Home‎ > ‎Stern Insights‎ > ‎

Happy New Year

posted Jan 1, 2015, 3:12 PM by Thomas Stern   [ updated Jan 1, 2015, 6:02 PM ]
We have just welcomed the new year of 2015.  This marks the end of my 5th year in private practice, the end of my 10th year of medical practice and the 22nd year since I graduated with a degree in computer science. For the past 22 years I have said "this is the year I put my computer science degree to work in medicine".  There are several barriers that have kept me from fulfilling my desire.  The main obstacle has been a lack of time.  My first year in medical school I tried to support myself by writing code for various  small businesses.  The mental demands of medical school simply would not allow me to do that.  After spending a day in class I simply could not sit down and write code in the evening.  I could not spend my days in front of books and my evening in front of a computer.  I could not maintain my concentration.  I was mentally fatigued.  Instead of writing code I started mowing lawns.  I had no problem doing manual labor after studying.  The physical activity made it easier for me to study.  Things certainly did not improve as I progressed through residency.  In the 3rd year of fellowship I finally found time and developed an asthma decision support system.  Then I discovered the second major obstacle...

Proprietary software.  Ugh.   The hospital where I trained was an early adopter of electronic medical records.  I liked that because I was more efficient using a computer than paper.  I wanted to apply my clinical decision rules for asthma to the hospital database to improve patient care.  I asked for permission to do this.  I think I would have had a better chance asking for the keys to Fort Knox.  I was lucky to get my code put on the hospital network.  As a computer scientist I know there is no technical reason all hospital systems can't talk to one another.  If a system can't communicate it is due to a conscious decision to lock others out. To this day most private medical offices and hospitals operate s if they were an island.  If financial institutions operated with the same approach as medical systems our country would not be able to function.  I finished the asthma decision support code but its impact was infinitessimal compared to what it could have been.

The third major obstacle to my desire to put my computer science knowledge has been regulation.  About 2 years ago I was moving my office IT onto the Google platform.  Finally - I thought - a system that will allow me to rapidly deploy simple programs that can imporve my delivery of care.  Then the HIPAA regulations changed and I had to have a HIPPA agreement with any entity that had access to my data. I had to set up a server in house and abandon the Google platform.  More government regulations have forced me to change vendors in 2014.  I will have to make more changes in 2015.  Luckily Google has decided to take regulations head on and is now signing the agreements that allow me to use their platform.  So here I am.  

I am hoping my patients will notice a change in how they interact with my practice in 2015.  This new web page is a start.  Hardly what I had in mind 22 years ago. Better late than never.