unfortunately, the healthcare system is powered by the physician order/encounter to care for the patient and this is not going to change. This exchange is the how reimbursement is determined. People lose sight of this very important fact!! Everything from that point of entry to the system depends on that one thing. Making it easier for clinicians (MD,NP,PA,RNs, PT,MSW, SLP etc) to do their complex work takes an integrated team approach with all of the players.

    Understanding that all levels of expertise are needed to integrate complex systems, and managing interpersonal communication is the guiding star. I know I have been impatient, and annoyed at MDs as a nurse trying to advocate for patients, and as a HIM tech advisor, so it behooves me to try harder at my game to help them to understand the reasons/logic behind why I am doing what I do. And we can’t assume that the know it all, knows it all. Thanks for listening.
    PS. MD and other clinicians interpret that data you program, and the worry about reliability and purity of it because it used for predicting, benchmarking, etc. For me, pairing me with a person who knows SQL is a dream, many healthcare organizations do not have those talented to master both!!

  7. Sean, you should try healthcare research some time. I think you would not only find your skills highly valued and the work rewarding and meaningful, but you would be impressed with the skills of those you are working with – clinician and non clinical alike are very dedicated and smart people and most work in an environment that often (though not always) simply doesn’t tolerate bull sh&t from anyone. You have to prove your point with facts and data, not blustering, ego, intimidation or being slick.

    I agree with you that far too often the “doctor knows best” attitude ruins working in hospitals and working on the IT or administrative side life can be highly dysfunctional. The people you are trying to help are the biggest impediment to your helping them. However, I have seen it both ways. We had a “hip” young developers with high level skills come in an act as if they can solve everything without knowing a thing about healthcare – truly ignorant on the basics and no apparent desire to read up on anything. How about “certified” project managers who care nothing about safety and quality, just getting that EMR up and running on time. And on and on. However, I am a little surprised you picked on the doctors so hard. In my experience there is no lower form of life than the healthcare MBA.

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