Dear Bob ...I've read and enjoyed your columns for years. I'm in healthcare IS and have recently changed jobs to being a consultant for a large, hospital software provider.My question is whether you've had any experience in the healthcare market? Why I ask is that despite everyone from President Bush down saying more I.S. is needed in healthcare to solve all the problems (yeah right), my experience is that Dear Bob …I’ve read and enjoyed your columns for years. I’m in healthcare IS and have recently changed jobs to being a consultant for a large, hospital software provider.My question is whether you’ve had any experience in the healthcare market? Why I ask is that despite everyone from President Bush down saying more I.S. is needed in healthcare to solve all the problems (yeah right), my experience is that clinicians (nurses mostly but also doctors, x-ray folks, etc.) look at using a computer as an optional activity. “I’m not a computer person – I take care of patients!”. The feds and hospitals can spend 11 quadrillion dollars on hardware and software but if the intended user base refuses to use it, why bother? The healthcare I.S. rags I read are in agreement that healthcare is behind the curve on implementing useful systems – – well, no kidding. It is a difficult area to automate and the primary clinical users won’t use it. And management makes no more than a token effort to “force” them to. I’ve always wondered why the need to “force” them exists.Having spent my entire working career in healthcare, I can only imagine manufacturing, banking, whatever-not-healthcare, don’t perceive using their systems as an option. Am I right? I have theories about why healthcare is different – a study waiting to happen. Now that I’m working with different clients, I’ve found this to be a universal problem in healthcare (although not one writers appear to be willing to write about.) What’s your (always well thought out) opinion?– In the field Dear Fielder …My opinion might be well-thought-out, but that doesn’t mean it’s well informed. For all I know it’s neither – I’ll let you be the judge.There are quite a few pieces to the problem. The first is intrinsic to the discipline: Human beings vary widely in the symptoms they display to the same diseases, and in their response to medicines. Different strains of the same disease also respond differently to medicines. The practical impact on the medical profession is that it isn’t going to be turned into a set of well-defined processes any time soon. It’s the distinction between a practice and a process, if you’re familiar with that terminology: You put as much intelligence as possible into a process, reducing the level of sophistication required of the people who participate in it. In a practice, following the steps gives you a chance of success – it doesn’t drive success. IT is most successful when it participates in processes. The steps are well defined and it’s possible to establish clear specifications for what IT is supposed to do. Supporting practices is harder because practitioners don’t always know what they’re going to need from the system until they get there. I’m pretty sure this is an issue with the medical trade, just as it is in law.Another challenge is the “rock star” syndrome. Also as with law, doctors – and to a lesser extent, nurses – go through a very long and arduous training program before they’re allowed to practice, and it has a significant rate of failure. Along the way, many doctors (and lawyers, along with celebrities of all stripes) end up with, shall we say, egos of a size that’s a bit larger than is the case with most of us. The focal point is the practitioner, not the process or the enterprise, so avoiding this outcome requires a strength of character that not everyone has.What’s the outcome here? In a sense, it gets back to the point of optimization. Remember that to optimize the whole you have to suboptimize the parts. Doctors, lawyers (and other celebrity professions) are unlikely to accept suboptimization on their part for the greater good of the organization. The organization exists to support them, not the other way around. This makes enforcing the use of standardized technology more difficult. A third factor that I suspect comes into play is what I’ll call the SFA problem. SFA stands for Sales Force Automation. Perhaps the single biggest factor leading to SFA failure is that too many systems have focused on supporting sales force management and too few on supporting the selling process. While I’m entirely unencumbered by facts, it wouldn’t surprise me in the least to find out that many medical information systems are designed to support medical administration, as opposed to being designed to support the practice of medicine. If that is the case, it’s hardly surprising that doctors and nurses, given any chance at all, will ignore them.They should: Their job is to practice good medicine. Sacrificing that to support better medical administration isn’t something I want them to do when I’m their patient.So here’s my advice, if you’re in a position to take it. Start by asking the clinicians how computers could help them do their work more easily and effectively. Listen carefully. Map their insights to what the existing systems currently provide. If they do what they ought to do, a second conversation, in which you say, “I checked, and we can do what you said would be helpful to you. Let me show you how the system can make your life easier,” should be productive. If the systems don’t do this, recognize that the doctors and nurses aren’t being obstinate. They’re being smart.– Bob Technology Industry