Health care IT demands surgical precision

A recent journal study cites the ghastly hazard of getting it wrong

Confession time: last month I took the easy way out in my column, “Doctors Turn to PDAs”. Instead of giving a balanced recital of the many obstacles to adoption of IT in health care, I made it sound like I was just pegging the blame on doctors and their big egos.

One alert reader I’ll call Bob (even though his real name is Larry) wrote in to straighten me out. “Health care IT is much more about process change than technology,” said Bob, who says he’s both a surgeon and an IT professional. “Physician resistance is fueled by the expectation of glitches in the face of the expectation of perfection by patients. Physicians generally fear process change, especially when they may not understand how or why things work, and still remain responsible for the clinical results.”

As if to reinforce Bob’s point (for which I thank him), the journal Pediatrics recently published a study that showed exactly the type of ‘‘glitches” that doctors are afraid of. The report linked a period of dramatically higher death rates (more than double) to the installation of a new computer system in 2002 at Children’s Hospital of Pittsburgh that supposedly caused all sorts of mayhem, including delays in medication delivery, the inability to preregister critically ill children, and nurses getting pulled away from patients to do data entry.

The study, Bob wrote, “is the kind of publicity that physicians reluctant to support health care IT re-create in their nightmares.” Although several experts subsequently criticized the report’s methodology and warned against drawing sweeping conclusions, it does reinforce Bob’s point that changes made to complex, decades-old systems involving life and death can be tricky, and must be implemented carefully. In the long run, IT systems will help reduce medical errors, possibly at the expense of some physician autonomy. But in the short run it’s not about egos, it’s about human beings.

Not Just for Hits Anymore: According to a new study by Forrester Research, Web analytics is quickly becoming a full-fledged enterprise application, increasingly offering cross-channel analytics capabilities and even integrating non-Web data imported from other applications, in addition to reporting on basic Web usage. Research Director Nate Root reports that 49 percent of the firms Forrester surveyed import data from domains such as retail point of sale or call centers into their Web analytics packages, and that many companies expect a significant rise in the number of internal users for Web analytics apps.

Although it’s exciting to see a new applications category grow, you have to wonder where this will all lead. When you surf to one of your favorite Web sites, will they start to use information about your offline habits to pitch you? (“I know you walked into our downtown store the other day, Dave -- are you sure you don’t need another pair of chinos?”)

Speaking of creepy but still promising, I got a letter from our regional toll collection authority notifying me I’d gone through the FasTrak lane without a valid transponder (it was accidentally still in the glove compartment). As proof, right there on the letter was a high-res, time-stamped photo of the rear end of my car, bumper stickers, license plate and all, flying through the toll. Wow. I guess the fake nose and glasses thing won’t work much longer.