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I just read a fascinating article about the future of IT. The article actually focused on alternative ways for IT (“the computer department”) to be managed. And the ideas are intriguing.

Historically, the IT department was filled with engineers, technicians and software developers that effectively work within a black box. CEOs and CFOs of companies knew that they needed computers to run the business. Everyone needed a copy of Microsoft Office, and when a new version would come out, it was the IT people who effectively went machine by machine to update the code. And of course, when the printers didn’t work and Excel didn’t load and there was no access to the server, it was the IT department that handled it.

It is understandable that this organizational structure led to a dissonance between the CEO/CFO and the CIO [the person basically responsible for the IT]. In many companies, even until today, the IT department is seen as a cost without a clear return on investment. When the bills are tallied at the end of the year, the CFO struggles to understand why IT costs went up by 5%. In the past, conversations between a CFO and CIO were at times antagonistic. The CFO would feel that the CIO had no respect for budgets, and the CIO felt that the CFO had no concept of how difficult it was to maintain the system so that there would be minimal downtime.

For many companies, things have drastically changed. The IT department should no longer be a black box. The CIO should have a business strategy that is founded on IT, and should be able to make a case  to the CFO for why $5 million is needed to upgrade the network. There should be a constant exchange between these C–level managers, such that they understand to a good degree, the needs of the other.

But things are going farther than this. IT is advancing so quickly that a significantly sized company must dedicate serious resources to research and development. Also, today’s IT departments should dramatically encourage cross pollination of ideas. A stagnant IT department that knows only how to manage office installations, and to do basic upkeep on an external service that runs the company, is likely doomed to failure. Such an environment sucks the life out of the IT staff and they degenerate into robots, carrying out standard tasks. Good people are lost, and the company eventually becomes stale and boring and uninventive. There are not too many successful companies that can survive being stale and boring and uninventive for very long.

In the medical world, technology is advancing so quickly that an IT department must be incredibly dynamic, in order to learn about, study in depth and then implement appropriate new services. In a previous blog post, I mentioned the latest products coming out of Microsoft. These products will revolutionize software development and the entire user interface. Apple is succeeding in getting people on board with their vision for managing health and research data. All of these innovations have been presented to the market just within the last few months. But an IT department within a healthcare service that does not embrace these new technologies almost guarantees that they will miss critical opportunities to make their company continuously competitive.

I have spoken with colleagues about the fact that Israel is extremely well-positioned to share medical data for both immediate clinical needs and research. Almost every day, there is a another paper that speaks to large population studies that are changing the face of medicine. I will be so bold as to say that there is no excuse for not having a universal anonymized data repository that encompasses clinical data from every Israeli healthcare service. With such a repository, real time statistics on disease spread and patient welfare can be extracted. Not taking advantage of modern-day technologies to build such a real-time data analysis system, dramatically diminishes Israeli physician’s ability to best treat patients.

Some parts of an IT department will have to be dedicated to doing the boring stuff. Whether the servers are in-house or in the cloud, they must be validated and regularly checked for viability. Certain standard reports will have to be generated on a regular basis, and from year-to-year, changing government regulations will demand the new development of incredibly boring forms.

But another part of this same IT department has to sit around the table with lots of Jolt Cola and doughnuts, and dream. Within this tomorrowland, some of the IT members will focus on learning the latest interface technologies. Another member can become expert in cloud-based databases. And so on. The coming together of such a group will generate groundbreaking ideas. I also mentioned in a previous post that one only need look at the demonstration for Microsoft’s latest holographic augmented reality, to realize that medicine will never be the same. If you are the CEO of a major EMR company and drag your heels in embracing these new technologies, you will find yourself falling behind your competition.

Physicians are tired of cumbersome, slow, nonintuitive computer systems that make their work a horror. I was just reading today about hours being spent on a daily basis  just to reenter the medication lists of admitted patients into  the hospital EMR. I apologize for being so brunt but this cannot be the best possible solution. Whether through a combination of OCR and voice recognition, along with dropdown lists to show the most common medications first, the process of reentering prescriptions should take moments, not hours. Voice to text systems that are specifically trained for medical software should allow a physician to read in medication prescription after medication prescription in a very short time. An intuitive and streamlined interface should allow physicians to easily and quickly make changes and adjustments to  already existing prescriptions.

I would actually say that the time it takes for a long list of prescriptions to be entered into an EMR is an excellent test of the ease or difficulty that physicians will experience with the entire system. Coders tend to code in a similar fashion throughout a project. If entering prescriptions is a slow and tedious process, then likely, all other parts of the EMR are slow and tedious. If on the other hand you have a dedicated team within the IT department that is focused on thinking totally out-of-the-box and taking full advantage of the latest and greatest software, they will likely come up with a prescription recording system that is clearly better than anything on the market. Apply the same approach to the other components of the EMR, and the EMR company could start grabbing market share from competitors at a tremendous pace.

I am biased. I have spent over 20 years of my life designing medical software and I am intimately aware of the pitfalls and successes in designing such software. But I am also a physician who made use of this software as I was developing it. For this reason, I am just as loyal to the IT side as I am to the medical side. And I can honestly and emphatically state that the entire process of software development has to experience a mind shift. If not, we will continue to experience evolutionary (not revolutionary) changes in major medical software systems, that are clearly inadequate to deal with the changes in the healthcare reality in the community and hospitals.

Doctors like to remind patients that medicine is an art. Well, software development is also an art. Just like with medicine, there’s a lot of science behind it. But when all is said and done, it’s about creating something that is unique  and special, not just functional.

I truly hope that C–suite managers open their eyes to this new reality. But if at least one company embraces this new model, they will capture the flag, and leave only bread crumbs for other healthcare companies to follow.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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