I am an engineer that works exclusively with academic medical centers, hospitals and clinics.
Most hospital expenditures pay for direct patient care. Very little (<2% capital budget) is spent on information technology. When it has funds, each medical department will purchase necessary software and hardware. As a result being purchased over time, clinical, laboratory and pharmacy systems do not often speak well to one another. Hospitals that merge to form an association will often have incompatible systems.
As evidence, let us examine an office visit for a chest condition. The general practitioner orders a group of diagnostic tests across a number of different specialties. The office then calls each department to schedule a visit time. If ordering x-rays, the patient may have his own film jacket to take from clinic to clinic. If the visit is at an off-site clinic, lab results will be faxed to the attending physician office and added to the patient's paper file. If hospital admission is necessary, the paper file, film and lab results are hand carried to the institution.
On an individual basis, this not a problem. However, the Centers for Disease Control reports 823.5 million physician office visits, 42.5 million procedures performed and 33.7 million discharges (2). This represents an extraordinary amount of duplication, faxing, and potential confusion.
My primary job is make hospital systems talk to one another. My secondary job is to design systems that people can use to make good decisions. Another job is to create strategies for future information purchases and to realign their organizations to take advantage of the technologies.
I work at an international public accounting firm. There are >120,000 employees in >700 offices in >120 countries. 2003 revenues were 12.1 bil euro. Over 40% of all employees are in Europe with another 25% in North America. With such a large knowledge base, it is possible to gather leading business and organizational practices from around the world, and to apply them to local hospitals.
The above diagram (Figure 1) provides a framework to further discuss my work. The diagram is broken into four pieces: A,B,C,and D. My work may encompass one, two, or all of the regions.
The letter 'A' represents a single hospitals with a single process. Clockwise, a patient is registered, scheduled, a surgical procedure performed, nursing applied, the patient is transferred to a step-down unit, released, provided post-operative medication, and then the entire medical procedure and financial conditions are analyzed. In such a situation, my job may be to interview users to find the attributes required to select a new system. If a system already exists, we may look at best use and practices, and then optimize parts of their business process and region 'C', the data center.
|At client site in St Louis, Missouri|
In other cases, my job is to study the feasibility of bridging two hospital systems, represented by regions A & B. In such cases, global practices are used to suggest a common set of procedures. We will also assist with identifying and purchasing systems that can translate data from A&B and will provide a common language through data cleanup.
Sometimes, the job is much more specific to Information Technology. Region C depicts networking, physical infrastructure, organization structure, and standard operating procedures (SOP's) used to ensure 100% system reliability for the hospital. We may be asked to provide technology strategy, organizational work, and to apply national and global best practices to their operation.
Hospitals have partners (Region 'D') for clinical diagnostics, knowledge, and medical/ pharmaceutical supplies. Information Technology is used to distribute and receive digital image (x-ray) readings and clinical results from off-site physicians and laboratories. Collaboration and tele-medicine technology can be used to display diagnostic results, an office exam, a lecture, and even a surgery across vast distances. Medical supplies and pharmaceuticals can be ordered on-line and as needed direct from the hospital floor. Clinical procedures can be tied to materials, and then those physical goods would be delivered without human intervention to slow down the delivery and patient care process.
|     birthday party at Engineering Center|
My job is also my vocation. I am good at and I enjoy applying my knowledge, teaching fellow hospital administrators, employees, and staff, and saving money for hospitals. There is a societal need to limit health care spending while providing a high quality care. USA consumption of health care is at 14.4 percent of the total Gross Domestic Product (3). In real terms, this is equivalent to France's entire economy.
Controlling health care expenditures is a public policy question. Between 1960 and 1993, health care expenditures as a percentage of GDP increased from 5.1 to 13.4 percent. Until a national consensus is reached, the best that an individual can do is to work within the framework of the system. During the day, I am working towards making the world a healthier and happier place to live. I am not making goods to be sold at market. When I go to bed, I sleep with the comfort of having helped those who could not help themselves.
(1)The American Hospital Association reports that 66% of all hospital employees work at non-profit hospitals.
(2)Physician Office Visits reported by the Centers for Disease Control and Prevention (CDC), National Ambulatory Medical Care Survey 2000 summary. Procedures and Discharges from CDC Hospital Utilization in non-Federal Short Stay Hospitals 2002.
(3)Health Care Spending as a percentage of GDP for 2001 is reported at $1.4 trillion, or 14.4 percent of Gross Domestic Product. National Health Care Expenditures, Historcal Overview, published by Centers for Medicare and Medicaid Services