My only request: can I help design the licensing exam?
It would be designed especially to root out the "usual suspects", e.g., shiny-haired, impressive-sounding, but otherwise incompetent "experts", "process jocks" and "process babes" with tunnel vision who believe the whole world operates like a Model T assembly line and create fiascos like this one, snake oil salespeople, and Medical Instamaticists, among others - although with a bit more finesse than used by Keyser Söze:
Health IT breakthrough possible in Washington by Eric Novack
Dec. 13, 2007
Unnamed senior officials at CMS confidentially report that serious bipartisan discussions are ongoing to help get the Health IT bill completed.
“Electronic medical records and e-prescribing, if mandated throughout the country, would save thousands of American lives each year”, one CMS official stated [as long a physicians are not coerced to be the venture capitalists and R&D arm/beta testers for the HIT companies as I posted here - Ed.]
A senior Democrat house staffer, speaking on condition of anonymity, said that the leadership thinks that the current situation, where dozens of private companies are aggressively competing against one another to get a foothold in the world of health IT, is counterproductive, wasteful, and costing lives.
“Venture capital and the drive for profits is a distraction that this country, with 47 million uninsured, can simply not afford.”
Proposals apparently under consideration include banning advertising of health IT to doctors, licensing requirements for anyone involved in the sale or promotion of health IT products, and a special ‘health IT tax’ on health IT companies which would allow the Office of the National Coordinator of Health Information Technology (ONCHIT) to distribute funds to areas of the country that lack a health IT infrastructure.
Calls to House Speaker Nancy Pelosi (D-CA) for comment have not been returned.
I first called for greater control of the HIT field almost a decade ago here (warning: crude, un-updated web page at that link):
... Healthcare IT seems to be a largely unregulated industry in terms of qualifications and certification, exactly opposite to medicine. (Imagine if anyone could practice medicine, if they were able to get enough "experience" through reading books or attending a varying number of unregulated training classes and "on the job" training.) Further, there are no standardized metrics of performance in clinical computing as there are in delivery of medical care, such as physician report cards showing morbidity and mortality rates.
At the beginning of the 20th century, medical education and practice was largely unregulated. In 1910 the Carnegie Foundation published the Flexner report which depicted a lack of admission and curriculum standards in medical education and accreditation, and poor quality facilities among medical education institutions. Flexner's report stimulated system-wide reform in medical education with programs integrating a scientific base and government implementing rigorous testing and certification boards to protect the public.
In January, 1995, the Standish Group reported that 52% of IT projects overrun their initial budget estimates by 189%, and 31% are canceled before completion. A report published in Computerworld (June, 1998) stated that 63% of large IT projects are delivered late and 58% are brought in over budget. Even more damning is the report in The Wall Street Journal (April 30, 1998) which states, "42% of corporate information-technology projects were abandoned before completion." In medical terms, the mortality rate of IT projects is too high. A sobering thought when one considers that each year in the USA, information technology projects are launched at a cost of $250 billion. (From a report by Gopal K. Kapur, Center for Project Management, Palm Desert, Calif.)
A story in the newspaper USA Today, "When Computers Fail" (Dec. 7, 1999), puts the cost of IT failures at $100 billion per year in the United States. Significant, expensive IT implementation failures at varied organizations such as Nasdaq, Hershey Foods, Whirlpool, state agencies, and the Pentagon are cited as just a few examples.
Notes one technology consultant in this story, "There's this mystique that these systems are managed and built by the most qualified pros on the planet. But most [I.S. personnel] are just regular Joes who aren’t measured for any standards about what they know. If you can program your Nintendo and can do a good selling job, you’re a hot commodity."
... Such a lack of standards on education and accreditation for healthcare IT workers contributes to healthcare IT's morbidity and mortality, and is likely to contribute to patient morbidity and mortality as well. At the same time, a milestone Nov. 1999 report "To Err is Human: Building A Safer Health System" from the Institute of Medicine (of the U.S. National Academy of Sciences) describes almost 100,000 deaths each year as a result of preventable medical errors. The report indicates that such errors are often caused by information-related problems (such as illegibility and unavailable or inaccurate records) at the point of care. Corrective measures at a national level are being recommended. Success and quality in healthcare IT are imperatives in correcting this problem.
Considering the critical nature of healthcare, standards of accreditation for those who want to work in clinical computing settings, and metrics for performance, will be of significant benefit. Healthcare accrediting agencies such as JCAHO (Joint Commission on Accreditation of Healthcare Organizations), American Medical Association, etc. should consider requirements for healthcare IT workers involved in clinical computing, and perhaps move towards basing accreditation of hospitals on the presence and proper roles (i.e., authority) of medical informatics-trained clinical personnel.
I stand by those words today.