Three reasons why information technology won't save health care

Between rising health care costs, increases in chronic illnesses, an aging population, and the complexity of health care reform, the US healthcare system is facing an onslaught of challenges in the coming years.  In particular, the fragmentation of health care services is a particularly strong challenge to the system as people are living longer while living with more chronic conditions that require some level of monitoring.  On top of this, administrative costs make up at least 7% to 14% of health care spending.

Some argue that administration is the problem, and that it's things like paperwork that clog up the system and make it inefficient.  Leslie Ziegler asks "Can designers and developers save health care?"  and suggests that what we're really dealing with is a design problem. She recommends that entrepreneurs focus on creating better user experiences for patients and providers.  She describes some of the innovative new products and services that have recently been developed by entrepreneurs, like an online diabetes management support group and an app for spine surgery patients to better understand their diagnosis. 

But can a few gadgets really save health care in the US?  Probably not, but it may help some people have better outcomes.  Here's a few other reasons why launching a bunch of technology solutions at health care will not save the system.



1. Too many payers and a lack of transparency.
 Many restaurants have their menus, including pricing, posted outside the front door.  Ever seen this at a doctor's office?  Didn't think so.  Transparency in pricing of medical services and procedures is remarkably absent in a so-called private "market" for health care (I guess it is so private that the prices are hidden).  While some people may argue that health care providers don't disclose prices because they are shady people, the real reason is that prices vary depending on who's paying.  Each insurance company negotiates a reimbursement rate, individuals paying out of pocket pay another rate, and Medicare/Medicaid have yet another rate with the SAME doctor for the SAME procedure.  So posting a price list clearly becomes problematic. 

As high-deductible plans and HSA accounts become more prevalent, some entrepreneurs have developed searchable price databases.  Healthcare Blue Book is one of these, as is OkCopay.  While these don't solve the transparency problem, with people becoming responsible for a larger portion of their health care payments, such databases may force physicians and hospitals to compete on pricing, potentially reducing some of the out-of-pocket costs for consumers.


2. Technology requires people who can effectively use it
3/4 of physicians say that electronic health records distract from patient care.  Less than half believe that electronic health records are designed with physicians in mind, and the percentage of physicians who have a favorable opinion of electronic health records has decreased from 39% in 2011 to 32% in 2012. Design may be a large part of the problem with successful use of digital technology in health care, but that's only part of the answer.

Your new app may be super easy to use, but integrating new technology into an existing organization with its own culture is about more than just learning how.  People come with all kinds of preconceptions about how technology can enable or hinder their goals.  And they might feel like the new technology is just out of place with their daily activities. Enter Christian Briggs and Kevin Makice of SociaLens, who have developed an assessment tool for organizations aspiring to implement new technology, measuring what they call "digital readiness."  Understanding digital readiness can help an organization (or an entrepreneur) to figure out how users might respond to an innovative technology in the context of their work environment.


3. Human error.
The recent story about a nurse throwing away a kidney that was being donated by a living man to his sister illustrates that no matter what else is going on, and no matter how important the task is, people do stupid things.  Wasteful things.  Things that can kill people.  200,000 people die every year from preventable medical errors, more than the number of those who die in car crashes each year.

There is no technology that can completely solve this problem, but if patients have better ways of educating themselves about their health and health care through the use of new technology, we stand a chance at being advocates for ourselves. 

Technology has the potential to drastically change the way that health care is delivered, financed, and taught.  But it's no panacea.  We need to be aware of the ways in which health care, technology, and culture interact when proposing new user-friendly designs.

Women, Technology, and Stereotype Threat

It's no secret that women are underrepresented in the tech world.  With a smaller proportion of women receiving computer and information science degrees in 2009 than in 1985 (it went from 37% women in 1985 down to 18% in 2009!), the future for women in computer science looks bleak.  A recent article on the Women 2.0 blog by Christian Fernandez highlighted the lack of female representation in computer science courses in universities, with women representing only 10-20% of students graduating with computer science degrees, despite some programs starting with a 50/50 gender ratio.  He attributes this to women feeling intimidated by a hostile environment that leaves them feeling inadequate.

The sociological term for this phenomenon is called "stereotype threat," and it means that the individual (woman in this case), being part of society, recognizes that there is a negative stereotype about them. In this case, the stereotype is that women are not as good as men at technical stuff.  Because they recognize this, they become anxious that they will inadvertently confirm the stereotype.  In response, they behave in certain ways that can undermine their success, or, they may overcompensate for what they think will be a negative reaction by working harder than everyone else.  In the first case, they are faced with failure, and in the second, with burnout.  Sociologists have studied this phenomenon in great detail when it comes to racial stereortypes.

But stereotype threat is also a concept that tends to blame the victim.  By saying that women's worries about confirming negative stereotypes are causing them to drop out and feel inadequate, we are missing out on the importance of the social context in contributing to women's under-representation in technology.  In particular, Fernandez's report that women felt the environment in computer science courses was "hostile" towards women, indicates that this is not just about how these women feel about themselves and their abilities.

The context and culture of the university (or workplace) are critical in creating this hostile environment.  This includes things like whether women are in leadership positions, whether the work is structured as competitive or collaborative, and whether efforts are made to highlight the contributions of minorities and ensure they are included in activities.  Thus, it is one thing to prepare young women for university-level coursework, but it is altogether another to create an environment in which they can thrive without gender being an issue.


What's the solution?
Universities and high schools need to place an emphasis on structuring the work environment in a way that doesn't privilege the status quo.  For example, women may feel isolated from the community of computer science students if study or work groups are divided by gender.  Providing opportunities for more interaction among students in a non-competitive environment may help to bring down some of the barriers women face in these programs.  Young women may also be looking for role models, and either bringing in guest lecturers or hiring more female faculty members would provide young women with an opportunity to learn from those who have been there before them.

Why does this matter for startups?
In industries where there are few minorities, like women in tech, it's important to be aware of ways you may be alienating those who are not typical of your industry.  For example, while Beer Fridays can be a great team spirit-building time for small companies, they may also exclude those who choose not to drink alcohol, or who feel obligated to drink alcohol when they'd prefer not to.  This is something that women think about because they are physically smaller and cannot process as much alcohol as men, so two beers for a petite woman could make her quite tipsy while a 200 pound man would barely notice it.  Because of this, some women or people who do not drink alcohol, may remove themselves from otherwise fun group activities.  So try to make your events as open and welcoming to all kinds of people in your business.

What else can universities or businesses do support gender equality in computer science and technology programs?