Thursday, November 27, 2008

The Health IT Nerd

I’m a Health IT Nerd. It’s all I ever do: living, breathing and sleeping Healthcare IT until I dream about it: patient records, diagnosis codes, web services, and Snomed expressions. I’d much rather dream about nurses (who wouldn’t?). Hell, I’d be happy to dream about the clerical staff. But no, it’s all bits and bytes and needles and XML for me: it’s not even worth it for me to sleep at all. So I hole up in my hovel with my computer, spending all my time on the internet pretending I know how to make Healthcare better.

That’s all anyone can do: pretend. No one has the faintest idea how to make things better, although you’d never know it, listening to the way the experts go on about how clever they are. But don’t be fooled: they’re either dishonest or just plain dreaming. Or deranged, that’s always possible with these people. The fact is: no one has any idea how to actually fix all the problems that exist with Healthcare or even just Healthcare IT.

Rest assured: it’s not like there’s any doubt about the problems. Any fool can see them, even with their eyes shut and their brain turned off, just the way everybody goes about these days. And most fools do see the problems. The trouble is, the problems are so big, no one knows how to fix them. Everywhere you turn, you can see lots of smart ideas floating around, but even a quick look will make it obvious that they won’t actually work. All they’ll do – if anything – is make someone a quick buck.

Of course, you’re thinking, that’s the problem: it’s all about the almighty dollar, profit for the fat pigs, making money off poor sick people. But even that’s not true. Healthcare is just so stuffed up, it’s pretty much about the only industry where you can say, “let’s do this, it’ll make us money” (or “it’ll save you money”), and half the audience sits around saying, “Like, so, what do we care? What we want to know is, is it good for the patients?”

As if the patients get to have any say in it.

In fact, it’s the patients that are the whole problem. If we took patients right out of the system, we could have unbelievably efficient healthcare. Heck, we could run the operating costs right down to zero, and the system would no longer produce “totally negative healthcare outcomes” (that’s somebody dying, to you and me).

But we can’t get rid of the patients, or their stupid addiction to their own positive healthcare outcomes, so instead, healthcare systems around the world gradually consume ever greater amounts of money on a scale that beggars the imagination. You can join in the game of figuring out how much it costs too – just think of a number, and keep adding zero’s until you run out of space: it’ll be about right (or not any more wrong than any other number you read). Every country is trying to figure out how to protect themselves from this monster, this rampaging beast that just keeps gorging itself on an ever bigger GDP slice. And USA, that paragon of economic efficiency, it spends even more on healthcare than any other country as a % of GDP, and with worse outcomes than many, so free-market economic efficiency is no answer.

It just gets worse too, when you consider what the economic outcome of a successful healthcare system is: an even more expensive Healthcare system in the future. The only way is up, baby, this is a one-way growth industry. Healthcare is the real Rocket Science.

One of the most commonly discussed ways to reduce the cost of healthcare is to leverage the efficiencies that IT can introduce. So it makes total sense – I’m sure you guessed it yourself: Healthcare spends less on IT industry as a percentage of total costs than any other industry.

But even a small percentage of a gob-smackingly large amount of money is still more money than you can poke a stick at, and there’s a huge stack of dollars going down. And all the vendors, from super-small one-man expert consultancies through to mega-large my-turnover-is-bigger-than-your-country’s-GDP multigalaxial corporations, they’re all positioning to get themselves a piece of that river of gold. And the trough is so big, there’s plenty of space for all of us (because yes, my nose is in the trough too – I know what I am. Oink Oink), no matter how ignorant we are. Even if you can’t spell EHR (and a big thanks to Microsoft Word for always correcting EHR to HER).

What all this means is that there’s a lot of real interesting things happening right now in Healthcare IT. That’s “interesting” as in the old Chinese curse, “May you live in interesting times”. And we do, so I just can’t sit back and keep my mouth shut anymore. So I’m going to sit in my hovel, run off at the mouth, and be the Health IT Nerd.

Note that I’m not the original Nerd. Oh no, that’s the War Nerd himself. Compared to the War Nerd, I’m nothing. I’m not even worth to tie his shoelaces and all that sort of thing. Even so, I’m honored to follow in the Esteemed Masters’ footsteps. Particularly because war is just like Healthcare – it’s not driven by any sensible financial outcomes.

You might say, war - that’s a really interesting subject! How boring is Healthcare? Who’s interested in that? Well, think on this: you might be able to avoid a war – if you're lucky – but two things are sure in life: death and hospitals (though not usually in that order). (If you thought I was going to say taxes, where do you think all your taxes are going to go in the future?) Anyway, I spit on war. Healthcare guzzles far more money than war, and we kill far more people in hospitals than die in war (and I don’t even have to count the freebies, the do-it-yourself deaths people accidentally prescribe to themselves at home). And unlike war, just about every country plays at having a healthcare “system”. Well, nearly every country. There are a few conspicuous exceptions in Africa. And I’m told I should mention Canada at this point, too, from what I’m always reading in the US media (and that must make it right).

So, healthcare IT: it’s the piggy in the middle between clinicians, managers, bureaucrats, patients, academics, corporations and technology. It’s chock full of crazy behavior, and the whole shebang is fueled by the biggest pile of dollars anyone has ever imagined.

So sit back, buckle in, and hold on tight, because the Health IT Nerd is gonna show you round.

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