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Time Capsule: Dirty Geeks and They’re Done Dirt Cheap: How Wall Street’s Huddled Masses Could Reshape Healthcare IT If We Just Asked Them

May 10, 2013 Time Capsule 5 Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in October 2008.

Dirty Geeks and They’re Done Dirt Cheap: How Wall Street’s Huddled Masses Could Reshape Healthcare IT If We Just Asked Them
By Mr. HIStalk


Healthcare IT has always been inbred. The same folks just keep moving between provider and vendor, hospital operations and IT, and Organization A and Organization B. The name tags change, but the faces stay the same. Most of the value of the HIMSS conference is in reconnecting with all those folks who scattered like billiard balls since you saw them last.

HIT is an esoteric discipline, at least according to those who are in it. We’ve kept it that way by demanding healthcare experience for most jobs, ensuring that few strangers and their highfalutin’ new ideas enter our comfortable midst (it also helps that healthcare pays less and uses bizarre technologies that the rest of the techie world has never heard of, like MUMPS and Magic).

Nobody knows whether healthcare will dodge the economic bullet this time around. If it does, lots of non-HIT techies will be pressing their noses to our glass, seeking a chance to start earning a paycheck again. It will look like that Twilight Zone episode where the guy is holding a gun on his neighbors to keep them out of his bomb shelter.

This Mariel boatlift of geeks could be great news for healthcare. Banks and investment companies were (note the past tense) full of experts in online transaction processing, security, project management, and forecasting. What will we tell those folks when they drop by?

Traditionally, it would be a slightly more polite variant of “hit the road.” No healthcare experience means we don’t want you, no matter how skilled and experienced you are at the same kinds of technology that we’re planning to use. We’re healthcare and we’re different.

That’s a mistake. The industry could use some new, baggage-free ideas from people who have spent their lives doing what healthcare is just now learning about: running large-scale, mission-critical systems and conducting business innovatively over the Web. And right now, especially if your hospital or company is anywhere near New York, Boston, Chicago, Hartford, Charlotte, or other cities that revolved (note past tense) around the financial services industry, I bet you could hire them for about the same money you pay those same old retreads.

This could be the most exciting HIT development in decades. Many of our bread-and-butter applications are old, poorly secured, and Web-indifferent. Developing portals and RHIO connectivity is a snap compared to keep tracking of some of those bizarre investment instruments their former finance bosses just choked on.

Interested in patient payment systems, real-time adjudication, Web-based customer service, or throughput modeling? Those are the folks who could knock that out right now, already used to skipping lunch and working long hours.

Healthcare has always been jealous of banking IT people, visibly grinding their jaw when innocent outsiders make the inevitable comparisons of their cutting edge work vs. healthcare’s 1980s-era challenges still being solved. Deep down, we knew they were right. Former hospital staff turned self-taught analysts couldn’t hold a candle to the best and brightest techies who headed to Wall Street in droves and moved that industry from staid old storefronts to cutting edge electronic commerce. Hey, their stuff works – it’s not their fault that their big-dollar bosses were a lot dumber than everybody thought.

Now we get even. Pay them a lot less, squeeze them into cubicles, and make them take orders from clinicians turned semi-programmers. The tortoise won this race. We don’t care about your international arbitrage software – just write an EMR system that doctors will actually use.

Think of this as your own Wall Street bailout, with benefits.

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Currently there are "5 comments" on this Article:

  1. Pretty much one of the most ignorant and myopic perspectives Ive read about HIT in a long time. Comparing HIT to the banking/finance industry is, how do I say? … dumb.

    Interesting when a HIT geek who spends his 8-to-5 in the basements of a hospital pecking away at his keyboard comments on something he has no first hand experience on.

    Don’t want to do too much edumacation on this one, at least not for free (oops, theres that capitalist pig in me popping its head again). Buuut, banks arent molded into a fixed reimbursement fee like hospitals. Banking markets are global, hospitals are regional, I could go on foreverrrr.

    Needless to say, all that banking and finance high-falutin freaky fast techy stuff didn’t help when it came to the melt down did it? (See AIG, see bank bailout, see…..etc)

    Nope, the tortoise (HIT) knows something. Steady wins the race, not fancy-schmancy IT.

    Talk among youselves.

  2. This is dead on actually. Even when hospitals have hired these folks as consultants, they tie their hands, because after the consultant leaves, there’s no way the Regular employees can maintain the build, so don’t build what the system is capable of or what the end users need. If only CIOs would realize what their low level managers were doing to survive- or do something about it.

  3. Sounding like a defensive response from the inbred crowd there El. 😉

    IT people didn’t create mortgage back derivatives and in the case of AIG there sure as hell wasn’t any IT involvement when Joseph Cassano and his 20 people in the UK. They got a call from the Wall Street investment houses asking them to offer insurance on those fraudulent derivatives. Oh, did they ever agree and when those derivatives blew up AIG actually paid. Most insurance companies would’ve called that fraud, an investment house buying insurance on an asset/derivative that they know has upside-down loans/mortgages that would never be paid. http://en.wikipedia.org/wiki/Joseph_Cassano

    The point of this 2008 article was there are some highly skilled people in other industries. In HIT now, we need bodies to get the work done at hand.
    These IT geeks in other specialties are damn good and we need to recognize that and put them to good use.

  4. Ouch. A little more vitriol for Mr. H. that we are used to!

    It is possible there could have been some lurking entrepreneurs among the displaced from the meltdown. I don’t think putting banking programmers on the job re-creating the Electronic Health Record is going to work. It is true that the EHR needs to be blown up and re-imagined in a more user (doctor and nurse) oriented way, but unless these programmers are also human factors/user interface/work flow analysts I would not bet a mortgage-backed derivative on their success.

    We need end users who are trained in human factors, user interface and workflow analysis to partner with our existing HIT programmers OR banking leftovers.

  5. EHR development plagued by lack of requirements definition by business / functional analysts and UI experts who create logical data models (not tables & files), process flows (functions), and human factors driven UI design that drive (and shorten) development and testing.

    For decades, programmers (problem solvers / technologists) “coded up” app with replication of paper processes (data redundancy, inefficiencies), and now consumer models. Systems reflect lack of understanding of industry or problems we are trying to solve. Engineers are flogged by execs to rush products to market (revenue recognition) – speed only criteria. So we think solution is bringing in more technologists from other far less complex industries like banking?

    Some blame “arrogance of programmers” not hearing clinicians’ outcry regarding woeful usability, WF support and data integration – at times blaming users. Programmers often take on or ignore analyst role they are rarely equipped to perform.

    Blame shared by Wall Street investors and Agile-type approaches gone awry that encourage little feature sets cobbled onto unstable or ill-defined foundational models – built fast. Any wonder processes are disjointed and poorly integrated?

    EHR vendors spend more time defending bad products and fending off unhappy clinicians than looking at root cause of problem and changing (to their financial benefit ironically, but requires new thinking).

    A final blow was MU – a mish mash of mostly MD functions picked out by government wonks during Stimulus plan crisis. While EHRs have huge potential value and ONC clearly states MU is not an implementation plan, it is widely used this way for incentive payments. Most DC leaders (to this day) never developed or installed a full EMR, thus approach and timelines ignore critical success factors, (e.g. no focus on exec leadership /change management, usability/WF support that lead to desired adoption) and violate known best practices (e.g. CPOE last not first and never without an eMAR – see Stage 1).

    The rush to build/install MU features (good intent) exacerbated problem and rewarded vendors and providers for bad practices. We are now reaping what we sowed.

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