Monday, March 02, 2009

Where Is Our Medical Leadership on the Death Traps Known as Misdesigned Healthcare IT?

In my series on health IT (starting here) whose human engineering is ill conceived, philistine and presents clinicians with a mission hostile user experience, I have kept a neutral stance regarding the role of our so-called professional society representatives.

If we were pilots or police officers or even bus drivers asked to use such seriously impaired devices, we and our unions would have declared war long ago. (I worked some years ago as Medical Programs Manager for the regional transit authority in Philadelphia, and say this quite confidently. Mr. Lombardo would likely agree.)

Right next to my Feb. 18 Wall Street Journal letter to the editor on HIT was a letter from the President-elect of the American Medical Association, J. James Rohack, M.D.

Dr. Rohack wrote to the WSJ (emphases mine):

You admit in your editorial "A Health-Tech Monopoly" (Feb. 11) that electronic medical records "might do some actual good." We agree, and that is why we support the health information technology provisions of the economic stimulus bill.

The economic stimulus bill being considered will create important national HIT interoperability standards. These standards are essential to achieve the promise HIT holds to help increase patient safety, improve care coordination and reduce unnecessary paperwork. As is true in other industries, basic standards will provide the essential foundation on which the private sector can build innovative commercial products.

Competition and innovation are bedrocks of America's economic system, as they should be in health care. The HIT provisions in the bill maintain this vision, while building on existing federal efforts to encourage HIT adoption. This bill does not authorize the government to dictate clinical guidelines or national coverage decisions. Medical treatment decisions remain in the hands of physicians.

The bill also provides physicians with significant financial assistance for HIT purchases. This critical support is needed so that physicians can make HIT purchases [why would they want to buy defective and hard to use cybernetic monstrosities at any price? - ed.], and patients can then begin to reap the benefit.

Where's the innovation in vendor HIT products, whose user interaction even after decades of information science, computer science, biomedical informatics, HCI and other research looks like it was designed by high schoolers?

Interoperability standards and financial incentives are, I'm going to venture to say, nearly irrelevant to the poor acceptance of HIT by the average physician in 2009. Our medical leaders seem to be becoming parrots, repeating the irrelevant (in the near term, to 'Joe the Doctor' and 'Rosie the RN') mantras about standards and interoperability, seeing the galaxy while missing the Black Hole whose event horizon they are nearing.

Again, I speak from experience. When I was CMIO, we were getting quite good results from our HIT efforts at Christiana Care a decade ago, long before standards were as well formulated as today, for example as seen at the Consolidated Informatics Initiative site at HHS.

Completely lacking in this relatively milquetoast letter to the WSJ is the issue of the mission hostile user experience presented to clinicians by most current HIT applications, designed as inventory systems by MIS-inclined mindsets rather than as clinical tools (if you don't believe me, then believe the U.S. National Academies and National Research Council, and its informatics pioneers Stead and Barnett):

Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.

... Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient

I encourage clinicians injured and offended by the hostile products they are being coerced to use, organizationally and now nationally, to write to our medical leadership.

I wrote the following to Dr. Rohack:

Dear Dr. Rohack,

I wish to call your attention to my series on the site of the Foundation for Integrity and Responsibility in Medicine, the multi author blog Healthcare Renewal.

The series outlines the major problems with today's healthcare information technology: poor design and vendor freedom from accountability and information sharing on defects.

The series starts here .

Thus the AMA leadership is informed of these issues. They can ignore them (after all, I'm just a nobody writing on a godforsaken corner of the digital gutter known as the blogosphere), or they can represent their profession.

I encourage others to write their medical leadership as well.

-- SS


Elizabeth said...

I am not a doctor or even in the medical profession and do not understand all your arguments, although I have a worry about the results of the current and proposed stimuli involving IT. You need to write up these concerns associated with IT in a simple enough form that the politicians and other lay people can understand . The insurance companies have obviously done the advocacy for themselves, as they always do. The masses and the democrats are being duped again by big business thinking that something will "trickle down" for them. Are they really so inept?

MedInformaticsMD said...

You need to write up these concerns associated with IT in a simple enough form that the politicians and other lay people can understand

As I posted here, The Washington and San Francisco Examiners have it about right in this common sense-filled editorial in which I am cited (I played no part in its appearance). I think it's understandible:

America’s foray into HIT will likely be a miss

Examiner editorial 3/2/09

There is a provision of the $878 billion stimulus package rushed through Congress for $20 billion to develop a centralized national health information technology system. Proponents claim HIT will save $77 billion during the next 15 years and greatly reduce medical errors. Who could possibly object to that?

Well, for starters, ask health care providers in Britain’s National Health Service, who have been trying to get their HIT system to work properly for the past five years. The cost of NHS’ HIT has escalated to six times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the United States.

In January, Public Accounts Chairman Edward Leigh reported to fellow members of Parliament that essential systems are late or, when deployed, do not meet expectations of clinical staff. HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next six months. But even if HIT is eventually junked, British taxpayers will still have to pay for it.

The National Academies of Science noted that much of the electronic medical data collected in the U.S. is used mainly to comply with regulations or to defend against lawsuits, rather than to improve patient care. A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one. And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors.

After spending billions of dollars during the past three decades, only 4 percent of U.S. physicians have a fully functional HIT system, according to Drexel University biomedical informatics professor Scot Silverstein — and its not because doctors don’t want to use technology. These expensive systems are just not designed for their extremely complex and highly specialized needs. In an open letter to President Barack Obama, Silverstein said HIT is an experiment that’s unproven on a large scale. Computers in hospitals have also been linked to the spread of MRSA, a deadly antibiotic-resistant staph infection. Yet, the same federal government that can’t keep its own military veterans’ medical records secure is bound and determined to spend $20 billion in a top-down, centralized effort that has a very good chance of messing up yours.

Sarvesh Bagla said...

Sincere Congratulations! You make us all proud; well done.