Informatics, or Infomagic? Health IT Cannot Flourish When Everybody is an Expert

I recently saw a hospital ad for a surgeon in my local newspaper:

Professor of Surgery

Must have 5 year post fellowship exp as Thoracic Surgeon, fellowship in advanced minimally invasive surgery of lung & esophagus, & fellowship/post-fellowship exp in thoracic oncology, radio frequency ablation, & airway, esophageal & endoluminal techniques. Board Eligible/Board Certified in General & Thoracic Surgery. Fax resume to James Diehl, MD, Director, Thomas Jefferson University, 215-955-6010.

There is nothing at all unusual about this ad. It calls for someone who has completed premed (4 years), medical school (4 years), internship and residency training (4 years), one or two postdoctoral fellowships (~2 years each) in highly complex subspecialties, and at least five years of experience beyond the fellowship(s). Plus board certification after a grueling series of exams. This is what it takes to be a medical specialist.

Compare this to an ad for a "VP of Global Strategic Informatics" for a large medical consulting and practice management company (in another highly complex medical subspecialty I will not name to protect the organization's identity). I received this:

Vice President and General Manager, Global Strategic Healthcare Informatics

This new position reports to the Chief Executive Officer. Its primary responsibility will be to serve as an architect and builder of a newly formed healthcare informatics business. We seek a seasoned and polished professional with a minimum of 20 years of experience in positions of significant authority and a proven track record of building and leading highly dynamic businesses. Significant experience in the delivery of healthcare services or products is highly desirable.

You must have a proven track record as an entrepreneur, architect, builder, and driver of a successful organization. We prefer a strong leader with a solid general management, planning, business development, financial or marketing background. You must be experienced at working effectively with the investment community, stock holders, and Boards of Directors.

Notable are the domain neutrality of the ad. A VP of healthcare informatics has as a "desirable" requirement experience in "delivery of HC services OR products?" A "solid general management, business development, financial OR marketing background"?

Most notable of all: there is no mention of a true clinical background or formal medical informatics background whatsoever.

Now imagine an ad for a thoracic surgeon that does not call for thoracic surgery experience, just general skills such as chiropractic.

It's as if Medical Informatics is simply Infomagic, to be led by a domain neutral individual who knows something about healthcare, maybe through selling toothbrushes, acupunture supplies, or marketing diet pills and vitamins and "alternative medical products."

Compare this ad to the ad seeking a surgeon.

Several questions come to mind:

• Do the people who composed these requirements know anything about medical informatics?
• Do they know that it is a formal, highly specialized field whose training is supported by the NIH at major universities in the U.S., as well as by foreign governments and universities, and that has been called a critical subspecialty by the National Research Council? If not, why not?
  
• Do the people who composed these requirements know what they are doing?
• Did they consult experts in the field in composing these requirements? If not, why not?
• Do they think there may be value in making knowledge of medical informatics a priority in the candidate requirements? If not, why not?
• Do the stockholders in this company know what is going on?

I was asked if I knew of any hospital executives I could recommend for this position.

I explained to the sender of this ad that I did, but would not recommend them to pursue this position of "Strategic VP for Healthcare Informatics." I explained that the ad shows the crafters were themselves not thinking strategically (or perhaps simply not thinking at all!), and were setting up the incumbent and the company itself for failure in this highly specialized field, especially compared to competitors with more modern views about medical informatics and IT.

I did not receive a response nor do I expect one.

I've personally seen and commonly heard from my colleagues of this scenario - leadership of medical informatics-related activities by novices - causing expensive IT debacles, patient injury and death, severe elevated risk of injury or death, impaired pharmaceutical R&D, distracting infighting between clinicians and management, and other flavors of mayhem.

I've seen and warned against pharmas whose CEO's were engineers or lawyers for fast food chains and whose heads of research IT lacked any biomedical background whatsoever, impairing R&D, hospital CIO's who put contaminated computers over patient's heads in an ICU or whose ineptness in medicine created mayhem in a cardiac cath lab, HIT vendors whose lack of medical experience causes their products to provide a dangerous, mission-hostile user experience (more on that issue to come).

At this point, after my many postings on similar topics about informatics hiring practices here at HC Renewal, my HIT difficulties website, and other writings over the past decade, I can no longer get upset at this. I've fulfilled my medical obligations, such as in reporting on these issues in prominent places, and then some.

I can, however, take a perverse pleasure in knowing my valuable advice, given absolutely for free at a time when leaders of many of our business organizations have been proven incompetent (at best), will likely be ignored as the ramblings of a know-nothing or curmudgeon (or worse). Is this an instantiation of the saying "pearls before swine?"




I can also take perverse pleasure in knowing what companies to take a bearish position on, long term.

I take no pleasure in the harm being caused to patients by these attitudes, however, which I will be reporting on further.

Finally, one day one of those patients being harmed might be ... you.

-- SS