Superfreakonomics_ global cooling, patri - Steven D. Levitt [32]
Still, you sense that machines remain his first love. He is a fervent early adopter—he put a fax machine in the ER and started riding a Segway when both were novelties—and he excitedly recalls hearing a lecture by the computer scientist Alan Kay more than thirty-five years ago on object-oriented programming. Kay’s idea—to encapsulate each chunk of code with logic that enabled it to interact with any other piece—was a miracle of streamlining, making programmers’ lives easier and helping turn computers into more robust and flexible tools.
Feied arrived at Washington Hospital Center in 1995, recruited by his longtime colleague Mark Smith to help fix its emergency department. (Smith was also a true believer in technology. He had a master’s degree in computer science from Stanford, where his thesis adviser was none other than Alan Kay.) Although some of WHC’s specialty departments were well regarded, the ER consistently ranked last in the D.C. area. It was crowded, slow, and disorganized; it ran through a new director every year or so, and the hospital’s own medical director called the ER “a pretty undesirable place.”
By this time, Feied and Smith had between them treated more than a hundred thousand patients in various emergency rooms. They found one commodity was always in short supply: information. A patient would come in—conscious or unconscious, cooperative or not, sober or high, with a limitless array of potential problems—and the doctor had to decide quickly how to treat him. But there were usually more questions than answers: Was the patient on medication? What was his medical history? Did a low blood count mean acute internal bleeding or just chronic anemia? And where was the CT scan that was supposedly done two hours ago?
“For years, I treated patients with no more information than the patients could tell me,” Feied says. “Any other information took too long, so you couldn’t factor it in. We often knew what information we needed, and even knew where it was, but it just wasn’t available in time. The critical piece of data might have been two hours away or two weeks away. In a busy emergency department, even two minutes away is too much. You can’t do that when you have forty patients and half of them are trying to die.”
The problem agitated Feied so badly that he turned himself into the world’s first emergency-medicine informaticist. (He made up the phrase, based on the European term for computer science.) He believed that the best way to improve clinical care in the ER was to improve the flow of information.
Even before taking over at WHC, Feied and Smith hired a bunch of medical students to follow doctors and nurses around the ER and pepper them with questions. Much like Sudhir Venkatesh hired trackers to interview Chicago street prostitutes, they wanted to gather reliable, real-time data that were otherwise hard to get. Here are some of the questions the students asked:
Since I last talked to you, what information did you need?
How long did it take to get it?
What was the source: Did you make a phone call? Use a reference book? Talk to a medical librarian?*
Did you get a satisfactory answer to your query?
Did you make a medical decision based on that answer?
How did that decision impact patient care?
What was the financial impact of that decision on the hospital?
The diagnosis was clear: the WHC emergency department had a severe case of “datapenia,” or low data counts. (Feied invented this word as well, stealing the suffix from “leucopenia,” or low white-blood-cell counts.) Doctors were spending about 60 percent of their time on “information management,” and only 15 percent on direct patient care. This was a