Monday Morning Update 5/12/08

Your comment on Quadramed’s Pharmpro product as being primitive baffled me. Although it is built on an older architecture it still is much better than the Epic’s and Mckesson’s of the world today. The architecture is old, primitive absolutely not. I am hope you were talking about OS and not the actual product because the newer products of today are very weak in pharmacy but mostly because they are designed around CPOE which, lets face it, is installed (actually installed and used) in less than 5% of hospitals. when this is the case, a pharmacy driven system like this one or Mediware beats the “integrated” solution hands down. I have to say this is the first ignorant post I have seen you make to date.

New meaning of “solutions” from Eclipsys.
Has anyone else had problems with being hit with a trojan downloader immediately after attempting to view the Eclipsys solution page. I tried it twice because I couldn’t beleive that it was their site but each time the page crashes and seconds later Zone Alarms goes off to quaranteen it. All I wanted was some information on their products but I get so much more.

Re: Degrees. I have a Masters Degree but don’t believe it is a requirement to be an effective CIO. I am less concerned about degrees and more concerned about what a CIO is doing today to continue their learning. I know many who have a great degree from a big name university but that was some years ago. Our industry continuously evolves and en effective CIO must stay current with the latest in leadership and innovation. BTW, my Masters got me in the door to land my first professional position but only because the hiring manager misread my degree. “So, I see you have a Masters in Computer Science?” “Well actually no, it is an offshoot of business known as “Consumer Sciences”. She hired me anyway. The rest is history.

The other thing to consider is the impact of talent. See link and select “Talent Rules!”.
http://community.advanceweb.com/blogs/hx_3/about.aspx

SS. Thanks for the links. I will check them out. Drexel looks interesting. I don’t think we are far off in our views. We are fortunate to have 4 physicians on our team. Additionally, 11% of my team are RN’s. I am not a typical IT type myself. We must not become further insular and part of the reason we are so far behind our colleagues in other sectors..

Tom Shubnell wrote:

“I think a physician is no more qualified to run IT than a CIO is qualified to perform brain surgery. ”

Tom, it appears you just stereotyped physicians, who often have significant predoctoral and other experiences beyond medicine, especially those who’ve pursued graduate and postdoctoral training in informatics.

It it in part through such stereotyping, resulting in the exclusion or marginalization of needed cross-disciplinary domain expertise, that health IT runs into expensive, unnecessary difficulty, or fails.

However, you have not stereotyped CIO’s regarding inability to perform neurosurgery, unless that CIO has an MD and training and boards in neurosurgery.

I am a physician, practiced internal and occupational medicine, so I would appear to fall under your statement. My minor in college was computing, right up to IBM 370 assembler, and I began computing years before college via unfettered access to a DEC PDP-8 and via a Heathkit H-8 I built in medical school for clinical-related experiments, 1978. Also built an infrared-sensing heart monitor in my elective in biomedical engineering at BU School of Medicine.

That background is not entirely atypical for those in medicine who are interested in IT.

Please evaluate my other background items in my online bio, for example, and then tell me why doctors are “unqualified to run IT.” As an information scientist, it should be easy for you to locate that bio.

Scot

“I meant CIOs without medical background or training and Physicians without IT background or training.”

I agree, which leads me back to my original point: physicians with formal health IT backgrounds would be far better utilized in leadership roles than as internal consultants a.k.a. “Director of Nothing”, or in the more recent “C”-level title incarnation, “Chief of Nothing.”

— SS

This was a very thought provoking post. After I cooled down a bit I could certainly appreciate your views as true taken from a certain perspective.
Let’s shift that perspective a bit. Consider the nature of the two disciplines with regard to formal education. As a field of study, medical practitioners have the advantage of hundreds of years of collegiate tradition and lexicon with some fundamental concepts so well ingrained into the profession that most TV viewers can rattle them off with ease…breakdowns of anatomy, diagnoses, methodologies, pedagogical structures like “rounds” etc…all substantially similar over decades or hundreds of years.
A key difference in the IT realm is the shear pace of change within the mind-space. Obviously, technological advances in medicine cause rapid change, but I would suggest to you that the speed and scope of changes in IT far outpace and outreach those in medicine.
Here is a hypothetical example: A computer scientist who achieved doctoral-level credentials at a college in the late 1970s would have worked primarily in an environment of mainframe computing, focused on centralized data processing using procedural programming languages or machine-level code.
Jump forward to 2008 and the credential that that computer scientist received would provide little practical knowledge pertinent to the implementation of small-scale distributed (or web-based) applications using modular or service-oriented concepts. In fact, there have been several iterations since that time of re-writing the book on databases (RDBMS vs. file-based), coding (object-oriented vs. procedural), and architecture (n-tier, SOA etc…). Also, there is no common body of knowledge from which all IT professionals work. One site may use legacy technology, another may use cutting edge, and yet another may blend both.
I would further suggest that the limited value of formal education that we often purport is due to the fluidity of change in the area of concern. My IT training was accomplished through self-study. I have a music education degree and a Master of Healthcare Administration and I serve as an IT director for a health plan. I also have a professional certification in information security and I will no-doubt continue to seek further education as I go. However, consider this: My education included an alphabet soup of languages/skills that I don’t use anymore in my daily work. You are going to have a hard time convincing dedicated IT professionals that their lack of a rigid educational achievement indicates that they are not viable contributors because the pace of change thwarts all such efforts.
I value the input of my medical staff and our business directors for the value that they bring (oddly enough, it hadn’t occurred to me to question or even examine their credentials) and I hope that they judge my value primarily on the basis of their interactions with me and the results that we achieve together.

Repeating last post as comments I included in angle brackets were eliminated.

Preston wrote: “You are going to have a hard time convincing dedicated IT professionals that their lack of a rigid educational achievement indicates that they are not viable contributors because the pace of change thwarts all such efforts.”

I”m not sure who the above is addressed to, but if it is with regard to my writings, it is a strawman argument based perhaps on emotion.

Unlike your organization, where at meetings and in behind-closed-doors sessions such argumentation can be effective (been there, seen that), on the internet such argumentation will get shot down faster than Dan Rather’s proportionally-spaced documents allegedly from 1972.

My point has been that lack of biomedical credentials and clinical experience- which cannot be self taught – put leadership of clinical IT outside the core competencies of most in the IT fields. Those with cross-disciplinary expertise, however, are not being engaged enough into leadership roles to prevent the difficulty and failure scenarios in health IT many are documenting. Note that I said leadership, not making contributions.

“Jump forward to 2008 and the credential that that computer scientist received would provide little practical knowledge pertinent to the implementation of small-scale distributed (or web-based) applications”

I differ from you ideologically on this point. Basically, my response to this line of argument is that “people – especially smart people – can learn rapidly.” Perhaps this example from Intel will be understandable:

— Albert Yu of Intel, in Creating the Digital Future, writes “I consistently promote people [to leadership] based on how fast they learn rather than how much experience they have. Fast learners, when given a big task, tend to learn even faster and typically succeed even with no prior experience. Gadi Singer [for example], a bright design engineer … learned very quickly in managing an organization with hundreds of people. In three years he has become the best design technology manager we’ve ever had.” —

That the required particulars in IT change so rapidly support continual education of those who through years of experience have gained broad insights, not the current practice of “hiring to the job specs du jour” that particular month or year.

People wonder why the IT industry has such high failure rates (see the links to this data on my web site), and it’s partly due to the lack of appreciation of the value of wisdom over knowledge and facts.

As I’ve also written:

— IT personnel in healthcare often believe that success in implementing management information systems applications (“business computing”) supersedes or actually renders unnecessary the mastery of medicine in leading and controlling implementation of clinical computing tools. Yet, mastery of applied IT towards implementing management information systems is in large part mastery of process (e.g., in acquiring and supporting vendor-written software) and repetition, as opposed to the practice of medicine, which requires mastery of complexity.

In other words, applied IT is a field of a relatively small number of principles, a large number of arbitrary conventions and rules, and a narrow body of knowledge applied repetitively and programmatically, often without scientific rigor. This may be illustrated by the fact that most areas of applied IT can be done well, and often are, by those with little or no formal training. This is not to imply that applied IT is itself easy, which it is not. There is no substitute for talent and real-world experience.

In clinical IT settings, however, there must be the right experience. Experts in clinical computing must provide effective solutions via seasoned application of the concepts, techniques, knowledge, and processes of medicine, and display an expert level of critical thinking in applying principles, theories, and concepts on a wide range of issues that are unique to clinical settings. Business IT experience alone does not provide a sufficient background for such responsibilities to be carried out effectively. Further, medicine is a domain of many difficult, nonintuitive principles, experimentally-derived natural laws, and a large body of knowledge applied in a broad, interconnected manner, ideally with critical scientific rigor. It cannot be practiced successfully without significant mastery of an enormous body of biomedical knowledge and significant hands-on patient care. The IT model of “If it’s information, we do it” starts to fall apart and impede progress in such organizationally and sociologically-complex environments. —

By the way, as I’ve been writing on these issues for the past fifteen years, I generally have well-reasoned arguments for every point I repeatedly see. This is the material I and others in my field are teaching my students in IT and IS and in healthcare.

I say this with all sincerity: people in IT need to watch out for being left behind.due to resistance to today’s progressive, human-centered views about IT such as is taught in the growing consortium of iSchools to which Drexel IST belongs (see http://en.wikipedia.org/wiki/List_of_I-Schools), as well as others.

Preston wrote:

— I was enjoying your response until this intellectual letdown: “Unlike your organization, where at meetings and in behind-closed-doors sessions such argumentation can be effective (been there, seen that)” —

I think it’s obvious, since I don’t know you and cannot even identify you, that I meant “at many organizations.”

— please acknowledge that medicine has a 100% failure rate at keeping people alive for their desired lifespan —

Non sequitur.

—The “wisdom” that pervades your posts is a sense of victimhood—

Argumentum ad hominem. Please review that topic here:

http://www.nizkor.org/features/fallacies/ad-hominem.html

I would like to close out this thread on a positive note.

I want to make the point that I find the resistance in IT circles towards leadership of clinical IT by qualified biomedical informatics professionals quite puzzling. It’s not as if the latter want to run the entire IT shop including business IT, just provide leadship in clinical IT.

It’s a true win-win situation, after all. CIO’s and other IT personnel get reduced job stress and perhaps longer tenures due to the expertise and presence of an intermediary (it’s been said that in healthcare, CIO=”career is over”, as average job tenure is just a few years). Biomedical informatics professionals get to leverage their expertise and the sacrifices they made in pursuing additional training. The healthcare system benefits from improved HIT and less costly HIT errors, difficulties and failures.

And last (but certainly not least), patients benefit.