Micah Chalmer

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The Information Technology In My Recent Medical Experience

I spent most of the past week dealing with a kidney stone. It hurt a lot, and it sucked. But it also gave me a chance to see a huge sector of IT in action that I’ve never worked in before. I got to see this in action at two different hospitals: Lenox Hill Hospital in New York City, and Good Samaritan in Baltimore. And by looking at the tech equipment and thinking about it I could almost distract myself from the horrible horrible pain!

My impressions of the technology as I saw it as a patient:

  • Primary Key - Who Am I Exactly? I was given a wrist band with a bar code on it to identify me at both hospitals. I don’t think Lenox Hill ever actually scanned the bar code. At Good Samaritan they scanned it every time a nurse so much as said hello. Each time I moved to a different department, they would scan the wrist band and then ask me for my name and date of birth, verifying that what I said matched what they scanned on the wrist band. I was surprised that they felt that this sufficed. One time I asked a nurse what they do if they have two patients with the same name and birth date–she said they would then ask for a social security number.

  • Electronic Records - The Future Is Now! In both hospitals the record keeping generally electronic. No clipboards or paper-written notes were taken. Doctors and nurses punched codes into a handheld computer of some sort (it wasn’t any consumer brand piece of equipment that I recognized.) This was really nice since it allowed me to walk to the records department at Lenox Hill and come out with a nice printout of exactly what happened to me in my visit and when. Also, since my primary care doctor and urologist were both in medical offices attached to Good Sam, they could instantly call up images of the X-rays I got at the Good Sam hospital. Good stuff.

  • Sneakernet - The Future Is Not Yet! There was no way to electronically transfer any records between the two hospitals. To get the records from Lenox Hill to Good Sam, I carried a printout (and a CD with my X-rays and scans on it–more on that later) from one place to the other. They also could have faxed it. But no transfer of actual data by wire.

  • Digital Photography - Instant Gratification I also appreciated the fact that all the X-rays and scans were digital and so they could see the image immediately after taking the picture, and they could give me a CD with all the images from my CT scan on it (all 250 or so of them.) But about that CD…

  • Auto-Running Image Viewers - IT Security WTF???? When my urologist, Dr. A, wanted to look at my CT scan, I handed him the CD that I got from the records department at Lenox Hill, and he popped it into his Windows XP computer. Right up on his screen came a program ran that allowed Dr. A to view my X-rays and scans. Dr. A. wasn’t familiar with the particular program that ran, and wasn’t particularly fazed to see an unfamiliar program running on his computer either. He fiddled around with the clunky GUI interface until it showed him what he wanted to see (he even let me play around with it and I was able to figure out how to zoom in for him.) My impression was that it was the generally accepted practice for such CDs to have auto-run programs on them for viewing. I find that very disturbing. The program even had a link to Lenox Hill’s web site in it, which he clicked successfully–which showed me that there was nothing preventing that program from connecting to the internet or doing anything else it pleased on that PC of his. For all we know that program could have been scanning his whole computer and sending my and other people’s medical info to some creep on the internet, while we were sitting there trying to figure out how to zoom in. I don’t think it actually did anything malicious in this case, who knows? All it would have take is for the Lenox Hill computers to be infected with some worm for it to spread to this one. Dr. A’s computer could be sending out spam as we speak. I hope that there is something that the IT folks at his office do to mitigate this that I’m not seeing. But I suspect that there isn’t.

  • Quality Varies - It’s All In The Looks My primary care doctor was very impressed with the readability of the report that I got from Lenox Hill. It is apparently way easier to see what happened than the ones he gets from his own hospital. Seeing that reaction was familiar reminder for my own job–despite being the least interesting part of the software to a programmer, a big part of the quality of any kind of enterprise software is how good and readable the report looks.

I generally liked what I saw–besides the one big WTF in there, the systems looked pretty tight. I’d certainly like it if it all integrated together a little more, but I can appreciate how HIPAA and related regs can put the kibosh on it. And I appreciate them doing so–I’d hate to see the hospital’s records system “integrate” with an insurance company’s decision of whether to take me on, for instance…or an employer’s in deciding whether to hire me.