RE: Washing hands and compensation systems...
We've known since Pasteur about germ theory, and that hand washing saves lives. We've been pounding the hand washing pulpit in health care for over a century. Why don't we wash hands every single time we need to? I forget and I have other things that are "more important". So, you need to make infection control, or good hand washing more important to the individual practitioner. What other ways do you have of doing that? Give people a cattle prod to shock people every time they touch a patient without washing hands? No, give them an incentive for good behavior. It's basic Pavlovian psychology. Ring bell -> salivate. Pay people for no infected patients -> more hand washing.
RE: monitors talking to me...
My monitors already "talk to me" too much. There are many many beeps and buzzes that I ignore constantly. There are one or two kinds of beeps that I watch very closely, however. When I hear those, I go running to the monitor. Everything else, I ignore. A voice telling me to wash my hands would get ignored like the others.
Re: computerizing tasks.
It's a decent thought, but resistance to change is extremely high in health care, especially technological change. I work at a hospital now that transitioned to a new computer system hospital wide two months before I started. The entire hospital was pretty much in full-on revolt against the new system, and even now, 18 months later, there's still tons of animosity against the software and the IT people. It was a nightmare. So, there are many, many cultural issues that prevent adoption of high tech practices.
Battery time. I work 12 hour shifts, and in many hospitals I've worked at, I haven't even gotten a lunch break. A number of places I've worked, I don't get time to go to the bathroom for 12 hours. A PDA battery is not going to last a 12 hour shift, and nurses don't have time to change the batteries. If that's the case, they won't use the technology.
RE: startups in the health care field... The liability involved is astronomical. Getting a new medical device or new product through the FDA hoops is a nightmare and extremely costly. And, what happens if you have an obscure bug, and your IV pump that contains a life support drug runs dry, and the nurse isn't notified. In a number of cases, the patient could die if the drug is stopped for more than a few minutes.
What happens when the patient dies from a random complications, and the family is upset about the care received? They sue everyone involved. Even though your software/PDA product wasn't involved in the patient's death, you will get named in the lawsuit simply because you are considered a "deep pocket" and your product was involved in the care of the patient. You end up hiring a very extensive legal department when you have any sort of medical device. You have to.
Regarding the monitor beeps and buzzes, I always thought that was stupid. The Philips monitor in the ICU that I visited would beep loudly ten or fifteen times when the respiration rate went below 8. That means, every time the patient turned over, if the respiration rate went to 8 for even a split second due to the wires moving and incorrect readings, the machine started beeping incessantly. Even if the rate went back up, it continued to beep. That's a software bug, and it just makes doctors and nurses ignore the beeps even more.
I think beeping should be one of those sacred controlled sounds that are specifically designed, like fighter jet codes, to mean a single thing and only a single thing. They should be regulated extremely, and only used when absolutely necessary. One of the IV pumps I've seen played a little song when the bag ran out; it was similar to Jingle Bells. What the fuck?
Just because your monitors talk to you too much doesn't mean that having them talk to you more is a bad thing. The problem is that they beep and talk to you too much for stupid things. It needs to be better-regulated. If the low-resp alarm starts going off, no one even flinches until it's going on for more than fifteen seconds, because the machines beep all day long for false alarms. How hard would it be for someone to fix the software so that it waits 3-5 seconds to check for errors before it starts beeping?
I think that voice-controlled computers for checklisting would be a great idea that would save lives. And if you think that's too annoying, maybe there should be a financial incentive for you to use them. If you don't use the voice checklisting, you should lose money. There's pavlovian psychology that causes instant gratification.
Battery time is an interesting issue that I hadn't thought of. But to discount the use of PDAs because of batteries is kind of strange, especially if you think the idea is good. If it saves lives or helps nurses do their jobs, then the technology can be adjusted to fit the situation. There are batteries out there that can probably last 12 or 15 hours; and if they don't work, why is it so hard for a nurse to simply exchange a PDA in in the nurses station (taking 5 seconds)?
Regarding the adoption of technology in hospitals: The hospital I visited also had just a year earlier introduced a hospital-wide computer system for patient tracking. The nurses hated it because it is "a pain to use" and the computer locks the medicine drawers until it thinks the patient needs the medicine. Even the crash cart required a 10-character password before it would dispense any medication; how fucking stupid is that? My point is that the resistance to adoption is probably due to the poor design of the software. In web software, good user interfaces and ease of use are important to get business. In hospitals, it's imperative because it saves lives. And yet startups and innovative companies with talented software designers are afraid to enter the healthcare market because of the huge costs involved, like you said.
I think it's a shame. A well-designed hospital-wide system that contains all of the hospital operations (BP monitors, IV pumps, pulseox, CT scans, etc, etc) can prevent deaths because of standardization and ease of use.
RE: monitors talking to me... My monitors already "talk to me" too much. There are many many beeps and buzzes that I ignore constantly. There are one or two kinds of beeps that I watch very closely, however. When I hear those, I go running to the monitor. Everything else, I ignore. A voice telling me to wash my hands would get ignored like the others.
Re: computerizing tasks. It's a decent thought, but resistance to change is extremely high in health care, especially technological change. I work at a hospital now that transitioned to a new computer system hospital wide two months before I started. The entire hospital was pretty much in full-on revolt against the new system, and even now, 18 months later, there's still tons of animosity against the software and the IT people. It was a nightmare. So, there are many, many cultural issues that prevent adoption of high tech practices.
Battery time. I work 12 hour shifts, and in many hospitals I've worked at, I haven't even gotten a lunch break. A number of places I've worked, I don't get time to go to the bathroom for 12 hours. A PDA battery is not going to last a 12 hour shift, and nurses don't have time to change the batteries. If that's the case, they won't use the technology.
RE: startups in the health care field... The liability involved is astronomical. Getting a new medical device or new product through the FDA hoops is a nightmare and extremely costly. And, what happens if you have an obscure bug, and your IV pump that contains a life support drug runs dry, and the nurse isn't notified. In a number of cases, the patient could die if the drug is stopped for more than a few minutes.
What happens when the patient dies from a random complications, and the family is upset about the care received? They sue everyone involved. Even though your software/PDA product wasn't involved in the patient's death, you will get named in the lawsuit simply because you are considered a "deep pocket" and your product was involved in the care of the patient. You end up hiring a very extensive legal department when you have any sort of medical device. You have to.