EMTALA provides treatment, stabilization, and management regardless of the ability to pay. Emergency physicians among others provide at least $150,000 / yr of uncompensated care to those that don't have insurance, those that won't get insurance, or cannot afford health care.
I see it as an issue of low accountability for the most part, having different IT areas budgeted and the need to spend that budget before the year is out or otherwise we won't get the same amount of money next year. That's the mentality that most organizations take with silo-ing of budgets but to me seems to be a waste.
In my organization, they have outsourced the servers and support for the EMR to the EMR manufacturer for them to host in the "cloud" while adding more Citrix redirections and latency for the users. The entire EMR support staff is several orders of magnitude larger than the database / networking / software engineers combined. The people that they do hire to write support side software are imbeciles at best and have been here for several years -- no one is fired for incompetence but layoffs do occur.
Unfortunately, the higher ups in the C-level do not seem to understand the sandcastle that they've built within the hospital and IT department as their vision of what should be and the reality of it are completely divorced. I can see it as a physician with engineering and consulting experience who works in the ED day in and day out but the C-levels who are mostly non-physicians do not see the cruft that's built up or the inefficiencies that they have introduced.
If I had my way, I would bring everything in-house, bring in more open source systems, and hire engineers to write custom applications. Nonetheless, there is so much you can do when your ONE community hospital.
As to IT supporting its users, the issue is very simple and cuts across the entire healthcare system. Engineers do not talk to clinicians about the systems that they build and in so doing build clinical systems for engineers. I understand the mindset but as a emergency physician that has to see many patients in the day, the system that they've hoisted on us becomes a PITA to work with as the workflow I have created for myself does not equate with the workflow software engineers "think" that I should have. I want more input from physicians into the systems that are built. I want the engineers to come to the ER or to the inpatient floors or to the office to see how we work and help us perform in efficiently and safely.
As an emergency physician and former IT engineer with Unix system administration background, I'll say that most of the important software and hardware choices are made by the IT department and C-level executives without any input by physicians what-so-ever. I'll reply to your points line by line:
> 1) Over emphasis on the needs of the physicians over the needs of the patients and the other areas of the healthsystems. Many important IT choices are > made by doctors and not the professionals who were hired to be experts in these areas. That and the physicians are notorious for having almost no respect > for other professionals who are not a doctor.
The healthsystem SHOULD EMPHASIS the need of the PHYSICIAN over that of the patient when we are the ones using the EMR, PACS (picture archiving and communication system), network drive, intranet, and other features day in and day out. The needs of the patient come into play when interfacing with these systems to retrieve their laboratory and imaging results, physician communication, and others when at home or elsewhere. If the IT department doesn't like this, then too bad as the users needs outweigh yours -- remember that this is coming from a practicing clinician.
Just keep trotting out the old-line about how physicians have no respect for any other professionals as there's no basis for it in the real world. If you look around at the landscape of healthcare in the US, you'll see that it's the physicians that are dis-respected every day at the hands of the administration, fellow professionals, and patients.
> 2) Easy money. Money comes easy to these organizations. This plus...
Money does not come easy to any of these organizations unless your are a huge health system such as Mount Sinai in NYC or Mayo Clinic or any of the other health systems around the country. If you're that big, you can tell the insurance companies how much they will need to pay up. However, the majority of hospitals are 1-2 hospitals and have a very limited budget for many things including EMRs, IT staff and departments, and ultimately hardware and software. It's not like they have money to burn...
> 3) Non-profit tax status and requirements to spend or invest profits earned. This creates an environment of plentiful budgets where waste runs rampant, and > concern over things such as nepotism and incompetence aren't as important as they would be in other companies
IT departments in hospitals are rampant with nepotism, incompetence, and wastefullness. The heads of the security, network, and support divisions have no clue when it comes to support clinicians including physicians, nurses, LPNs, or any other staff that requires using the computer for any health related work.
I'm a doctor who is involved with the hospital's IT and EMR. The cost of switching over to electronic records is an already expensive proposition at the beginning and where the vendors get you is for maintaining the EMR on a yearly basis. Yes, it is minimal labor and not many pages but it is NOT minimal cost. Neither the private insurance nor medicare/medicaid reimburse the doctor for his or her use of the EMR and the patient is saddled with the cost.
I think that aurispector is suggesting the institution of health courts. The idea is that you have judges specially trained in health care issues who then retain objective outside experts to provide feedback and allow the judge to make a decision based on their findings. It's a lot more fair in getting money to more people injured from medical mistakes than the current system where the "jackpot" helps the lawyers than the patients.
What you might call a dictatorship I call a stabilization and modernization of Iran in face of growing Islamic and Communist groups working against the Shah and his policies. There are two sides to every story and it seems that you have clung onto one point of view and readily dismiss the positives outcomes that the Shah brought to Iran.
If I had to choose between a Shah run Iran vs that of an Islamic Republic, I would choose the Shah.
As a medical student, we are taught chemistry and biochemistry (not so much physics) including chemical kinetics in both our undergraduate training and in medical school. Your doctor either forgot the basics since he hasn't put them to use or is a dolt.
As one of the other posters mentioned, we get sporadic lectures on statistics and often it is in 60 minutes or less. Unfortunately, there are more important things that we need to concentrate on and stats just falls on the backburner of "things to do".
Nonetheless, statistics is useful to glean important information from medical journal articles and justifying whether a particular study is correct or incorrect in its assumptions and conclusions and by association how you can better treat and manage patients.
If a 6600 used paper tape instead of core memory, it would use up tape at about 30 miles/second. -- Grishman, Assembly Language Programming