Superfreakonomics_ global cooling, patri - Steven D. Levitt [33]
Smith and Feied discovered more than three hundred data sources in the hospital that didn’t talk to one another, including a mainframe system, handwritten notes, scanned images, lab results, streaming video from cardiac angiograms, and an infection-control tracking system that lived on one person’s computer on an Excel spreadsheet. “And if she went on vacation, God help you if you’re trying to track a TB outbreak,” says Feied.
To give the ER doctors and nurses what they really needed, a computer system had to be built from the ground up. It had to be encyclopedic (one missing piece of key data would defeat the purpose); it had to be muscular (a single MRI, for instance, ate up a massive amount of data capacity); and it had to be flexible (a system that couldn’t incorporate any data from any department in any hospital in the past, present, or future was useless).
It also had to be really, really fast. Not only because slowness kills in an ER but because, as Feied had learned from the scientific literature, a person using a computer experiences “cognitive drift” if more than one second elapses between clicking the mouse and seeing new data on the screen. If ten seconds pass, the person’s mind is somewhere else entirely. That’s how medical errors are made.
To build this fast, flexible, muscular, encyclopedic system, Feied and Smith turned to their old crush: object-oriented programming. They set to work using a new architecture that they called “data-centric” and “data-atomic.” Their system would deconstruct each piece of data from every department and store it in a way that allowed it to interact with any other single piece of data, or any other 1 billion pieces.
Alas, not everyone at WHC was enthusiastic. Institutions are by nature large and inflexible beasts with fiefdoms that must be protected and rules that must not be broken. Some departments considered their data proprietary and wouldn’t surrender it. The hospital’s strict purchasing codes wouldn’t let Feied and Smith buy the computer equipment they needed. One top administrator “hated us,” Feied recalls, “and missed no opportunity to try to stonewall and prevent people from working with us. He used to go into the service-request system at night and delete our service requests.”
It probably didn’t help that Feied was such an odd duck—the contrarianism, the Segway, the original Miró prints on his office wall—or that, when challenged, he wouldn’t rest until he found a way to charm or, if need be, threaten his way to victory. Even the name he gave his new computer system seemed grandiose: Azyxxi (uh-ZICK-see), which he told people came from the Phoenician for “one who is capable of seeing far”—but which really, he admits with a laugh, “we just made up.”
In the end, Feied won—or, really, the data won. Azyxxi went live on a single desktop computer in the WHC emergency room. Feied put a sign on it: “Beta Test: Do Not Use.” (No one ever said he wasn’t clever.) Like so many Adams and Eves, doctors and nurses began to peck at the forbidden fruit and found it nothing short of miraculous. In a few seconds they could locate practically any information they needed. Within a week, the Azyxxi computer had a waiting line. And it wasn’t just ER docs: they came from all over the hospital to drink up the data. At first glance, it seemed like the product of genius. But no, says Feied. It was “a triumph of doggedness.”
Within a few years, the WHC emergency department went from worst to first in the Washington region. Even though Azyxxi quadrupled the amount of information that was actually being seen, doctors were spending 25 percent less time on “information management,” and more than twice as much time directly treating patients. The old ER wait time averaged eight hours; now, 60 percent of patients were in and out in less than two hours. Patient outcomes were better and doctors were happier