Why is healthcare IT different?

I was in an interview recently and asked the candidate if they have any healthcare IT experience.  Their response was one that I might have given a couple years ago: "no, but I have a lot of
IT experience and IT is IT no matter what industry". I actually like that answer. It makes a lot of sense to me - it's intuitive. A computer is a computer. A network is a network. 10 years ago when I worked at a small regional hospital as a system administrator, that was largely true (for my position). I helped keep the servers serving, the network networking, and the PCs... err.. from crashing. From a hardware perspective there are few differences between healthcare IT and any other industry where a hardware failure could, quite literally, kill somebody. No pressure.

However, as soon as you look at the software and data, you see a very different animal. So, I'm going to make a short list of some of the things that I see that make healthcare IT different. Please, feel free to add your own.

1. A system failure could kill somebody

I know I mentioned it before, but I think it's worth re-iterating. If a patient is crashing and a doctor can't find out what medication they're on because "the system is down", it could have very serious negative affects. Yes, there are contingencies built into the workflow, but we're talking about an environment where any delay could mean the difference between life and death. Most IT guys aren't used to that kind of pressure.

2. Data entry is "optional"

I use optional in quotes because most places probably tell people they "have to do it", but never to the detriment of the patient, which means it's as the user's discretion, which means it doesn't happen reliably. Moving on...

Imagine a manufacturing environment where data entry is "optional".  If the operator is busy, they just skip it. Can you track your costs? Can you bill your customers accurately? Do you have any usable data at all? What a mess.

Now, imagine telling a doctor that he has to delay  treating a patient who is in crisis until he's finished documenting what he's doing, why he's doing it, which meds he's using, and what dosage. That can't happen in health care.

Therefore, treating the patients is #1, entering data is number 2 (or 3 or 12 or 50). When the data entry is secondary, the data is messy. And messy data is unusable.

3. Healthcare software typically has little input validation

Input validation, that thing that keeps you from entering a 2 month old patient who weighs 150 pounds, largely doesn't exist. Yes, we can rule out the extremes. Don't allow patients over 10 feet tall. Don't allow a height/weight ratio that would result in a BMI of greater than 150. But those lines are drawn way outside of the realm of possibilities which means that bad data is entered - a lot.

And it's not just validating logic that doesn't happen. Most fields can be left blank. This seems unthinkable in most industries. Imagine this - the bank doesn't know your last name, social, address, or phone number, so just leave it blank. Nope. However, we're going to treat that patient whether we know anything about them or not. Hopefully that data will get plugged in later, but in the hustle and bustle of saving lives, well... you can imagine how often that actually happens. Again, the data is messy and messy data is unusable.

4. Clean, accurate, usable data is absolutely essential

"But I thought you just said that healthcare data is so messy it's unusable." Now you're getting it. So, what we have is a messy system of documentation, and we as IT people have to turn it into something that can be used for billing, productivity tracking, cost analysis, meaningful use reporting, balanced scorecards, and research. And it has to be complete. And it has to be accurate.

If we can get this right we will have, at our fingertips, the ability to completely revolutionize the entire healthcare industry from the way research is performed, to the way patients are cared for, to the operational decision-making process.

I'm sure there are other significant differences, but I'll leave you with these for now. If you disagree with anything I've said, or have something to add, I'd love to hear it.