If someone would have told me four years ago that I would be where I am at right now, I would have thought that ‘someone’ was crazy. It’s not the idea that I would be majoring in Computer Information Systems with a minor in Business (although that would’ve sounded partly farfetched); it’s the idea that I have had the opportunity to shadow the Head of Neuroradiology at the Cleveland Clinic in an attempt to help pioneer the new Health Information Systems major at John Carroll University.
Now that sounds crazy.
But, that has been nothing but reality ever since I expressed an interest in the Health Information Systems track exactly one year ago. Even then, I knew this was an opportunity that I could not pass up. And that thought has been only been thoroughly reinforced as time passes by. I’m still earning my degree and the opportunities that have been presented to me have exceeded my expectations. Like I said before, I never saw this coming.
On February 10, 2011 I had the chance to shadow Dr. X, the Head of Neuroradiology at the Cleveland Clinic with Dr. Y. Upon hearing that Thursday was his day to operate, nerves started to fly. We weren’t sure what kind of surgery we’d be witnessing, so my mind started to wander. When we arrived to Dr. X’s office and were instructed to put on scrubs, reality set in. “Nervous” doesn’t even begin to describe what I was feeling. But upon meeting Dr. X, some of those nerves began to vanish. He showed us around one of the many buildings that compose the Clinic. For lack of a better term, I felt like “a big deal.” But there was still the thought of an operation lingering in the back of my mind.
While walked back towards the operating area, I felt like I was not supposed to be there. I have no certification, no biology experience, and I didn’t even sign a release form. I couldn’t back out now, we had hair nets and masks on and the whole nine yards. We met other surgeons and operating technicians who were very helpful and welcoming. I didn’t expect that at all. Because radiation was being used, we needed to wear lead vests, skirts, and thyroid guards. Again, there was no turning back now, although seeing the patient on the operating table gave me the urge to do so. It was then time for us move past the glass that separated us from the location the surgery was being performed. That glass was my security blanket. It then had no purpose to serve as it was time for us to relocate behind Dr. X and the other surgeons and assistants who were near the patient.
The patient had a brain tumor that was scheduled to be removed the following day. What Dr. X had to do was thread a wire through the patient’s femoral artery to see where the tumor was. Once that was located he sent liquid through the tube that was in the artery which contained small water-balloon type particles to the tumor. That cut the blood supply to the tumor, which eventually would “kill” it so the surgery the following day would be “easy.” While Dr. X was doing this, we proceeded to talk to the technicians about the conflict in Egypt, and then would turn around to Dr. Y and I to continue discussing a new HL7 program the Clinic is working on. I was amazed at how lax the operating room actually was. I was stunned about what was happening in front of me. It was an out of body experience, one that I would do again if I had the chance.
After the surgery, which seemed to be successful, Dr. X took us around other departments of the clinic. He showed us an imaging center, a new MRI machine/room, and robots that are programmed to transport pertinent supplies to specific areas.
Upon leaving the clinic, I really couldn’t believe what had just occurred. I was speechless. I never would’ve thought I’d get an opportunity like that; not many people do. All of my nerves and anxieties I had days before the shadowing experience were completely worth it. Like I said before, I’d do it all over again if I had the chance.
The second shadowing experience I had the opportunity to participate was on April 14, 2011 with Dr. Z in the Department of Cardiology for imaging in the Clinic. Dr. Z influences the future electronic imaging distribution strategy for the Cardiac Catheterization lab (8). I was beyond apprehensive about this day; I had no idea what to expect. Once we found his office, Dr. Y, Paul and I were split up among three other IT specialists that work for Dr. Z. I had the opportunity to shadow Rolanda, a systems analyst for the clinic. On that particular day, she had to go into the operating rooms to fix the audio output in one of the rooms, and to work on the live internet feed for the head camera’s surgeons wear while operating. We had to wear scrubs and hair nets and masks, something that I’ve become somewhat comfortable doing this semester. I was able to walk into these rooms and watch what she had to do on the networks, and call in and order new parts for the audio system. We were able to walk in on two different open heart surgeries. I wasn’t able to view them directly, but I saw what was going on via head cam on the 55 in plasma screen right above the operating table. Watching this happening was mind-blowing. Seeing the heart beat was so surreal, something that you only get to see in movies. But I was there; about ten feet away from the operation, witnessing these 5 surgeons replace valves in a patient’s heart.
After seeing the operating room, we were all able to venture up to the server room. Only a computer science major would get excited about this place; but it was thrilling to see all of these servers working in one room, keeping the clinic running. If you think about it, that room is the center of that building. If something goes wrong there, it goes wrong elsewhere. One of the thousands of boxes has the ability to hold one petabyte of information. We also traveled down in the basement to see the transportation robots again. I was told that if one was to break, or you were to cause one to break, you would be charged $250,000.
This experience was quite different from the first one I had. It was focused more on the hardware aspect of computing. While interesting and intriguing, I realized that I’d rather be on more of the software side of things. If I had the chance to do that again, I definitely would. It opened my eyes to a lot, and there are not many people who can just walk into an open heart surgery, or two, especially as a college student.
Healthcare Information Technology has somewhat of a silent prominence in our society. Many don’t realize how imperative it is in day-to-day operations in offices or hospitals. In 2004, President Bush made this importance visible by stating a ten-year; $100 million plan to convert to Electronic Health Records by 2014 (1). Bush felt that this adoption would drive change to the health care system in America, by evolving with the technology push. The original plan was to advance this even further so that patients would carry key chains that contained their information. This electronic record would easily available for any authorized physician to access when necessary (1). This plan also was designed to create incentives for health care providers to adopt and use electronic medical records. Also with this plan, the Office of the National Coordinator for Health Information Technology (ONC) was created (2). ONC was created to lead the establishment of EMR’S in the nation’s health care systems.
As of 2009, only 25-35% of the 5000 American hospitals are using EMR’S (2). Bush’s 10 year plan has now been extended to 2015 and needs further funding to keep on the track. Obama has now taken the project and pledged to supply $10 billion per year to fund this change. This threatens the budget with a $100 billion deficit over the next ten years. That number is daunting to many; however in an industry that spends over $2.7 trillion per year, it’s rather miniscule compared to other spending (2). Dr. David Brailer, an advocate for EMR’S, claims that a successfully implemented EHR system has the ability to save the nation $200-300 billion per year (2). If the system has the ability to cut down duplications, reduce costly errors, avoid fraudulent claims, and coordinate care between doctors and physicians, the nation’s health care system will display the essence of efficiency.
With this need for efficiency comes the responsibility for maintaining privacy. These records, once in place, cannot and should not be easily accessed. For those who can access them, a standard needed to be put in place for the security of the information being accessed. In 1996, The Department of Health and Human Services was required to establish national standards for electronic health record transactions (3). With the implication of the Health Insurance Portability and Accountability Act (HIPPA), effectiveness of the nation’s health care system would improve along with security of the information attached to it (3).
Title II of HIPAA’S “Administrative Simplification” contains three rules. The first rule is The Security Rule. This rule is self-explanatory; it involves security defenses used with a patient’s Electronic Protected Health Information (ePHI). This rule constructs principles health care providers and physicians should abide by to guarantee ideal confidentiality of all electronic records that are accessed. This rule also ensures proper precautions each provider should employ to defend electronic threats such as viruses or breaches of security by other employees (4).
The next rule is The Privacy Rule. This rule guarantees any health information, paper or electronic, is protected, even including health care payments and insurance information. For this to be properly implemented, those with access to Electronic Medical Records are required to study guidelines, watch a video, and pass a test to become HIPAA certified. (4).
The third rule is the Enforcement Rule. This rule involves penalties against any who violate the previous two rules. Violators are subject to pay hefty fines if any of the following rules are breached. Medical information is very sensitive, and if handled or accessed incorrectly, can create threatening issues to all parties involved. The Enforcement Rule also details the process of an investigation, how penalties are determined, and how to appeal these violations in a court setting (4). Some cases even involve time in jail for those who violate HIPAA laws. A doctor in California was sent to jail for 4 months for inappropriately accessing medical records. He was also fined $2000 (5). However, a nurse is facing a charge of 10 years in jail and a $250,000 fine for inappropriately accessing medical records for personal gain in a case that directly involved her husband (6).
According to the U.S. Bureau of Labor and Statistics, jobs in medical records and health information technology are expected to grow 16% through 2018 (7). The technical field keeps growing, and demand is not being filled with qualified employees. Employment is expected to grow faster than the average field. There are jobs available that just require an associate’s degree, but bachelors and masters programs in Health Information Technology create the opportunity for advancement. Bachelors programs require four years of education, with a basis of computer science instruction and a math and statistics background as well. Masters degree programs require an additional two years of education, requiring the degree-seeker to specialize in a certain area of the field (7). With the requirements for EHR’s in the next few years, jobs should be secure for those with degrees in health information.
The classes that I have taken this past year have given me many opportunities to grow as a student, computer science major and an adult. I was exposed to different methods, career paths, people and opinions. Taking Programming Perspectives (CS 302) was a struggle for me, but I feel like I learned so much in that class; computer related and otherwise. I had never been exposed to languages such as C, Python, C++, or HL7; which is why I felt the need to enroll. I knew it was going to be a tough class. I went for extra help on a daily basis; something that I was never really used to before this class. Before that point, classes (in many subjects) came naturally to me. I’d occasionally hit a road block, but I would overcome it within a day’s time. This class took me a semester to overcome. I became extremely frustrated and second-guessed my decision to major in Computer Information Systems many times. If I didn’t understand basic programming languages, how was I supposed to make a career out of this? But with the constant help and reassurance by Dr. Palmer, I fought through the difficult programs and passed the class. This class helped me realize that life isn’t going to be like it has been for me. I’m going to struggle, I’m going to need help, and I’m going to doubt myself. Shutting down isn’t any way to get through those tough times. I just need to open my mind and accept that things aren’t going to arrive to forefront easily. On that same note, I can say that I have experience in more than one programming language. I wish we had more time with HL7; I think an entire class could be dedicated to that language alone. It’s extremely complex and intricate, but would be beneficial to the Health Information track/major.
Health Information Seminar (CS 476) exposed me to many different paths I could take after graduation. It was beneficial for the entire class because there were many different career choices represented; most of these choices began with a degree in Computer Science. Personally, I was interested in those who were involved in Health Information; but many other paths were also represented. This helped us understand and realize that there are many different courses we could all go with the same degree. I also feel a bit relieved about life after college because of this class. There have been times where I feel like I have so much to learn before I graduate. While some of this is true, learning happens after college as well. I’ve learned that it is a “learn as you go” type of industry. I’ve accepted that I can’t learn everything about computers in 2-3 years time. I’m going to need experience out of the classroom, as well as time with a text book. I also enjoyed that many of these speakers that took time out of their day to speak to us were John Carroll graduates. They know where we’re coming from; many of them took some of the same classes we have. It was refreshing to get that similar point of view from those who have been out of the classroom for years. It was reassuring to see the successes of these people as well.
I also am very grateful that we were able to get doctors from the Clinic to speak to us. While on the Health Information track, I now understand that I need to associate with those other than just IT people. Communication is an integral skill in this field. I understood that it was important, but after this class, I realize that communication is imperative to success and promotion in this field. It was beneficial to see an MD’s point of view of IS, which is a point of view that I must be able to understand while on this track. The shadowing experience also helped with that understanding. Like I stated before, I’m not really sure where else I would have gotten the experience to do that; it is something I am extremely grateful for.
With those experiences came other realizations as well. I was able to face the truth that at times, dated views of reality can still make an appearance in society today. I was faced with opinions of others that I could’ve either taken personally or just ignored. Initially, I wasn’t sure how to react, but after much thinking, I understand that dwelling on it or taking it personally wasn’t going to get me anywhere. I could’ve counteracted some things with humor, but decided against it given my current position as an undergraduate. This position I am in is as much as an advantage as it is a disadvantage; given the dated opinions of those in the industry. Being exposed to this before going entering the “real world” has made me realize that no matter where I go, I’m going to have to prove my ability to co-workers; even more so than I had initially prepared.
Switching back to the effectiveness of the class, I really enjoyed the wiki idea. It gave us work to do, and helped us to better understand the topics we couldn’t get that much in depth with. I also think that the assignment we had to do with Cathy Stein’s speech helped the class understand a topic we wouldn’t usually be exposed to. Researching a relative topic before the speech gave the host team a chance to be able to ask more questions and sound somewhat educated on what the speaker is talking about. I think having each host team do some research before the speaker arrives would utilize class time most efficiently.
My outlook on future plans have been somewhat altered due to this path. I’m even more interested in Health Information Systems than I had been before. It has opened my eyes to an industry that is not only growing and prospering, but also integral to health care. As a child growing up, I always wanted to be a doctor. But as my opinions and interests changed, I realized that wasn’t the right path for me. But seeing the opportunities available in the Health Information track, I may end up in the health industry after all, just on a different front.