Once again I am amazed at how money is misspent in health care, even though mucho technology is out there to cut costs.

Arizona Health-e Connections Summit is a conference/trade show for people interested in linking disparate bits of data into meaningful information for both payers and providers (never mind the patient–she comes last).

Roaming around the trade show floor,  I saw two great examples of health IT misadventures:

In an era where almost everything has an API, a company called Certify Data Systems is selling a literal “black box” to create a “secure handshake” between Cerner’s data, which is in use by enterprise health systems and hospitals, and the  simpler products used by physician practices.  But in the era of OAuth and Facebook Connect, why do we need a black box to bring data from one software application to another? Don’t answer; that was a rhetorical question.

Second example: Intel is demonstrating a device similar to a tablet with a kiosk-like touch screen, meant for the home night stand of the chronically ill.  The device can transmit data from peak flow, blood sugar, or blood pressure monitors back to a doctor’s office, initiate a call to a nurse through a simple command button (Call My Doctor), or a prescription refill through another button (I Have Run Out of Medicine.) This is the opposite of the black box in its user experience.

But it costs about $100 a month to lease, and as a patient you can’t have it unless both your payer and your provider agree, because they are in charge of your records. And who will pay for this if you can’t afford it? Unless it becomes part of the attempt to control costs put forth by the new legislation, it will never get into the market.

On the other hand, it just might, because buried in the bill we all love to hate is a provision that if a doctor admits a patient to the hospital and that patient gets discharged and re-admitted within 30 days, the hospital and the doctor both won’t get paid. So there will be an incentive to monitor those chronically ill patients at home. In addition, the speaker from CMS said that Medicaid and Medicare were looking for expanded definitions of “meaningful use” for health information technology products, and to that end were examining the medical home concept and other drivers of quality and value (effectiveness) rather than mere quantity of services.

Wouldn’t that be cool? I’d love to have the convenience of remote monitoring as a patient, and my absence from my doctor’s office for routine matters of chronic illness (blood pressure monitoring) would free him up to see other, more interesting  patients.

I’m beginning to think we need to stop Obama from implementing electronic health records. I didn’t always feel this way.

I’m sitting in a meeting with a doctor friend of mine who is now working for a clinic that uses GE Centricity.This man, a D.O. with a master’s degree in medical informatics, is telling horror stories about how an entire state’s health care system is trying to run on an electronic health record that no one can use.

They are using it because they bought it, although the doctor who bought the system said it bankrupted him and forced hin to sell his practice to the hospital. The hospital doesn’t even use Centricity, it uses Cerner. There’s a jerry-rigged interface to make Cerner talk to Centricity. The databases are not shared.

These are the two leading EHR products on the market right now. But NextGen and Allscripts are no better; I’ve evaluated them all, and I know. Before we implement EHRs, there had better be a panel of users (physicians) talking to Obama, rather than a panel of software companies.

This same doctor, and another friend of mine and I started a small non-profit a few years ago to evaluate these systems and help small practices implement them. The other friend is an MIT grad who has been a professor of Medical Informatics. I was their marketing front end. After helping one practice implement a system, we dropped out of the field. We realized that health care IT doesn’t help the doctors as it is now deployed; instead, it kills their productivity and hurts them. When they don’t adopt it, we criticize them, but THEY ARE RIGHT!!!

A few big products control the movement for CCHIT certification, which keeps smaller, perhaps more useful products out of the market. To get your product certified by CCHIT costs a $30,000 application fee, and then a couple of hundred grand more to go through the process.

This doctor has written his own EHR, so he knows how they work. He gave up marketing it because he was such a small fish in a big pond.

He says GE doesn’t want you to be able to do anything, so they can service the doctors who buy the system. He says GE’s database is sloppy to the point of of absurdity. GE acquired the database from another company, and rather than fix it, they just layered things on top of it. Key fields are named differently even though the data is supposed to relate to each other. And the rich text markup is stored with the data. It’s unreadable.

It’s this doctor’s opinion that no one understands this product. GE’s documentation is also difficult to use. These are expensive, IT-controlled products that are productivity and efficiency killers. You can’t even see the data in the software the way that you want.

Before we force the doctors to make health care worse with these existing products, let’s examine what we are doing. From a usability perspective, the software just isn’t there.