I work in a hospital Quality department. Mostly because they wanted control over their personal data miner and statistician rather than having to go hat in hand to I.S. every time they needed something.
HL-7 standards helped make data transfer easier between various applications and databases for insurance agencies and the hospitals; but really didn't go far enough. And HL-7 is a bandaid on a gushing wound. What I haven't seen is a healthcare appplication database system designed from the ground up to handle electronic patient clinical records, financial and insurance data, inpatient/outpatient/ and external doctors office two-way data transfers, as well as the plethora of required reports for in-house, and government use. Every application and database currently available is specific task designed and interoperability is cobbled together from spit and baling wire.
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I build HL7 interfaces between systems. The only thing standard about HL7 is how you spell it, and even that is iffy since I see about half the vendors call it H7L.
If you don't want to put up with being available 24 x 7, even on vacation, getting yelled at because a physician doesn't understand why you can't reprogram a vendor's custom code to fit what he wants to do (even though it's against about 50 federal and state regulations), live and breathe HIPAA and all sorts of other compliance regulations, and in general being completely unappreciated, then Healthcare IT is not for you.
All kidding aside, working in IT in a hospital is not like working in IT in other organizations. You need to learn and understand a lot of clinical information, depending on what you do. Yes, we have nurse informaticists for a lot of our clinical systems, but I'm not clinical, and I had to learn a whole lot about how the cancer center works when no one else was available to install and manage that system.
It's also not easy to schedule down time. We don't have a time when we can shut down without affecting someone, so you have to develop elaborate downtime procedures and do your best to minimize downtimes.
If you don't want to put up with being available 24 x 7, even on vacation, getting yelled at because a physician doesn't understand why you can't reprogram a vendor's custom code to fit what he wants to do (even though it's against about 50 federal and state regulations), live and breathe HIPAA and all sorts of other compliance regulations, and in general being completely unappreciated, then Healthcare IT is not for you.
All kidding aside, working in IT in a hospital is not like working in IT in other organizations. You need to learn and understand a lot of clinical information, depending on what you do. Yes, we have nurse informaticists for a lot of our clinical systems, but I'm not clinical, and I had to learn a whole lot about how the cancer center works when no one else was available to install and manage that system.
It's also not easy to schedule down time. We don't have a time when we can shut down without affecting someone, so you have to develop elaborate downtime procedures and do your best to minimize downtimes.
Look at Epic - they do not have everything covered (yet), but do seem to have an integrated system. Ambulatory, inpatient, sched, billing, homecare is new but working.
I think the the term legacy, especially in healthcare, has no business in IT. Add to that people that have no idea of the complexity of inter-related systems of IT who make decisions on what gets done, and I am out! In my experience, Dr's and lawyers make the worst people to work for as they can be financially tight, and quite controlling. If the Dr's can not keep their systems up to date, why would I walk into an environment to support that? It says a lot about a Dr's ability to trust others, or lack there of. I think the only way I would consider this industry is if I was out of a job.
I have worked in healthcare IT for about 15 years now. There is always something new going on. The real IT challenge is indeed the legacy data. Laws often require data to be kept forever, but the systems they live on won't last that long. So you always have to keep your eyes on how to get the old data into the new systems; which can sometimes be a major challenge, especially as you move from paper to digital. Laws also require restrictive access, and balancing the accessibility of the data can also be challenging. A doctor or nurse may need access RIGHT NOW! to save a life, but unauthorized people are NEVER allowed to access the data. Quite the challenge, and we are not always successful.
The people challenge can be the doctors and nurses, but they are wonderful people to work with. If I treat them as equally intelligent but specialized in their field and expect the same from them I find that we get along great. And I try to learn as much as I can from them and assist them to learn from me and it gets even better. Many of the best doctors and nurses are polymaths and love to learn all they can about as many things as they can. Medicine is such a complex field that it is very fulfilling, but everyone likes a change of focus occasionally.
And yes, you don't have a life when you work in Healthcare IT. As doctors and nurses may be called on at any moment to save a life, the IT people may be called upon at any moment to assist in saving that same life. It can be very fulfilling to know that you are helping save lives in a tangible way. On the flip side, we all make mistakes and sometimes you have to step back and ask yourself if you could have done something different or better, but you need to focus on lessons learned so it gets done correctly the next time, and move on.
When you work in Healthcare IT, you are not just a computer person anymore, you are part of the healthcare team. Not everyone can take the pressure, I've seen a lot of people come and go, but for those of us who enjoy the work it is wonderful.
The people challenge can be the doctors and nurses, but they are wonderful people to work with. If I treat them as equally intelligent but specialized in their field and expect the same from them I find that we get along great. And I try to learn as much as I can from them and assist them to learn from me and it gets even better. Many of the best doctors and nurses are polymaths and love to learn all they can about as many things as they can. Medicine is such a complex field that it is very fulfilling, but everyone likes a change of focus occasionally.
And yes, you don't have a life when you work in Healthcare IT. As doctors and nurses may be called on at any moment to save a life, the IT people may be called upon at any moment to assist in saving that same life. It can be very fulfilling to know that you are helping save lives in a tangible way. On the flip side, we all make mistakes and sometimes you have to step back and ask yourself if you could have done something different or better, but you need to focus on lessons learned so it gets done correctly the next time, and move on.
When you work in Healthcare IT, you are not just a computer person anymore, you are part of the healthcare team. Not everyone can take the pressure, I've seen a lot of people come and go, but for those of us who enjoy the work it is wonderful.
If you have a year or two of IT experience, just apply. My background is 10 years of network experience and I got in to a software developer who needed someone who could do troubleshooting for how their software connects to 3rd party systems. Now I'm working on database administration and studying for my first MS SQL exam. I work with other people who have business administration backgrounds but they work with hospitals on how we can customize our front-end to work the way their clinical staff needs.
While it does not get as much press as some of the other fields that people are talking about, it has some wide open opportunities.
Curious about any comments/information on the CompTia Health IT technician cert. It's a good mix between IT and healthcare. I'm currently taking this class, and there is not much out there as far as information.
I'd appreciate any thoughts, etc on it.
Curious about any comments/information on the CompTia Health IT technician cert. It's a good mix between IT and healthcare. I'm currently taking this class, and there is not much out there as far as information.
I'd appreciate any thoughts, etc on it.
The mentions of handwritten scrip and penmanship here in this article reminded me of something funny, but somewhat typically true.
There is a classic scene in the movie "The Fugitive", where Harrison Ford's character, who is also doctor, is in a hospital. In the process of avoiding the U.S. Marshals, on his way out, he comes across a child patient where an incorrect decision was made, noted on the kid's chart. He instructs the nurse to make a change, thereby correcting a medical mistake and potentially saving the child's life. She informs him that she can't do what he asks without an authorizing signature. He confidently and hastily scribbles an illegible signature, as just about any other doctor would do. She glances at it, at him, and then carries on and does as he instructed.
There is a classic scene in the movie "The Fugitive", where Harrison Ford's character, who is also doctor, is in a hospital. In the process of avoiding the U.S. Marshals, on his way out, he comes across a child patient where an incorrect decision was made, noted on the kid's chart. He instructs the nurse to make a change, thereby correcting a medical mistake and potentially saving the child's life. She informs him that she can't do what he asks without an authorizing signature. He confidently and hastily scribbles an illegible signature, as just about any other doctor would do. She glances at it, at him, and then carries on and does as he instructed.
Since my Health System went through EMR (Electronic Medical Records) back in 2007 it has pretty much been non stop. If there isn't something new coming in there is something that needs to be updated or replaced. most all of the comments I read are pretty much on the mark, it's not like any other IT you've worked. You are a part of patient care as much as anyone of the Doctors or Nurses; they can not do their jobs effectively anymore if we aren't doing ours effectively, Down times are a major happening everything effects everything else and has to be scheduled down to the minute, you are on call even when you are not on call - if your co-workers need a hand or if you are closer you get there and take care of business. It's probably the toughest, at times, job I've ever been in but it is also the most gratifing especially after you see all your hardwork in motion.
I worked three years in the computer room in a military hospital. It's fortunate my job didn't require me to leave the computer room very often, as I felt personally uncomfortable outside it. I didn't interact with patients, but I would actively avoid chance encounters. I'm not generally interested in people and especially not in their private lives. I felt like even making eye contact was intruding on an unwanted experience I assumed they would rather keep as private as possible. The ironic thing is that I don't have any privacy issues of my own when I'm a patient.
It's probably another aspect of my poor interpersonal skills. Regardless of the reason, it doesn't strike me as the right environment for someone as unconcerned with the customers as I am.
It's probably another aspect of my poor interpersonal skills. Regardless of the reason, it doesn't strike me as the right environment for someone as unconcerned with the customers as I am.
Geez, the guy is expressing an honest reason why he should avoid the field. What's the problem?
Healthcare IT is a bubble set to burst. It has been spured on by incentive programs (EHR, PQRS...). That incentive money is drying up and will turn to small penalties, that are less than the cost of maintenance of an EHR. So if you want in Healthcare IT, join now. Just like Y2K, the bubble will burst.
Others commented on how bad it is to work with Dr's. At our hospital the Dr's are great. IT personnel are the real problem. Our IT does not allow access to data warehouse data. Does not allow people to build their own BI reports... Add to that the legacy nature of MUMPS, the 24X7 support and the pressure to completely customize a vendor product - yuck! By the way I've been in healthcare IT for 14 years now. I am hoping next year will be my last year here, or maybe the problems are just at the big hospital I work for.
Others commented on how bad it is to work with Dr's. At our hospital the Dr's are great. IT personnel are the real problem. Our IT does not allow access to data warehouse data. Does not allow people to build their own BI reports... Add to that the legacy nature of MUMPS, the 24X7 support and the pressure to completely customize a vendor product - yuck! By the way I've been in healthcare IT for 14 years now. I am hoping next year will be my last year here, or maybe the problems are just at the big hospital I work for.
Another bubble to consider is how the healthcare industry is expanding to accommodate the baby boomers. In a decade or two it will need to shrink because most of us old folks will have died off. Granted, that's a long time away, but as many folks know, changing careers isn't an easy thing to do, especially if you're already middle-aged or more. 20-something techs entering healthcare now could find themselves being 40-something unemployed down the road. That is not a good situation in a culture so obsessed with youth the way ours has been.
I moved from the insurance industry to healthcare IT in 2011, and while I am grateful for the experience, I would not make the same choice if I had it to do over again.
The money is much better with all the initiatives going on as cbslc pointed out (my salary jumped $23k in 12 months). But the very first thing that was explained to me was "We treat every doctor as a VP" - basically, if a doctor is upset with the hospital, there is the fear he will take his business (both his own employees and his patients) to another hospital. The amount of money that can potentially be lost is huge. So you end up with doctors who refuse to listen, don't have time to troubleshoot when they have issues, and just want you to "fix the damn thing now".
It takes people of special patience to work in this industry. Personally, I decided I the headaches outweighed the rewards, and am moving back to IT in a more sane industry.
The money is much better with all the initiatives going on as cbslc pointed out (my salary jumped $23k in 12 months). But the very first thing that was explained to me was "We treat every doctor as a VP" - basically, if a doctor is upset with the hospital, there is the fear he will take his business (both his own employees and his patients) to another hospital. The amount of money that can potentially be lost is huge. So you end up with doctors who refuse to listen, don't have time to troubleshoot when they have issues, and just want you to "fix the damn thing now".
It takes people of special patience to work in this industry. Personally, I decided I the headaches outweighed the rewards, and am moving back to IT in a more sane industry.
Healthcare IT demands a LOT and pays very little - for work that is usually unsatisfying. No thank you.
Where have you been working?! The pay for HIT Professionals is through the roof. 6 figure incomes are the average for anyone with 10 years of experience. If you aren't getting paid then that is your fault. Just look at Monster and Dice if you don't believe me.
nobody said you had to stay there for your entire life, but you have to start someplace. starting at the top is a fairy tale and it won't take the business world long to relieve you of any of those fantasies. I basically got my feet wet in the biz by working in medical research while I was in college, and it DID pay off. but just like anywhere else you have to pay your dues, and take crap from some arrogant doctors sometimes. on the other hand there are some doctors that you would want to keep as friends and a lot of nurses who have less in the ego department and more talent than the doctors
I work for a health care software provider and while our customers are demanding, we do have a layer of insulation from the clinicians themselves. Personally, I'd go crazy supporting the clinicians.
I have worked in healthcare IT for 30 years and it is not a good option. First, healthcare IT pays poorly for the starting person. Secondly, healthcare IT is heavily regulated and behind some trends (e.g., the BYOD debate could be inconsequential in a healthcare environment). Third, and this is part of the old Catch-22, it is an environment that really needs experience. While it is true that many current H/R folks are simply looking for buzzwords, some of the candidates they send are totally unprepared (sure, they may have years of .NET experience, but they have no idea what they are doing with it ... but everybody needs 'worker bees'). Plus the end users are some of the least sophisticated and most demanding ever.
HIT for over 30 years?! sounds like you never collected unemployment. That is the beauty of HIT, you are never out of work, even during a poor economy! Obama's health plan ensures that we HIT's will be employed for the next 20 years. Even if it is repealed the other party has a plan of their own thus ensuriing our job security...
Yes, all are required, but if the system isn't clinical, it isn't funded. Back end decisions are often made on two year old information because the researchers and clinicians see no value in spending on anything that isn't directly related to patient care. And pay is pathetically low, as has been stated already.
If you're interested in clinical facing support, you can be on the cutting edge of technology, but the trade off is having to deal with some very large egos, who may or may not know what they're talking about on a technology level, but most certainly do believe they know what they're talking about. And you'll likely be paid at least moderately well.
If you're interested in back end/infrastructure support, you'll stay busy (at least at my workplace), and you won't have to deal with the researchers/clinicians, but you certainly won't be on the cutting edge.
As for another poster's comment about BYOD being a moot point in healthcare. Not here. ALL the doctors want to use their own devices, and they want to use them as if they were corporate devices...
If you're interested in clinical facing support, you can be on the cutting edge of technology, but the trade off is having to deal with some very large egos, who may or may not know what they're talking about on a technology level, but most certainly do believe they know what they're talking about. And you'll likely be paid at least moderately well.
If you're interested in back end/infrastructure support, you'll stay busy (at least at my workplace), and you won't have to deal with the researchers/clinicians, but you certainly won't be on the cutting edge.
As for another poster's comment about BYOD being a moot point in healthcare. Not here. ALL the doctors want to use their own devices, and they want to use them as if they were corporate devices...
Between the prevalence of obsolete systems, HITECH and the change to IDC11, the possibilities for improvement in Healthcare IT are limitless. I see projects every day I long to sink my teeth into, but getting funding is another thing entirely. With all of the business pressures on healthcare providers it is a wonder we have so many people practicing good medicine at all. As IT professionals, we should be looking at all the ways we can reduce friction in the providers' systems so they can focus on getting people well.
As noted above, the physicians exert too much control in that industry - and this leads to technical concessions that healthcare IT professionals can be left holding the bag for, including both civil and *criminal* penalties.
Healthcare IT is seen as another cost-center by providers - and this means that you're entering into a hostile environment from day one. If you work at a technology driven company where productivity is tangibly increased by IT, you'll have a much more positive relationship with the individuals making decisions. Finding that environment in healthcare is rare. The physicians can be condescending and tend to regard IT professionals as snake-oil salesmen and not legitimate, educated professionals like they consider themselves.
It is also an industry that has remained static and resisted technological encroachment longer than just about *any* other industry around. It isn't uncommon to enter a GP where the practice still has *most* of their office dedicated to rows of file cabinets storing physical patient records. Many physicians, especially the older ones, resent EPM and EMR solutions. They're uncomfortable with the technology, it challenges them and makes them feel like they're not in control, and that is like a spark in a coal mine with the ego many providers carry with them.
I did not look to replace my last position with another in Healthcare when I exited.
Healthcare IT is seen as another cost-center by providers - and this means that you're entering into a hostile environment from day one. If you work at a technology driven company where productivity is tangibly increased by IT, you'll have a much more positive relationship with the individuals making decisions. Finding that environment in healthcare is rare. The physicians can be condescending and tend to regard IT professionals as snake-oil salesmen and not legitimate, educated professionals like they consider themselves.
It is also an industry that has remained static and resisted technological encroachment longer than just about *any* other industry around. It isn't uncommon to enter a GP where the practice still has *most* of their office dedicated to rows of file cabinets storing physical patient records. Many physicians, especially the older ones, resent EPM and EMR solutions. They're uncomfortable with the technology, it challenges them and makes them feel like they're not in control, and that is like a spark in a coal mine with the ego many providers carry with them.
I did not look to replace my last position with another in Healthcare when I exited.
I'm seeing some commenters saying that health IT is a bubble about to burst, while others are saying it's an under-funded field in need of a technological jump-start. How can both be true?
The bubble is from the incentive programs. The need for jump start comes from the crappy quality of EHR products. For example, our hospital system will have spent over $20 mill on a large EHR. The EHR is based in MUMPS/Cache. This is a proprietary "database" that is difficult to get data out of. So we have tons of interfaces and KB SQL(requiring a separate product) to send data here and there to other proprietary systems or to an actual operational data store. So $20 mill spent and many big non-interoperable systems getting in place. That $20 mill was borrowed with the idea that the incentive money would pay it back over then next 5 years. However, the measures that need to be met to get the full incentives get harder every year. We are finding out that even if our EHR can do it (which is a challenge, updates every week...), the physicians do not want to spend the extra hours doing data entry. So the end result is a very low measure compliance and now we are not expecting to get the full incentive amounts. Our projections are that we will be several million short. So to summarize: incentives created bubble, big EHR's rely on old/proprietary systems, can't meet needed measures for full incentives and ultimately short of full funding to pay off EHR implementation loan. Ultimately, we jump started a 1972 computer system.
I noticed that it was described that some pharmacies in the USA are still try to decipher hand written scripts. Maybe US IT should take a look at Australia. Of all the doctors I have been to all of them have a computer generated script which they print out and then sign it. They all have computers on their desks where they enter the details of the consultation. Australia is moving towards E-records where the patient carries their records with them and if they go to a different doctor than they normally do then the treating can view the patient's records without the patient trying to remember everything.
Though even with the GP's there are restricted to 2 main Programs Medical Spectrum and Pratics, both still needs lots of work and the new Federal Initiative of E Health leaves lots to be desired.
Col
Col
I've worked in health care IT in both pharmaceuticals (sales & clinical) and claims processing. It IS rewarding, meaningful work. Whenever the work gets hard, I remind myself that people's lives and livelihood are at risk. The only beef I have is with HIPAA regulations (Health Insurance Portability and Accountability Act). I fully understand the need for it. The consequences are: it's very difficult to do meaningful systems testing or even software bug resolution. I work with health care providers who interact with software I help develop. The HIHs (health information handlers) are held to a higher HIPAA standard than providers. The government (Medicare and Medicaid) IT systems I work with barely provide any test environments. Try doing bug fixes or enhancements and not being able to do a true end-to-end test. Really focuses the programmer's mind!
The federal government is updating the National Health Information Technology Strategic Plan. The Cornell e-Rulemaking Initiative (CeRI) has partnered with the Office of the National Coordinator for Health Information Technology (ONC) to facilitate public participation in these efforts. CeRIs participation website (http://planningroom.org/) provides a forum for understanding the goals and strategies for development of e-health records, health information exchanges and consumer health IT products. It makes it easier for a broad range of interested participants doctors, patients, caregivers, other healthcare providers and developers to have their say. If you have any suggestions or comments relating to the adoption of e-Health practices in the US healthcare system, join the discussion at http://planningroom.org/
Most of what I infer from reading about NHS IT is a saga of poor vision, defective strategy, incompetent management and outsourced and uncontrolled execution. My perception may be wrong - my sources are public domain news and views. I believe the NHS is potentially the best thing about UK, and was once the envy of the world. I also believe there are many dedicated and competent technical staff working there.
However, the scale of recent alleged problems - of which IT/IS problems are only a part - has seriously damaged its reputation.
I would like to use my decades of IT/IS experience - and wide programme management experience - to contribute. But, because I have not worked on NHS systems, I am specifically excluded from most of the positions I see advertised.
In my experience, if an organisation is suffering the type and scale of problems reported for NHS IT, then many management incumbents - at all levels - need to be replaced The "corporate culture" also needs to be adjusted - and key knowledge and skills built up in-house. It's unlikely they will improve the situation if they continually re-hire and recycle the very people who created the problems - and outsource the technical skills inventory to anonymous third-parties.
This is hardly a new observation - and aligns with a saying attributed to Einstein - We can not solve our problems with the same level of thinking that created them.
Maybe it's time for a radical change. Not just the creation of fashionably buzz-worded new organisation charts and dashboarded process frameworks - and then shuffling the existing players into new locations and job titles.
Get some deeper thinking, and broader experience in there - and ensure the knowledge is retained in-house for the future.
However, the scale of recent alleged problems - of which IT/IS problems are only a part - has seriously damaged its reputation.
I would like to use my decades of IT/IS experience - and wide programme management experience - to contribute. But, because I have not worked on NHS systems, I am specifically excluded from most of the positions I see advertised.
In my experience, if an organisation is suffering the type and scale of problems reported for NHS IT, then many management incumbents - at all levels - need to be replaced The "corporate culture" also needs to be adjusted - and key knowledge and skills built up in-house. It's unlikely they will improve the situation if they continually re-hire and recycle the very people who created the problems - and outsource the technical skills inventory to anonymous third-parties.
This is hardly a new observation - and aligns with a saying attributed to Einstein - We can not solve our problems with the same level of thinking that created them.
Maybe it's time for a radical change. Not just the creation of fashionably buzz-worded new organisation charts and dashboarded process frameworks - and then shuffling the existing players into new locations and job titles.
Get some deeper thinking, and broader experience in there - and ensure the knowledge is retained in-house for the future.
I rarely or never see any job offers for IT in health care. I'm close to retirement, healthy and I believe I could make a difference.
The one comment that comes to my mind while reading the article and the comments is : "Gee, we're not the only one !".
In most other fields, if IT fails, money gets lost. In HC, lives get lost (AND money, too, admittedly). Another difference is that a hospital is never as necessary as in the case of a major catastrophe, which makes disaster recovery quite a different challenge. I've had recently an outsourcer saying to me that if the city was wrecked by an earthquake, his staff might have other concerns than business continuity; that outsourcer is obviously more used to hosting banks and insurance companies systems than 1000-beds plus public hospitals'.
In most other fields, if IT fails, money gets lost. In HC, lives get lost (AND money, too, admittedly). Another difference is that a hospital is never as necessary as in the case of a major catastrophe, which makes disaster recovery quite a different challenge. I've had recently an outsourcer saying to me that if the city was wrecked by an earthquake, his staff might have other concerns than business continuity; that outsourcer is obviously more used to hosting banks and insurance companies systems than 1000-beds plus public hospitals'.
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