The Problem with Health Care Technology

I've been ruminating a lot about Dave Winer's thoughts on this and this. There's a great divide between those who have problems to solve, and those who develop the technology to solve the problems. The consequences of this are kind of frightening when you extrapolate them to industries like health care. Here's an example:

There is a cardiac monitor. It's at the center of the patient's care in the ICU. It produces the information that the caregivers need to maintain this patient's fragile state of health. The nurse watches the data coming out of this machine like a hawk. She uses a set of protocols to record the data, and to make decisions about how to respond to the data.

There is a problem. An overwhelming number of alarms get through to the nurse that don't require action. They occur as a result of the patient moving in the bed, or if a sensor slips out of place. We call these "nuisance alarms." In a perfect world they would be eliminated, but because of the critical nature of the data being collected, the alarms continue, creating a stressful, noisy environment. The opposite of how you need things to be to be when you are attempting to heal someone.

But more than that - there's a danger. Imagine when a series of alarms are going off and the nurse or tech who is responsible for watching the monitor stops responding to them because they are nuisance alarms. 25 nuisance alarms go off in a row, but then the 26th alarm is real, and requires a response. But no one responds. The patient dies. This actually happens. We call these "sentinel events." You can read more about them here.

Then there's the company that produces the patient monitoring technology. A top level executive has gotten the idea that there should be metabolic data built into this monitor. It's a noble idea. Theoretically this could improve patient outcomes with sepsis, a common ICU affliction. But at this point it's only theoretical. And few if any of the clinicians caring for the patients have asked for this feature. Nonetheless, they build this feature into the monitor, and implore the salesforce to go out and convince the clinicians that they need this feature. If the whole thing works, the top level executive gets a big promotion.

Meanwhile, there are armies of start-ups working on shiny little apps that "track your health." The kind that Biz would probably green light. They're fun and easy to use and who knows - maybe in the long run they will solve some problems. But the people with the boots on the ground (the clinicians) have urgent problems that need to be solved. Unfortunately, they are too far removed from those who are developing the technology. How do you cross that divide?

And speaking of boots on the ground, try extrapolating the above example to the military. That's when things really start to get scary.

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By The Blog Where I Learn to Use Fargo, Tuesday, July 23, 2013 at 10:22 AM.