I'm glad somebody else remembers Deming. The US should put his picture on the highest value banknote they have. Failure to listen to him is the main reason for the trade defecit that the Ginger Whinger complains about..
For healthcare the magic word is "disintermediation." Automating 19th century business practises was not a good decision.
In the UK, the NHS's computerisation is... a mess. My background: I started out life as a medical biochemist (except we were called chemical pathologists back then) and any computerisation was primitive. Our lab computer had valves and took twenty minutes to warm up! Fast forward and I'd switched to programming and systems analysis and the company I worked for had a contract from the NHS for some software. Given my background and familiarity with NHS culture, I was considered an ideal employee to head the team. It didn't go well. The trouble with behemoths such as the NHS is goal-post moving. It's endemic. You get a specification, design a system and then get the team writing the code. Halfway through you get a phone call. "We've been thinking about this computer system. Could we possibly have this feature added in?" Repeat this over and over, deadlines slip, code doesn't function well - or at all... and so on. By the time anything usable has been produced, hardware has moved on (and so have I!) and the system gets scrapped and a different company's employees get to age rapidly trying to work with the NHS.
I have no illusions that things have improved. A year ago, I lived in Wales, then I moved to England and discovered that the computer systems in Wales are totally incompatible with the systems in England, with the result that I've had to be re-diagnosed with all my ailments, have all my medications re-prescribed (including a scary moment where I didn't get my prescription for insulin until the last minute). I've had double vaccinations for Shingles, Pneumonia, Covid and Flu. I've had to fight for one particular medication because "we don't prescribe that in England" and my glaucoma hasn't been checked in over a year, probably because someone hasn't entered that diagnosis on my record, even though I do have a prescription for eye drops.
I'd love to apply some Deming poke yoke to healthcare!
1. Is the US a special case? Or, does how a nation set up its healthcare funding system(s) change the IT need?
2. More generally, is this year to
(a) Figure out how to use IT to facilitate the current arrangement of funding, providers, etc.? or
(b) Figure out how funding, providers, patients, etc. SHOULD be related, and THEN design the IT to facilitate it?
3. Obviously, ONE part of the answer is not to design EVERYTHING before starting ANYTHING. Rather, to sketch out the whole system, but design and build some one useful portion of the eventual system, and get it working and integrated into medicine, and then repeat. Perhaps something peripheral, perhaps something invisible but core. An arm or a spine.
The first thing you need is the will to change, and the insight to do it gently and right. I'm a reasonable convert to Popper's piecemeal engineering---rather than trying for revolutions. And as I said before IT is just a tool, currently one that is being used wrongly to inflate unreasonable expectations.
However you look at it, though, I think the US is a terminal basket case, particularly when it comes to health care. Your parasite load (billionaires, health care executives and middlemen) is unsustainable and likely resistant to all reasonable anthelminthics.
I'm glad somebody else remembers Deming. The US should put his picture on the highest value banknote they have. Failure to listen to him is the main reason for the trade defecit that the Ginger Whinger complains about..
For healthcare the magic word is "disintermediation." Automating 19th century business practises was not a good decision.
In the UK, the NHS's computerisation is... a mess. My background: I started out life as a medical biochemist (except we were called chemical pathologists back then) and any computerisation was primitive. Our lab computer had valves and took twenty minutes to warm up! Fast forward and I'd switched to programming and systems analysis and the company I worked for had a contract from the NHS for some software. Given my background and familiarity with NHS culture, I was considered an ideal employee to head the team. It didn't go well. The trouble with behemoths such as the NHS is goal-post moving. It's endemic. You get a specification, design a system and then get the team writing the code. Halfway through you get a phone call. "We've been thinking about this computer system. Could we possibly have this feature added in?" Repeat this over and over, deadlines slip, code doesn't function well - or at all... and so on. By the time anything usable has been produced, hardware has moved on (and so have I!) and the system gets scrapped and a different company's employees get to age rapidly trying to work with the NHS.
I have no illusions that things have improved. A year ago, I lived in Wales, then I moved to England and discovered that the computer systems in Wales are totally incompatible with the systems in England, with the result that I've had to be re-diagnosed with all my ailments, have all my medications re-prescribed (including a scary moment where I didn't get my prescription for insulin until the last minute). I've had double vaccinations for Shingles, Pneumonia, Covid and Flu. I've had to fight for one particular medication because "we don't prescribe that in England" and my glaucoma hasn't been checked in over a year, probably because someone hasn't entered that diagnosis on my record, even though I do have a prescription for eye drops.
As I said: it's a mess.
I'd love to apply some Deming poke yoke to healthcare!
1. Is the US a special case? Or, does how a nation set up its healthcare funding system(s) change the IT need?
2. More generally, is this year to
(a) Figure out how to use IT to facilitate the current arrangement of funding, providers, etc.? or
(b) Figure out how funding, providers, patients, etc. SHOULD be related, and THEN design the IT to facilitate it?
3. Obviously, ONE part of the answer is not to design EVERYTHING before starting ANYTHING. Rather, to sketch out the whole system, but design and build some one useful portion of the eventual system, and get it working and integrated into medicine, and then repeat. Perhaps something peripheral, perhaps something invisible but core. An arm or a spine.
The first thing you need is the will to change, and the insight to do it gently and right. I'm a reasonable convert to Popper's piecemeal engineering---rather than trying for revolutions. And as I said before IT is just a tool, currently one that is being used wrongly to inflate unreasonable expectations.
However you look at it, though, I think the US is a terminal basket case, particularly when it comes to health care. Your parasite load (billionaires, health care executives and middlemen) is unsustainable and likely resistant to all reasonable anthelminthics.
Apologies for being so frank. Dr Jo.
First, one has to admit they have a problem.
:-)