Every major industry is now computerized with one glaring exception; health care delivery. Thirty years after Steve Jobs began selling personal computers out of his garage, far less than 50% of physician practices and hospitals have converted to any form of electronic medical record.

The vast majority of medical documentation is still done via paper and writing utensil just as it was 100 years ago.  For a society and economy that has fully transitioned from being mostly industrial and manufacturing based to being primarily information based, this is a stunning omission.

The reasons for this are varied and complex but in an article that spotlights several lows in the career of a software programmer, Scott  Reynolds writes about one experience with coding software for the next generation of electronic health records and what happened after it was finished, shipped to the customer, and went live:

You didn’t know what to do with yourself so you sat there all day refreshing a view on the database to spy on what [the first few customers were] doing. Answer: not much. The things they did do, they did wrong. They found bugs. They found ways to circumvent all of your carefully constructed system rules and validations. Not because they were master hackers or brilliant technicians … but because they were just stupid.

They clicked on things they shouldn’t click on. They typed things in that they shouldn’t type in. They didn’t read simple instructions. They didn’t listen in training. They were personally insulting you by being terrible at using your software.

In a field labeled “Enter the number of specimens:” they typed “five specimens.”

In a field labeled “Social Security Number:” they typed “he doesn’t have one because he is an illegal.”

Instead of using the button labeled “Create New Patient Record:” they kept changing the information in a single patient record over and over and saving it.

Then the calls came in from the sales team demanding to know why the system was broken and why you had taken so long to develop something that clearly didn’t work.

There was nothing you could do but respond to the bug reports and issue system patches that added no value other than handholding people through the software. You wondered aloud how these people had managed to survive this long without drinking bleach by accident.

Sad but very true. Like many industries, the medical business is loaded with tons of paper pushers, unmotivated mid-level managers, mindless bureaucrats, poorly trained ancillary staff, and lucky professionals who slipped through the cracks and managed to get a degree despite being borderline bleach drinkers.  It’s far easier to conceal stupidity, laziness, and incompetence while utilizing a paper based documentation system than an electronic one.  Paper documents are regularly loaded with errors, inaccuracies, and out-right crap. Lucky, very little of this has any impact on patient care or is discovered until the chart is audited by insurance companies, Federal agencies, or malpractice attorneys.

It’s not until the paper form is replaced by a computer that can fact check and give instant feedback that the massive scope of all this crap documentation becomes known. It’s not just that people are “computer illiterate.” At the hospital where I work, forms are regularly incorrectly filed under the wrong tab in the paper chart, medications are misspelled, illegible test results printed long after the printer toner has run out, daily weights randomly documented using lbs or Kgs, blood sugar levels written in the blood pressure column, etc. etc.

Combine this fact that the health care industry is not immune to employing bleach drinkers with the fact that it’s inherently a very complex information system and we start to get an idea of just how daunting a task it is to design a software system for health care documentation.

But, then again. As the article makes obvious, why is a software programmer designing and coding  a computer system for health care? Isn’t that like an oil company executive designing a formula one racing car or lawyers writing health care legislation? Yea. That.

Chris Rangel is an internal medicine physician who blogs at RangelMD.com.

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