Friday, June 27, 2008

House Energy & Commerce Calls for Sharing of "Lessons Learned" on Health Care IT

U.S. Rep. Charles W. Boustany, Jr., MD, R-Southwest Louisiana, introduced the Patient-Controlled HealthIT Act (H.R. 6345) to allow patients to control their medical records. Electronic medical records have indeed created much potential for misuse. This is an interesting piece of legislation. Boustany, a former cardiothoracic surgeon, introduced the bill to spur investment in Health IT to help reduce the cost and improve the quality of healthcare for all in Southwest Louisiana, an area seriously affected by Hurricane Katrina.

Of even more interest is H.R. 6357, recently released by Energy & Commerce on Health IT: H.R. 6357 , the “Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008", a.k.a. the "PRO(TECH)T Act of 2008."

I note the E&C HIT bill calls for the National Coordinator (ONC) at HHS to prepare a report:

IMPLEMENTATION REPORT. - "The National Coordinator shall prepare a report that identifies lessons learned from major public and private health care systems in their implementations of HIT systems, including information on whether the systems and practices developed by such systems may be applicable to and usable in whole or in part by other health care providers" (Item 5, page 12).

It is possible that the numerous hits I noted from domain "" on my website of collected HIT difficulties over the past few months played a role in this proposed language. I track my site's viewers by IP for research purposes (e.g., see this 2006 AMIA poster "Access Patterns to a Website on Healthcare IT Failure":
Abstract [pdf], Poster [ppt]. Evidence for this is the language at my site's introductory page to lessons learned:

"Organizational and human factors issues associated with healthcare IT have led to project difficulties and failures. Detailed case accounts might improve knowledge sharing between healthcare organizations on lessons learned and best implementation practices. Web-based, detailed information on healthcare and other IT project difficulty that can be used as “lessons learned” by others in their own projects is uncommon.

With the increasing push for EMR implementation at national levels, knowledge sharing via the Web on project difficulties might be helpful to those involved in design and implementation. In clinical medicine and indeed in any scientific field, you cannot just count the hits and ignore the misses ... We believe filling the information gap on healthcare IT difficulties is an essential goal to which medical informatics specialists can contribute, and that doing so would be helpful to patients and the healthcare community.

The E&C language is a good summary of that wording, which I crafted years ago.

This "lessons learned" item in the proposed legislation suggests Congress is aware that there are lessons to be learned, which implies they are also aware of difficulties, failures etc. that waste precious healthcare resources and time, and transfer money from healthcare to the IT and IT consulting sectors.

As readers here certainly know from my postings, I've been calling for this type of information sharing about HIT problems and solutions for the past decade, to little avail (as an information science "experiment", try a google search on "healthcare IT failure" or similar concepts and see how little comes up).

One might ask where, in fact, the large management consultants have been on this issue. Firms such as Accenture, Deloitte, Booz Allen Hamilton, and many others that have large health care consulting practices but lack experts with formal Medical Informatics expertise have been asleep at this particular switch, it seems.

One can imagine they will try to capitalize on this proposal should it pass into law (which I believe it will). This is both amusing and scary, because in my view (after watching these firms in action in my various healthcare IT leadership roles), they have been more part of the problem in HIT difficulties, closely allied with the Management Information Systems culture and its rigid data processing-card tabulator paradigms and methodologies, much less part of the solution.

In any case, this E&C proposal is a welcome development.

Finally, to those in the HIT vendor sector and in the Medical Informatics community itself who've disparaged writings on HIT difficulties and failures because they were not "academic", not "useful", were "anecdotal", or even "disingenuous" (such comments were actually made about Koppel's paper on CPOE difficulties, see here and here and here and here),
I can express this simple observation:

You were wrong.

-- SS

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