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.