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IT and Productivity

A long-standing quip is that computers are seen everywhere but in the productivity numbers (due to Robert Solow? Dale Jorgenson?). Why?

James Kwak in the Baseline Scenario blog gives a nice example: electronic records in healthcare. Let me quote:

Also last week, a RAND study revealed that, despite billions of dollars of investment, electronic medical records have done little to reduce costs for healthcare providers. This is more complicated than a simple programming error. The issue here is that projected savings of this kind are typically based on some model of how operations will be done in the future, and that model depends on perfectly-designed software functioning perfectly. Medical records systems apparently fall far short of this ideal: as the Times summarized, “The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems.”

I think this understates the issue: if all that happens is that doctors type into a computer rather than writing notes out by hand (or dictating them), well, doctors and PAs and RNs aren’t selected to be fast at typing, indeed it interrupts their workflow. In many cases MDs continue to do their end by hand — I’ve watched it happen several times of late — and someone else has to type them into the system. (BTW thanks to the internet dictation can be sent to India.) But then to access the information you can no longer just flip through the chart — and we’re very good at scanning pages for the information we need. The net effect is that it slows a doctor down. In addition, medical billing is its own specialty, and what a doctor needs for diagnostic and treatment doesn’t match that. There’s no simplification in billing.

So while Kwak focuses more on issues in software design (the medical case is but one of several examples), for IT to enhance productivity requires in workflow. At present the primary purpose may be quality [and liability] control: medications are all bar-coded, as are patients, and those “giving meds” are required to do a double-scan for everything. Error rates are much lower, it’s now hard to give a med at the wrong time or to the wrong patient. A doctor can still write the wrong prescription and the pharmacy fail to catch it, but now the pharmacy sees all prescriptions together. All of this however does not show up in productivity.