Where Automated Healthcare Has Gone Wrong... And How To Fix It

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I somewhat kinda almost work in the healthcare industry. I've also talked to many doctors and made observations while at my own appointments. I think we can all agree that while American medicine is some of (if not the) best in the world, we can also all see that there is squandered potential. Doctors, nurses, staff, and patients are all stretched thin.

Automation To The Rescue?

You've probably experienced the same things I have. Interdepartmental confusion where the left hand of accounting doesn't know what the right hand of healing is doing and vice versa. Filling out the same form in triplicate. And I've never been to the doctor that they didn't ask me, again, for a list of my medications and dosages.

Most people seem to think that the holy grail in health care management right now is a computerized system that can get the right information to the right doctor instantly, automating all the paper work that used to require an entire staff to manage effectively. This is only half right. An automated system like this is, I suppose, the end goal, but we're going about it the wrong way.

I've heard it said that what will finally push us to computerized medical systems will be a big push by the government to design such a system. Surely they are the only ones capable of implementing such a system, right?


No. And guess what: it isn't going to be the private sector, either. It is going to have to be both.

Foot In The Door Mentality

The main problem, as I see it, is that everyone is competing to deliver the best healthcare management system, which is a good thing. But this also leads to some of the problems we have right now, the most egregious of which is that every system out there is a closed system. If a hospital or practice buys System A, they're stuck with it. There is no interoperability with System B. As a software engineer, this makes me want to scream. What if they need to move to System B? What if they have a patient who needs to get a procedure done at a facility that has System B?  What if a patient moves? What if System A's vendor suddenly jacks up its licencing fees?

You're stuck, that's what.

This kind of lock-in shifts the competition from vendor's trying to produce the most useful product for their customers to trying to be the first system a customer buys. If you can get in on the ground floor, those suckers will be hooked, no matter how much or how little effort you put into the product. And lucky for the vendor, few institutions will put the effort into examining the technology under the hood of whatever solution they're looking at. This kind of sales decision is usually made in a board room after a fancy slide show presentation showing stock images of happy doctors and patients in gowns, obviously smiling from all the great care they're getting thanks to whatever integrated system the vendor is peddling.

I do, however, feel that there is a solution to this current state of affairs. One that involves both the private sector and government agencies. One that takes advantage of the strengths of both.

Open Standards, Baby!

I propose that rather than the government create a competing integrated system that tries to be everything to everyone, and rather than companies competing to be the first to plant roots at a practice, that we split the job. The government, along with a consortium of business and healthcare provider interests, should develop a single, standardized API for healthcare data management. Define a standard for the types of information needed by all institutions. Define a method to store custom information that may be exclusive to certain practices or certain types of facilities that could be read and interpreted by other institutions that may or may not want or need to implement that part of the API. Define a common data transfer method. Legislate the use of such a system.

This creates one standard that the private vendors can work around. This shifts the focus on being the first to get your system in the door to being the best system for the types of customers you're courting. If a vendor is under the threat of a customer simply moving to another system if their current one doesn't meet their demands, the incentive to deliver a superior product is created.

Institutions will be able to store data and retrieve it. More importantly, institutions will be able to share their data. Transferring records would be easy, since you could be assured that every system available would be able to receive and interpret your records.

This is a problem that could be fixed with the right approach and some forethought by all the various interests. It's not an impossible problem. It has been proven that standardized systems agreed upon by multiple parties can be very beneficial without harming the economic interests of said parties. These vendors are already competing for your business. I'm just suggesting we shift the competition to inspire improvements to the actual technology itself rather than improving sales pitches.