Tuesday, December 1, 2009
Is Healthcare IT a White Elephant? Or Are Semi-Luddites on the Loose?
A curious article in Computerworld, headlined, as you can see above, "Harvard study: Computers don't save hospitals money/Hospital computer systems are often built for administrators, not doctors."
In the piece, reporter Lucas Mearian interviews Dr. David Himmelstein, who healthcare observers know to be one of the leading advocates for single-payer health coverage, a.k.a. British-style socialized medicine. Here at SMS, we are always reluctant to assess people's motives from afar, but a critic might wonder whether Dr. Himmelstein is throwing mud at a healthcare status quo that he doesn't like, for ideological reasons that transcend concerns about the practicality of a certain technology. Or it could be concluded, for reasons that we shall see, that Himmelstein just doesn't like technology very much.
But, we report, you decide. Here's the nut of the Computerworld story:
The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld.
Himmelstein, an associate professor at Harvard Medical School, said that in its current state, hospital computing might modestly improve the quality of health care processes, but it does not reduce overall administrative costs. "First, you spend $25 million dollars on the system itself and hire anywhere from a couple-dozen to a thousand people to run the system," he said. "And for doctors, generally, it increases time they spend [inputting data]."
Himmelstein said that only a handful of hospitals and clinics realized even modest savings and increased efficiency -- and those hospitals custom-built their systems after computer system architects conducted months of research.
The issues of healthcare IT, are, indeed, huge: there's $19 billion in the stimulus package for health IT, just for openers. But how well that money will be spent is subject to debate. This summer, my colleague at the New America Foundation, Phil Longman, wrote a thoughtful piece for The Washington Monthly about the software challenges confronted by the Department of Veterans Affairs. In a nutshell, none of this is easy. And so to the extent that Himmelstein wishes to be a part of the solution--achieving better healthcare outcomes for people--more power to him, even if we don't agree with him on single-payer.
But Himmelstein, who speaks from the authority of Harvard, as well as the medical profession, might wish to try harder to communicate a positive problem-solving tone--lest he be mistaken for a Luddite. A true optimist--and all doctors should be optimists, shouldn't they--would say that these problems can be solved.
But in fact, Himmelstein seems to have a second agenda, in addition to single-payer. He seems to be dubious about the value of health IT:
"For 45 years or so, people have been claiming computers are going to save vast amounts of money and that the payoff was just around the corner," he said. "So the first thing we need to do is stop claiming things there's no evidence for. It's based on vaporware and [hasn't been] shown to exist or shown to be true."
That seems to be Himmelstein's bottom line: This IT stuff is unlikely to work, or work well, so don't spend too much time on it. In this sense, Himmelstein is clearly part of a movement within medicine--a movement fitting snugly within the larger Green worldview--that argues that social and political concerns should trump technological advance. That's an opinion, but it is not an opinion supported by the weight of technological history, including med-tech history. And, fwiw, it's certainly a loser, politically, with the American people.
As Americans have always said, "If at first you don't succeed, try, try, again."
And that's the point here: When confronted with a hard challenge to an important goal, the way to solve it is keep pushing forward against challenges. That's the only way to overcome the difficulty. Remember what telephones were once like? And if you remember back to the days of heavy Princess phones, then maybe you're not old enough to remember rotary phones. And few today are old enough to remember the phones that came before rotaries, the "candlestick" phones of yore. It was hard work, every step of the way, to get from there to where we are now. And along the way, there were plenty of critics. But there were many more eager consumers, and so now we all have not just phones, but smartphones.
Here at SMS, we can see many ways to push ahead with healthcare IT, but would say that the challenges of healthcare IT are much more likely to be solved by our mixed economy, by a pluralist and competitive economy that accepts general goals articulated by society and then uses invention and entrepreneurship to find the best way forward. And that the best healthcare outcomes are likely to come from a similar approach on healthcare policy--sorry Dr. Himmelstein.
But every step of the way, in any field of scientific inquiry and engineering improvement, we have seen trial and error, followed by trial and success. Here at SMS, we have made this point many times, most recently concerning swine flu. It's easy to criticize the way that the federal government has handled H1N1, and we should never hesitate to speak truth to power (especially incompetent power), but the greatest laurels should go to those who can solve the problem.
And that's the mission of the Serious Medicine Strategy: To help develop a framework through which we can achieve the best possible medical and healthcare outcomes, for all Americans, and for the peoples of the world.
Posted by James P. Pinkerton at 1:16 PM