Interview: Dr. Barry Chaiken on healthcare IT

For this special Wisconsin Technology Network edition, we interviewed Barry Chaiken, chair of the Digital Healthcare Conference. Chaiken is a physician and associate chief medical officer of BearingPoint.

WTN: If I'm a hospital executive, what questions should I be asking about my information technology resources now?

Chaiken: Am I getting any value from the money that I'm spending? Value is on two levels. One of them is going to be: Am I saving money and increasing throughput in my hospital? What you're able to do there is leverage existing infrastructure. A bed costs you X number of dollars per day, so if you can utilize that more you can make more money. And then: Am I addressing safety and quality to differentiate my hospital in that space, which is very important in the consumer market?

WTN: Is healthcare behind when it comes to IT? Is it going too slowly?

Chaiken: The successful deployments – and when I use the word successful I don't just mean it's been implemented – successful deployment of technology is going very slowly. We in the marketplace are really struggling with how to do it right, and we are struggling as an industry to change the way we do things so we can obtain value from using the technology.

Maybe a nurse shouldn't take your temperature. Maybe a patient should take their temperature when they walk into the doctor's office. What they do is, they walk up to a machine and they stick it in their mouth, and it goes beep and they've got the temperature. They put their arm in a device and it will take their blood pressure, and they stick their finger in another device and it takes their pulse oximetry plus their pulse rate.

Today the nurse walks in, and there's all this overhead. Maybe the nurse, instead of doing all that, should be listening to the patient's lungs to identify something wrong, then ask the doctor: I heard this murmur, or I heard this wheeze, go listen more carefully.

WTN: You've written about artificial intelligence's role in healthcare. But is anything actually happening?

Chaiken: Isabel Healthcare is basically using a system where you enter in signs and symptoms and it gives you a differential diagnosis. Now, funny enough, Larry Weed, 20-plus years ago, developed something called the problem-knowledge coupler. You entered in all these signs and symptoms, and it gave you a differential diagnosis based on probability. Then it would learn over time.

WTN: 20 years ago?

Chaiken: More than 20 years ago. Unbelievable. Nobody talks about it anymore, but it was really the first thing that was done in the area of these expert systems. But you know what, expert systems are great, and I'm glad people are developing them, but until we start to say to ourselves "How are we going to use them and make them part of the workflow?" they aren't going to be used.

WTN: Does a system like that, which could potentially make the wrong diagnosis or lead to the wrong treatment, need to go through FDA approval? Or as long as the physician makes the final decision, is that not necessary?

Chaiken: Currently, as I understand it, there's no need to go through any sort of a trial process, but that one day may change. I don't know when, but I think it's going to change soon. As long as the physician is involved in making the decision it doesn't have to go through trials.

[And there's] a question of when the liability is going to change. When is the liability going to fall in the hands of the vendor?

WTN: What's it going to take to actually make this happen?

Chaiken: I've been reading Thomas Friedman's book, The World is Flat. One of the things he talks about is, all of these PCs were bought in the 1990s, in particular, yet there was no increase in productivity or efficiencies, and they were saying, "What happened to the IT revolution?" Friedman said it just took time for people to figure out how to use the technology to do things more efficiently.

We have these clinical IT tools, but we're still trying to figure out how to use them to increase quality and to become more efficient. Because of the structure of medicine, the hierarchy of medicine, and its rigidness in the way we do things it's even a little more difficult to break down those barriers.

WTN: You're talking at the Digital Healthcare Conference about IT's role in responding to a flu pandemic. Where is the greatest benefit or need inside the hospital?

Chaiken: I think the greatest values of IT in the clinical setting are going to be emergency room tracking – if they have an available ER – because that's going to be slammed, and patient tracking in the physician's office or the clinics, in terms of getting information out the patient – your test was positive, your test was negative. It's all a question of how well you can automate the transfer of information between people.

For more information about the Digital Healthcare Conference, visit the conference web site, dhc2006.com.