Monday, February 23, 2009

A Vendor/Doctor Dialog On Healthcare IT?

In response to my recent post to the American Medical Informatics Association's clinical information systems (CIS-WG) and organizational issues (POI-WG) workgroups about my WSJ letter to the editor, Charles Jarvis, an AVP of Healthcare Industry and Government Relations at HIT vendor thoughtfully suggested I "come and listen to how the government, providers, insurers and yes- HIT providers- can work together for the common good before drawing such strong conclusions."

Dialog is a useful idea. I am always open to listening.

However, dialog must be among equals in an atmosphere of complete transparency. Otherwise it is not dialog, it is politics.

How can there be "dialog" in an environment where one side is able to squelch open discussion of the issues?

Right now, there are generally agreements in vendor contracts with HC providers specifying that information about EHR problems cannot be shared.

For example, screenshots demonstrating reasons for poor user experiences or defects (or even shots with none of those) cannot be shared with the community. I have been told this is due to such screens contractually being considered as IP and "protected" to prevent "reverse engineering" (of features and functionality familiar to undergraduate CS students, no less).

It has forced me to resort to hand drawn mockups to present issues of poor user experience, poor biomedical information science, poor information presentation, promotion of cognitive overload and error, etc. I am doing this to circumvent the effective censorship in a series I am writing here (with a deliberately provocative title to attract attention) on actual production EHR problems.

Dialog in healthcare begins with full public transparency. Will the HIT vendor community open its sharing of information about its products to allow a true dialog to occur?

Will the HIT vendor community stop (meaning, NOW) experimenting on patients, doctors, nurses, and other users without their consent?

Perhaps then we can talk as equals and demonstrate the patient wreckage from the selling of experimental devices that have not been rigorously studied for safety and efficacy, and where the data that we do have points to some quite real problems.

-- SS

Addendum: I shared this bit of irony with the AVP at NextGen:

... in late 2003 after the collapse of Merck's pipeline, I wrote to your [NextGen's - ed.] CEO and HR department in Horsham about my availability to help in their EHR efforts. This was prior to the bulk of my writings on HIT difficulties. I did not so much as even get a response or inquiry, although I live thirty minutes away.

Perhaps you could explore why your company showed no interest in perhaps the only formally trained medical informaticist in this area, and former CMIO of a major hospital in the region (Christiana Care).

One cannot have a dialog with an industry that holds your occupation in low regard.


Anonymous said...

The inability to take and publish screenshots as being a violation of intellectual property law is horse puckey, dating back to the bad old days when Apple, Microsoft, HP and others were suing each other over "look and feel".

Apple calls it a trash can, Microsoft calls it a recycle bin, but it boils down to the same thing: It's garbage.

How can something be fixed if you can't convey exactly how it's broken? If one HIT vendor has problems such as you describe in your linked article, it's safe to say they all do. I would not be surprised if the HIT vendors' ensure there are clauses written into every contract absolving the vendors of any negligence or liability due to software problems of any nature.
What you describe should be nominated to the User Interface Hall of Shame.

MedInformaticsMD said...

What you describe should be nominated to the User Interface Hall of Shame.

I predict these screens will be nominated to the "large whiteboard in the courtroom" as more patients suffer injury resulting from HIT misdesign.

-- SS