This may be heretical.

This may also tick off a lot of current HIT workers. It shouldn’t but it may.

For those it does, please realize that this is not casting fault on your capabilities, your skill sets, your accomplishments – nor those of your organizations or managers or management chain. I’m not holding any of you culpable, simply because you didn’t know better and given the peculiarities of HIT and HealthCare culture and general HealthCare professional and management education – you were not taught better and did not experience the necessary.

So, this is just a little tough love from someone who cares.

Basically, HIT must embark on engaging more technically capable folks on their teams and utilizing clinical expertise more as subject matter experts. Extending their skill sets with deeper technology skills is another approach. There needs to be a de-emphasis placed on clinical experience for HIT workers – in so long as you have a core of clinical workers you can draw on or hire as Subject Matter Experts (SMEs).  Yes, you’re going to want more geeks and nerds around; trust me, we’re way cooler now than we were in high school and we’ve developed some great social skills since.

Many verticals have established as best practice the merging of technically skilled individuals with SMEs. Fundamentally, any modern enterprise – which HealthCare must become if it is to survive – must have an intrinsic ability to detect, assess and implement technical change – which is only coming faster – at the speed of or slightly lagging but not lagging behind from a few years to a couple of decades.  Having the right people with the right technical skills on-board – as part of your brain trust – is necessary.

There are two sidebars here.  The first is that certain regulations could also be decoupled, for example, making it easier for a vendor to support recent browsers instead of being stuck supporting browsers from 3 or more years back. Second, a more technically competent customer can better compel their vendors to deliver technology adept, open solutions. This goes for the patient-hospital relationship as much as it does for the hospital-vendor relationship.

The current inability of HealthCare organizations to leverage modern technologies, assess technological change or otherwise take control of their technology - is unique to HealthCare and one of the fundamental brakes on HealthCare’s ability to efficiently grow. It is, respectfully, insufficient to insist that a HealthCare system is unlike a technology company. Many enterprises rely heavily on IT, as does HealthCare. Unlike other organizations, HealthCare has the least amount of understanding of technology and the technology it uses – too many things are a blackbox in IT. Does every Clinician need to know how a message queue works? Definitely not. But your pertinent HIT staff should know enough about message queues to know the difference between and applicability of synchronous vs. asynchronous, for example.

In HIT the typical HIT worker likely has a clinical background ranging from RN on up and has just enough technical skills to implement a product or work it’s configuration switches. Some of those workers are  more technical when it comes to writing custom scripts or other geegaws to extend or enhance a particular product. As important, while they bring a process-centered mindset from their clinical backgrounds, they lack the process focus on IT.

Who does the Hospital depend on currently? Vendors – consultants or big box vendors whose clinical system they buy.  The vendor comes in and does a turn-key install, their level of involvement being driven by how much the investment the Hospital has put into IT. Again, same 80-20 rule, sometimes a shop get’s more technically capable from the experience, too often it doesn’t, but fundamentally your brain-trust is left anemic.

Note that buying and installing a product is not an investment in IT – it’s a capital cost, a one-time outlay. An investment, for example, is training your HIT folks so that you need to supplement your talent pool when needed, not essentially bring in another layer to your team to get an implementation done. There’s a time for vendors – it shouldn’t be every time.

More technically capable workers in your HIT department are necessary to ensure you’re making the right product choices and laying a good strategic, roadmap for your IT & IS future. Your current, typical HIT worker has grown up in a silo – they should be given the opportunity to evolve certainly but realize  the best approach may be to take advantage of reform efforts and add more technically focused skill sets to your system, and leverage your clinical workers as a critical interface, say as Business Analysts, for example.

Here’s one real word example why. A healthcare system recently bought a web-based decision support system (DSS). The decision was made to feed it data from a particular HL7 stream. The vendor required that this data be formatted (keeping it simple here) as Red-Blue-1-2-Sky. No other format was acceptable; no other data elements were acceptable. So, the already overworked integration team had yet another interface to implement, test, monitor and roll-out.  When a technical resource looked over the project details months later, they discovered that the interface engine the vendor was using was a very well known multi-format, best-practices based system quite capable of consuming a message, say Blue-Sky-1-2-Red-A-Dog, and converting it for the DSS’s needs.  Yet no one had challenged the vendor or pushed back or found a more technically viable and cost effective solution because, at the time, no one had the appropriate technical skills to contribute to that decision. A decision that cost both in capital and on-going operational costs and maintenance! Once it’s in production you also have heightened customer expectations to work through, make it a much more expensive mistake to fix – at which point the mistake is left, adding costs that should not otherwise be there.

There’s other examples I can pull from, ranging from hardware load balancing setup on an extremely rudimentary level but paid for as if it was 5 9’s of uptime,  to a persistent insistence that a particular internet traffic router absolutely, positively could not re-route traffic a specific way – when there were at least 2 How-To’s easily found online.

A compliment of IT workers with deep technology skills that interface within your HIT system can provide the technology guidance necessary to truly leverage IT. Note, by the same token, this would imply dedication by the health system to that goal and a change in how HIT is approached within a system – not as a service, but as an integrated business partner.

HealthCare IT workers are raised and live in a silo where they are experts in their own rights, in their own fields. Unfortunately, that’s not enough, especially not these days with the new focus on HIT for healthcare reform savings and the push to hire gobs of new HIT workers. The right systems and the right technical skillsets that bring a deep understanding of technology are critical if the pitfalls of the past are to be avoided – and new, exciting, productive mistakes made!

Otherwise, we’re all just making the same mistakes over and over and expecting new efficiencies – and isn’t that defined as insanity?