Friday, February 12, 2010

The Yin and Yang of Electronic Health Records

Lest we be led into believing that healthcare IT is a tried and true, safe, proven technology:

Friday, February 05, 2010

iHealthBeat.org

Has Your Organization Had a Patient Safety Issue Directly Resulting From an Electronic System?

Thirty-two percent of health IT professionals surveyed said their health care organization has had a patient safety or health care quality issue that could be classified as being a direct result of having an electronic system, according to a recent Healthcare Information and Management Systems Society survey.

Meanwhile, 10% of respondents said they have had clients report patient safety or health care quality issues that were a direct result of having an electronic system, according to the survey.

The survey also found that 29% of respondents said their electronic health record implementation has exceeded or vastly exceeded their expectations, while 22% of respondents said their EHR implementation has not met expectations.

Results are based on an online survey conducted in January of 217 health IT professionals.

Source: HIMSS, "Value of Electronic Health Records."
It might perhaps be prudent to heed this three-decade-old Texan wisdom on the true nature of computers (link, see page 2):

What is a Computer?"

... A computer is an extension of the human brain. It is to the mind what the lever is to the arm - a machine capable of multiplying effectiveness. It can free you from tedious, repetitive work which does not require judgment. IT can provide facts and figures with lightning speed, giving you more time to exercise your judgment thoughtfully.

The key words are that IT can free a person from tedium which "does not require judgment." That has not changed, and in medicine it is likely to not change before we retire.

There is an existential problem related to what IT can do, and what it cannot do in a cognitive, judgment-based field such as medicine, as opposed to straight information retrieval or other "tabulating machine"-based uses of IT.
(As I wrote previously, medicine's problems are not due to a reductionist "platform database deficiency.")

Health IT designed and oversold as if it can do more than freeing clinicians from tedium so they may exercise better clinical judgment (based on hard-earned experience), and that in fact often makes their work more tedious than it already is, will always be a double edged sword.

-- SS

5 comments:

Anonymous said...

There is an interesting article that everyone should take a look at. It is an article written in the WSJ: “Health-Care Reform Could Create a Litigation Explosion.”
http://online.wsj.com/article/SB10001424052748704541004575011390617073222.html?mod=googlenews_wsj

Excerpts below:
“By creating new federally enforceable rights and obligations, layers of complex federal regulations, and dozens of new programs and agencies—not to mention 50 newfangled “exchanges —ObamaCare would guarantee a flood of litigation.

That means more money wasted on attorney fees, physicians focused on legal rather than medical considerations, and growing delays in our already-overburdened courts. “Now that the federal government is inserting itself between you and your insurance company, we’ll also see coverage disputes in which the feds are among the defendants. HHS might even wind up as a defendant in medical malpractice lawsuits."

"The Constitution applies to government actions, so the feds’ dramatically expanded role in health care promises an explosion of constitutional claims, driven both by financial gain and interest group agendas. Lawsuits claiming equal protection violations will be limited only by the human capacity to feel discriminated against. ”

This could also mean of flurry of lawsuits against the government for forcing hospitals and small to medium physician practices to implement an EHR. HIMSS’ EHRVA members could face lawsuits in the years to come!

There appears to be a grass-roots movement across the nation against the government EHR program. No one should be surprised by this.
http://blog.srssoft.com/

In a Feb. 27, 2009 post on your blog, you argued that there should be a Congressional Investigation and that HIMSS and CCHIT might be a little too closely linked.

HIMSS sent out lawyers instead of facing tough questions from the HIT industry. Questions we tax payers still demand answers to.

Anonymous said...

Not only does current HIT gear make doctors' work "more tedious than it already is", it actually causes disruption of the complex cognitive processes of managing scores of data points and interval changes of varying degrees of ambiguity and certainty.

As such, they are a potent impediment and communication disruptor to the effective clinician.

Get rid of the unproven and user unfriendly CPOE (multiple clicks and questions to order an aspirin_hello?) devices and keep the electronic repositories of lab data and PACs for digital imaging.

Anonymous said...

I ask you "What percentage of organizations that use manual paper-based information systems experience safety or quality of care issues related to their systems?"
I would argue 100%. The relevant question is not whether mistakes occur with automated systems but whether they occur less frequently than with manual systems. There is an extensive literature supporting reductions in errors with computerized physician order entry. A system doesn't have to be perfect to be an improvement.

You are creating another straw man argument. Who said information technology could or should replace human judgment? Do you have a quote or a citation?

MedInformaticsMD said...

The relevant question is not whether mistakes occur with automated systems but whether they occur less frequently than with manual systems.

Since the figures for mistakes and even more importantly, unintended consequences from automated systems are not well known, I think we should not be so eager to experiment on live subjects on a mass scale to find out.

Who said information technology could or should replace human judgment?

I guess you missed the hyperlink in my posting.

"Google CEO Schmidt said ... So when you show up at the doctor with some set of symptoms, in my ideal world what would happen is that the doctor would type in the symptoms he or she also observes, and it would be matched against the data in this repository...... Then this knowledge engine would use best practices, and all the knowledge in the world to give physicians some sort of standardized guidance."

Guess physician judgment basically sucks and they need this guidance for every patient they see.

Also, grandiose statements that HIT will "revolutionize" healthcare certainly don't have as their central ideology that IT will just provide the doctors the ability to do faster calculations.

Anonymous said...

"There is an extensive literature supporting reductions in errors with computerized physician order entry."

Where?