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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Healthcare IT or Not: No excuse for bad service

Healthcare IT or Not: No excuse for bad service

  • Comments 4

I applaud my colleague Michael Millenson for shedding light on a very important topic in HHN's January 11th, Most Wired On-Line Magazine, "A Patient's View of Health IT".  I referenced my own family's horrible healthcare experience in an earlier post on this blog.  While Michael's son's episode happened in a highly wired hospital, our little horror occurred in a setting that was hardly wired at all.  My point is that we must never excuse bad service in a medical setting because of, or due to the lack of, information technology.

Would anyone argue that healthcare is a service industry?  Would anyone dispute that patients should always receive the most dignified, professional and expedient care possible?  Should not all clinicians and hospital workers do unto others as they would want done unto them?  Give me a break!  We shouldn't have to put up with bad service ever; information system or not.  You don't need a computer to show compassion or provide a human touch.  You don't need and can't blame a computer for really bad communication between the givers and receivers of care.  I estimate that my own family member's recent hospitalization cost the government (Medicare) tens of thousands of dollars over just a few days.  Yet did anyone ever explain what the diagnosis was?  Did anyone reach out to the family to inform us what transpired during the stay, why medications were changed, what kind of follow-up was recommended?  Need I go on?

Sometimes I'm honestly ashamed by the way my profession treats its customers; customers who sometimes figuratively and literally are giving us an arm and a leg for their care.  We wouldn't put up with it from a restaurant, bank, broker, carpenter or plumber.  Why do we tolerate it in healthcare?  It's time for change; a change in attitude.  And it will take a lot more than IT to get us there.

Let us know what you think?

Bill Crounse, M.D.  Healthcare Industry Director   Microsoft Healthcare and Life Sciences

  • Once again I find myself squarely in your corner. My wife is a pharma rep and the stories I hear about how badly she is treated in the average physician's office are appalling. Everything from outright sexual harrassment to blatantly nasty behavior seem to be the order of the day...every day.

    Some of this I attribute to physicians bitterness at the way they've have been dissed by insurance companies, government regulators, and the legal/political quagmire we're all in. Of course some of it is our own doing.

    Nevertheless, I think that information technology, if applied in a compassionate way can help alleviate the stress of the profession by giving doctors the tools they need to work efficiently. Without those tools we are simply wasting our time. How sad is a life of wasted time?

    Douglas Krell MD
  • Beneath the professional discussion, I sense and share your passion for and frustration with our health care system.  

    The attitudes and behavior of many physicians and others offering health care services are deeply embarassing for those of us who have seen being a physician as a higher calling.

    In the 1980's working in the bowels of California urban emergency rooms, it became clear where the rubber meets the road that the health care system and the majority of physians in that system had become deeply tainted by the  fee for service system in which they found themselves.  

    The raw truth was if a patient with an evolving MI came to the ER and had an insurance card, he or she was cathed and found themselves in the OR for bypass surgery.  If a patient did not have insurance, they were given an IV and a portable monitor and sat waiting on a gurney for a transfer to County Hospital where they would be "watched" if a nurse had the time.

    Obviously the standards of care for evolving MI have changed but the essence of the problem remains.  In the largest industry in the world [U.S. Health Care] most of the economic benefit for providers derives from illness and injury.

    Almost no one providing health care services in the U.S. is economically rewarded for preventive care with the goal of preventing or mitigating disease and its symptoms.  In the U.S., the sicker you are, the more money your physician or surgeon makes.

    I found myself meditating on a Chinese model of rural health care said to be practiced 3000 years ago.  In this model, the physician was paid a monthly fee [perhaps a few chickens and some grain and even a pig for larger families].  They received this fee as long as the family was healthy.  However, if illness or injury struck the family, part of all of the monthly fee was withheld until the physician had done everything possible to restore health and harmony.

    At that point, I abandoned the path of proving hands on care as much as I thrived and enjoyed doing that and began to work on the entrepreneurial path of designing and developing preventive medicine hardward and software technology.

    As a trained economist, 25 years ago it seemed clear to me that the health care system would be forced by double digit inflation to begin shifting economic incentives away from sick care and toward preventive care.

    Twenty-five years later it still seems crystal clear that comprehensive, professional preventive medicine from cradle to grave is the holy grail for health care cost containment.  But the economic compass needle  for health care seems to have been stuck longer than expected

    In truth I have been sobered by the slow pace of change and the tenacity of the "fee for sick care service" profit mentality that still permeates our health care system top to bottom.  This confusion between providing top flight health care at every level and making more money on a personal level poisons the attitudes and behaviors of even the most dedicated providers.  An objective analysis can make the case that profit motive poisons health care.

    The core sense of being involved in a "spiritual mission in the real world" has been lost or set aside for many doctors today.  This probably is the at the core of the disturbing attitudes which you encountered while seeking health care services for a family member over Christmas.

    At this point in the battle however, there is one choice:  That is to soldier on with an eye on the goal of developing preventive medicine technology and systems that are good enough to make a material difference in the real world of clinical medicine.

    Al Libke, M.D.
    February 15, 2006





  • Thanks for sharing your perspective, Al.  Having just returned from HIMSS where I walked the several-acre exhibition halls crammed with over-the-top displays of IT and hardware solutions for the industry, I am struck once again by the fact that there is plenty of money in healthcare.  We just need to spend it more wisely.  We need more cost-effective IT solutions, more intelligence behind the decisions we make, more efficient healthcare delivery mechanisms, tort reform, and better reimbursement schemes to reward preventive services.
  • I have been mulling over my latest Consumer Reports magazine on the topic of healthcare from a variety

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