Wednesday, January 07, 2009

Why The Joint Commission Sentinel Event Alert On Healthcare IT Will Likely Be Ignored By Hospitals And Health IT Vendors

In "Joint Commission Sentinel Event Alert On Healthcare IT" I applauded the Joint Commission (the organization that accredits U.S. healthcare organizations such as hospitals) for releasing a Sentinel Event Alert in December 2008 on the risks of improperly implemented health IT. At "A 21st Century Plague? The Syndrome of Inappropriate Over-Confidence in Computing" I pointed out that prior to this Alert, those who have written on the issue of HIT risk when improperly designed and implemented have taken reputational hits as alarmists.

Finally, at "The Health IT Clueless, Or, Mr. Obama Gets Wrong Cautions on HIT" I wrote that resistance to, or lack of acknowledgement of the findings in this Alert were leading to bad advice on Health IT challenges to the incoming administration. The administration is being advised that all would be well in HIT if we just invest more in the technology.

I also observed that:

The focus of that [Joint Commission Sentinel Event] alert was minimally on technology per se, and maximally on sociotechnical issues: inadequate planning, insufficient testing or training, failing to include front-line clinicians in the planning process, failure to consider best practices for HIT operationalization, failure to consider the costs and resources needed for ongoing maintenance, failure to consult product safety reviews or alerts or the previous experience of others, over-reliance on vendor advice, failure to carefully consider the impact technology can have on care processes, workflow and safety ... need I go on?

I now am hearing anecdotal stories of the Joint Commission Health IT Alert being glossed over by hospital IT planning meetings and by vendors. It seems the Alert will likely be treated as nearly invisible in these circles, like the rest of the literature on Health IT failure and difficulty. Unless, that is, after inspection the Joint Commission starts seriously "dinging" hospitals on the basis of their health IT problems. I doubt that will occur.

This raises the question: why would hospital leadership and its IT departments, as well as health IT vendors, not put this alert as a top priority regarding their businesses? Why would they not see it as an opportunity to have their eyes opened to an entire dimension of wisdom that they have largely ignored in the past?

An answer occurred to me as follows:

The Alert's findings seriously challenge the business models of the health IT industry.

Specifically, it challenges the leadership models of healthcare IT projects and of healthcare IT vendors. Not explicitly, but through just a little introspection the challenge is apparent. It is likely terribly threatening to hospital IT leadership, the health IT industry, and pundits of these cybernetic miracles which they believe will "revolutionize medicine" (or at least make industry insiders a lot of money).

The Alert's basic message is that "it's not the technology, stupid", it's the manner in which the technology is designed and implemented and used by actual humans, clinicians for the most part, in the care of patients.

The leadership model of health IT (and all IT) seems to be based on the assumption that "technologists know best" and should lead all IT initiatives.

The Joint Commission Alert alludes to the problem that technologists have fallen down on issues that in fact are critical to IT success: the issues involving people, their work, their emotions, their cognitive capabilities, social issues, and the like. The implication is that such personnel are perhaps inappropriate for ultimate leadership of healthcare IT initiatives (as I have long argued here).

These very human sociotechnical issues, in fact, are largely outside the purview of technologists; outside their education, outside their core competencies, perhaps outside of their worldview and cognitive capabilities altogether (a bold statement, indeed, but backed by my observations of many such personnel and of some of my students who've yet to take courses that inform them of these issues).

In the biomedical world, these issues are also largely outside the purview and comprehension of the non-IT, not technical bureaucrats very often placed in leadership roles in health IT initiatives.

If this is the case, the Joint Commission Alert and others like it that follow will be ignored and people promoting its findings will likely be marginalized, just as have been the people in the fields of biomedical informatics, sociology, true computer science (as opposed to management information systems), and others who have been writing on these issues for years.

If this is the case, the Joint Commission Alert's intent will fail and the wasteful, harmful mismanagement and other nonsense that goes on in healthcare IT will continue.

I suggest any clinician or interested party reading this posting familiarize themselves with the Alert, found at
(pdf file)

Spread it around among your associates and professional societies, and bring it to the forefront of any meeting with hospital administration and vendors when discussing health IT difficulties (which are most often reflective of the issues in the Alert).

The question should be, "what are you doing about the findings in this Alert, and what part of it don't you understand?"

-- SS


Anonymous said...

There is a conspiracy of silence linking manufacturers. hospital administrators, quasi HIT "specialists", lawmakers, and now, Obama HIT seductees. Thank you for exposing the real truth (as opposed to the "made up real truth").

MedInformaticsMD said...

'Obama HIT seductees'...what a metaphor!

Problem is, I think Mr. Obama may be an HIT seductee himself, thanks to the daily doses of Dr. Data's Cybernetic Miracle Potion he's being fed.

Jay Frerichs said...

Some things to consider for any other Health IT professionals like myself.. and I share this have made these mistakes.

- When your in a project being run by a vendor and a workflow question comes up.. the opinon that matters most is the nurse
- IT vendors know products and problems... Nurses no the workflow reality
- Your hospital workflow is customized by your unique facility layout, positioning of equipment, and many other choices that software cannot adjust for... and clinicians have spent decades polishing processes that fit this envirnment
- Letting experts (clinicians) lead key initiatives changing their workflows does not mean you are not a leader. Leadership is also knowing when to get out of the way.

Best Regards,