Healthcare Stovepipes

Originally published June 22, 2006

If any profession is familiar with stovepipe information systems, it is the IT profession. First there were stovepipe applications found in business, followed by stovepipe systems in government systems. Stovepipe silos are found everywhere.

The pain that accompanies stovepipe systems is well documented. It includes the exorbitant cost of maintenance, lack of integrity of data and instability of reports. These aspects of stovepipe systems have been recognized for many years.

But if you think that the commercial and governmental stovepipe systems are bad, take a look at the medical profession. Yikes! You haven’t seen anything until you look at the institutionalized stovepipes in medicine and healthcare.

Recently I was at a distinguished doctor’s office. This doctor – a very nice and knowledgeable person – described how there was no intersection between the records of his office and any other doctor’s office. A patient could visit a gynecologist, a cardiologist, an endocrinologist and a general practitioner, but there would be no systemic, holistic view of data. The gynecologist knows nothing about the patient from the standpoint of the cardiologist. The cardiologist knows nothing about the patient from the standpoint of the endocrinologist, and so forth. These specialists do not share data about their patients with other specialists. Period.

Some of this lack of sharing of data is because of HIPAA, but a lot of the lack of sharing of data would be occurring even if there never had been a HIPAA. The world of medicine is a world of chopped up, little systems where there is no interconnection from any point to any other point.

When asked about the fact that a patient – any patient – might want a truly holistic view of his/her health, the specialist simply said that there is no way to do that.

Perhaps the most disturbing aspect of the conversation was the fact that the specialist had no inclination whatsoever to create integrated data for the patient. There simply was no incentive – no motivation – to step outside of the silo.

The doctors we interviewed were not bad or dumb people. On the contrary, they were very good people who are very smart and truly care about the health of their patients. However, their perspective of the need for information out of the silo is often such that they just can’t imagine it. And I guess that is the really scary part.

As an information practitioner, I know full well the problems the problems that develop around stovepipes. There is an extraordinary expense for everyone. There is the pain of non-integrated information, there is the uncontained sprawl and there is the confusion because there are different values of data for the same data type. All of those symptoms of stovepipe systems have long been recognized.

However, in this case, the person that is hurt is the patient – that’s you and me, in case you hadn’t noticed. If medical data cannot be integrated at the patient level, then a holistic treatment of a patient will never be possible. In the long run, this means ineffective and more expensive healthcare for everyone.

The doctors that we talked to were so wrapped up in their specialty that they could not look up and see the larger picture. They needed redirection when it comes to perspective. As a consumer, I want my doctors sharing information about me. Let me sign some forms giving them permission to share my data. HIPAA be damned. I want the best healthcare I can get, and storing data away in secret little silos is surely not the way for me to achieve the best long-term healthcare.

It is information that holds the promise of a whole new level of healthcare, but as long as we are all satisfied with (or trapped by) stovepipe silo systems, new medicine and new procedures can only progress minimally. And we all will suffer.

  • Bill InmonBill Inmon

    Bill is universally recognized as the father of the data warehouse. He has more than 36 years of database technology management experience and data warehouse design expertise. He has published more than 40 books and 1,000 articles on data warehousing and data management, and his books have been translated into nine languages. He is known globally for his data warehouse development seminars and has been a keynote speaker for many major computing associations.

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