Wednesday, June 10, 2009

Lessons From Aviation Heroes Towards Healthcare IT

One of my largest concerns about the state of health IT is its safety, and the effects the irrational exuberance about health IT, including coming use/misuse of EHR data, may have on physicians' ability to exercise judgment borne of experience. For more on this, see my essay "The Syndrome of Inappropriate Overconfidence in Computing: An Invasion of Medicine by the Information Technology Industry?" in the Journal of the Association of American Physicians and Surgeons (AAPS), Summer 2009, at this link (PDF).

I believe there is a strong lesson to be learned that is applicable to healthcare and HIT from the aviation industry. Namely, the wisdom of Captain Chesley Sullenberger, who guided a damaged and unpowered jet safely into the Hudson River on Jan. 15, 2009, saving all aboard.

The lessons are so obvious, I will not comment on the parallels between Capt. Sullenberger's observations and the issues in healthcare and healthcare IT:

Excerpts from:

Wall Street Journal
June 10, 2009

Hero Pilot 'Sully' Stars at Safety Hearing
Transcript Reveals Details From Hudson Splashdown

By Andy Pasztor

WASHINGTON -- US Airways Capt. Chesley "Sully" Sullenberger, the much-heralded hero of the January airliner ditching on New York's Hudson River, told federal investigators Tuesday that in a matter of seconds he determined only the river was "long enough, wide enough and smooth enough" to put down his crippled jetliner.

... At a time when many commercial airline pilots say they are frustrated by dwindling pay, longer work weeks and eroded pensions, the testimony of the captain recalled the golden age of aviators exuding confidence and sangfroid. [self-possession or imperturbability especially under strain - ed.]

Many of the flight attendants and passengers thought the Airbus was headed for land. But Capt. Sullenberger, who started flying at the age of 16 and has been at the controls of everything from gliders to three different jetliners, told the safety board he picked his landing spot with care.

The airline's training instructed pilots that if they ever had to ditch, they should "land near vessels to try to facilitate rescue."

Responding to questions about the lessons to be learned from the extraordinary landing, Capt. Sullenberger mentioned training to help pilots work together as a team and additional efforts to improve emergency evacuations. But his comments repeatedly swung back to the notion of an airline culture that stresses safety and respects the judgment of experienced pilots. US Airways pilots received classroom instruction in ditching procedures, but Capt. Sullenberger testified that they never practiced any ditching scenarios in simulators.

In a pointed remark on the cost-cutting and heightened corporate regimentation that currently drive many airlines,
Capt. Sullenberger considered the intangibles of safe airmanship. "The captain's authority is a precious commodity that cannot be denigrated," [see all too typical IT attitudes about physicians in this post - ed.] he said.

The captain's testimony also highlighted the importance of relying on experience and memory, rather than rigidly using written checklists to deal with unexpected emergencies. With both pilots in the cockpit boasting about 20,000 hours of total flight time, Capt. Sullenberger said that teamwork and experience "allowed us to focus on the high priorities without referring to written" checklists.

Cybernetic miracles would not help here and might in fact have caused a different outcome than this, especially if they malfunctioned, caused cognitive overload, or otherwise impeded the pilots' abilities to utilize their expertise:

Billy Campbell, one of the passengers on the plane, testified about seeing the left engine engulfed in flames as though it were "a bonfire," and then scampering out of the aircraft as water was seeping in near the tail. "We were so fortunate to have an unbelievable pilot, an unbelievable copilot" and a highly experienced cabin crew, he told the board. [Note not a mention of "great computers", which in fact might be implicated due to faulty speed data in a recent and unfortunate Air France crash with no survivors - ed.]

The parallels between Capt. Sullenberger's observations and the observations of those concerned with ever growing exuberance about HIT should be obvious. (If not, spend some time here.) The lesson can be summarized through a line from another aviation hero:

"It's the man, not the machine."

That hero was Chuck Yaeger:

The most famous Mustang pilot and ace is Chuck Yeager. Yeager was the ultimate fighter pilot. As a young Mustang pilot he once downed five German fighters in one mission. He downed two much faster Me-262 jet fighters, escaped captivity after being shot down over occupied France, and when the war ended, it was still just the beginning of his amazing career. After the war Yeager became a test pilot, and in 1947 he earned his place in the history books as the first man who "broke the sound barrier" in the daring first supersonic flight.

The WSJ article concludes:

Robert Sumwalt, the safety board member chairing the hearing, said that after listening to the cockpit voice recorder after the ditching of US Airways Flight 1549, he was impressed by the actions of the pilots. "I've never walked out of a flight recorder lab with a smile."

I wish I could walk with a smile about the state of health IT, but lately that just has not seemed possible.

-- SS

1 comment:

Anonymous said...

Mark Leavitt is my hero. In business, there is nothing like the scheme of having an "independent" organization (CCHIT) provide an illusion of safety for a product known to be dangerous, that concomitantly provides the machinery to convince Congress to pass laws to create $ billions in wealth to the vendors who founded the said trade group.

Only in America!