Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
The cost of lost opportunity: Medical Informatics can't gain a foothold (4 stories)

The cost of lost opportunity: Medical Informatics can't gain a foothold (4 stories)

A reader in the United States writes:

Thank you for your messages to the CISWG listserv -- and for your web site. As a recent graduate of a medical informatics training program, I have devoured most of it and am now taking the time to digest and reflect. Currently I am struggling in a relatively new informaticist position for me and for my organization.

Two years ago I accepted a position with a not-for-profit integrated healthcare delivery network. Though I was not a novice in the business world, my excitement upon graduating and joining the "real world" again may have contributed to the "blinders" I was apparently wearing during setting up the position. My far-too-many bosses (problem #1) understood that to have a medical informaticist on staff would be a good thing on paper -- but claimed they didn't really know what to do with a person with this expertise. I attempted to help provide structure to my position and responsibilities. Unfortunately, I soon ran into some well-established organizational and cultural obstacles which were not initially apparent that prevent me from applying my informatics expertise, to the detriment of the organization.

In any case, the time has come to fish or cut bait, as it were. We have a new CIO who, although not informatics or medically-trained, seems to understand that IT isn't just about hardware and software. For example, he is proposing a Medical Management team led by clinicians that, in the course of the larger scope of their work, would help set IS priorities (whatever that means). Perhaps that has potential, if the team is not just a figurehead. Not surprisingly, I had proposed a similar idea a year ago. The executive clinicians had loved my proposal. IS ignored it and would not allow me to continue work on it, and everyone else got involved in planning for the new budget year, etc. etc., so it died. Perhaps this was just a classic case of political marginalization as your site indicates. It certainly didn’t help the organization in any way and may have harmed it in the long run, strategically and financially.

The present challenge: finally, I have been able to schedule a meeting with my current supervisor, a Director of Clinical Information Systems (not an informaticist), our new CIO and an executive clinician on staff. The topic is "Who am I in this organization? Exactly what am I going to do? And where organizationally do I belong?" As if the answers weren’t obvious. That’s like asking where a surgeon belongs. In the operating room, perhaps?

I am preparing to present some very concrete, realistic ideas that are in line with what I understand of the priorities of our new CIO and the corporation as a whole. My bottom line is whatever responsibilities we agree to must be supported by the appropriate organizational position, authority, and resources.

Truly, I am not on some sort of a power trip here. I just want to spend more time doing meaningful work than wringing my hands in frustration. Above all, I don't want to give up and move on prematurely. Nevertheless, I am aware that my pride in not being a "quitter" may be getting in the way of making the decision to cut my losses and move on. My greatest concern is that I am not growing. Practicing Medical Informatics is not just a job for me; it is my chosen profession and an integral part of my personality and life.

I am not a clinician, although none of the people in IS are either, nor do they have any formal medical informatics background. I have been and continue to be diligent in learning all the clinical material I can -- reading, attending seminars, rounding with physicians and nurses, asking lots of questions. I hold a Master’s in Organizational Behavior, did some time with a Big 5 consulting firm, conducted my research in data mining of real-world ER / specialty data pertaining to the treatment of acute, life-threatening medical presentations.

It is a shame this organization cannot get its act together in leveraging the expertise of medical informatics in its healthcare IT projects.

A reader in a European country writes:

I've recently taken up a position as Director of Medical Informatics at a not-for-profit hospital. I have been greatly heartened and encouraged by your comments to the CIS-WG (AMIA Clinical Information Systems working group listserve) and the pieces you have on your WWW site.

We are implementing a major-vendor suite of applications (EMR, Order entry, ICU, ER, Surgical documentation, Theatre Management, etc). My five months here seemed to have mirrored a lot of your experience with Information Services departments. The CIO here has a background in health administration and business, with no formal training in computer science and no clinical background.

As you've noted in your postings to the AMIA listserve, the "Director of Clinical Information Systems" position seems all to frequently to be "director of nothing." I too have very little control over decision making for our CIS project, in fact I have been actively excluded from the real decision making process.

One of the problems is that administrations of hospitals make themselves dependent upon Heads of MIS/CIOs/etc to advise them about the set up of projects mostly well before our kind are involved, thus ensuring that power and resources are not shared.

Cheers and keep up the excellent postings and WWW content on your web site.

Another reader in the United States writes:

We definitely have the same problem here. Everything that is not the MIS "gold standard" is considered completely "unsupported" and they will do their best to "get rid of it" - people included!

One of our former attending physicians was on our hospital's MIS-dominated pediatric electronic medical records (EMR) committee. He always told me that his biggest fight, when they were in the planning stage, was convincing the EMR committee that you can't have "people on separate sides of the fence". You need to have physicians that speak and understand computer talk and programmers that speak some "medicine". Otherwise, it will never work, he said. He also pointed out that MIS people ONLY need to be involved in the deployment of the database, not in the development. An informatics-familiar physician should lead that process. This type of thinking, of course, "ticked" MIS off.

It was very difficult for MIS to accept any of this. Eventually they gave in, sort of, and the physicians on the committee picked one of our former neonatologists as pediatric EMR project leader. However, the neonatologist had to do so much "head butting" with MIS, and MIS made the project so politically unbearable for him, that he quit within two years.

An orthopedic surgeon in the United States writes:

An excellent website! I discovered it in a discussion forum on Physicians Online.

I am beginning my "hard knocks" education in medical informatics on the smallest scale: implementing electronic medical records in our office. Although "micro-informatics" differs in many ways from the "macro-informatics" you discuss in your site, there are obviously similar basic principles involved.

Your grim tales of Dilbert-ish CIOs and befuddled healthcare execs would be amusing if they didn't impact so negatively on our ability to efficiently manage patients and patient information. One of our local hospitals "upgraded" their hospital information system with an expensive, user-hostile system which was obviously designed by someone who hasn't the faintest idea of what a clinician needs. Example: when I request my rounding list, I receive a gigantic compendium of every patient whom I've "encountered". This means that my inpatients are scrambled with discharged or even deceased patients, consults, patients for whom I'd given voice orders while on call, etc. There is no way to sort through this mess, and I have to resort to checking the census floor by floor to find my inpatients. Complaints to the "help desk" yield no useful information, only suggestions to attend additional "training sessions" (which are 50% propaganda) and the assurance that "this is the best patient management software available". Despite the superlative qualities of the software, we have been informed it will be "upgraded" again next year!

Be careful not to attribute to malice that which can be explained by mere stupidity...