Tuesday, April 13, 2010

Is H. Stephen Lieber, CEO of HIT Industry Trade Group HIMSS, Misinformed or Simply Lying?

In the Wall Street Journal article today entitled "Can Technology Cure Health Care?" by erstwhile WSJ reporter Jacob Goldstein, H. Stephen Lieber, CEO of the health IT trade group HIMSS disputes the idea that "electronic medical records systems focus on billing [and other administrative tasks] at the expense of patient care" and says:

[These systems] are "primarily designed for improving clinical outcomes, and a secondary benefit is that they improve administrative efficiencies."

Is Mr. Lieber misinformed, or worse, could he simply be lying?

In fact, these systems do neither of these things, as repeated studies are showing such as I aggregated in "2009 a Pivotal Year in Healthcare IT" at http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=2009, and as in this new 2010 study report in Health Affairs:

Electronic Health Records' Limited Successes Suggest More Targeted Uses

The team, led by Harvard Medical School professor Catherine M. DesRoches, surveyed more than 3,000 U.S. community hospitals to assess factors such as inpatient costs and mortality and readmission rates. Here are their findings:

Understanding whether electronic health records, as currently adopted, improve quality and efficiency has important implications for how best to employ the estimated $20 billion in health information technology incentives authorized by the American Recovery and Reinvestment Act of 2009. We examined electronic health record adoption in U.S. hospitals and the relationship to quality and efficiency. Across a large number of metrics examined, the relationships were modest at best and generally lacked statistical or clinical significance. However, the presence of clinical decision support was associated with small quality gains. Our findings suggest that to drive substantial gains in quality and efficiency, simply adopting electronic health records is likely to be insufficient. Instead, policies are needed that encourage the use of electronic health records in ways that will lead to improvements in care.

... the researchers determined that the technological systems, as currently implemented, do not have a significant impact on improving care and reducing costs, DesRoches said.

A key phrase is "as currently implemented." To that, I'd add "as currently designed under the leadership of the HIT industry", which is to say, poorly.

I commented on this report in my prior post "Yet Another Study Shows Health IT Does Not Bat The Ball Out of the Park; And, is HIT an Issue of States' Rights?" at this link.

These results are also in line with the 2009 National Research Council report, the highest scientific authority in the U.S. that involved Octo Barnett and other health IT pioneers. The NRC report calls current approaches to health IT "insufficient" and calls for major redesign of health IT to support clinicians' cognitive needs.

From the NRC report:

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.

And this was from the country's most advanced centers in terms of healthcare IT.

As to cost savings, there's the Nov. 2009 “Hospital Computing and the Costs and Quality of Care: A National Study” (Amer J Med 123:1; 40-46) by Himmelstein and Woolhandler at Harvard Medical School, that also concluded “as currently implemented, hospital computing might [very] modestly improve process measures of quality but not administrative or overall costs."

There's also the June 2009 Wharton School of Business article "Information Technology: Not a Cure for the High Cost of Health Care" that I wrote about at this HC Renewal post.

Typical of the recalcitrant, recidivist IT industry, Lieber goes on to blame doctors:

"... there is a resistance on the part of some to recognize the professional clinical advantage that these systems give them, many default to 'This is designed for billing, not clinical outcomes.'"

Never does he consider that doctors might have good reasons to avoid the technology - as in, to protect the lives of the patients in their trust. (When they see user-hostile HIT products from major vendors such as these, who can blame them?)

He then waves off "glitches" - the kind that result in untold clinician inconvenience and disruption, and have resulted in an unknown but "tip of the iceberg" rate of patient injury and death per the FDA - by stating that:

"There is a range of systems out there, just as in any kind of product line, ranging from poor to mediocre to excellent."

His merchant computing, card tabulator/data processing mindset reveals itself in this statement. Unfortunately, health IT, as in other medical devices, IS NOT JUST ANY KIND OF PRODUCT LINE. Malfunctions and poor design do not simply cause a truckload of candy bars to be delivered to the wrong merchant.

As in pharma and other medical devices, when trade group leaders of the HIT medical device companies are unaware of current research, dismiss it, and blame end users, or simply are liars, that industry deserves serious academic and governmental scrutiny.

-- SS


HIMSS Insider said...

Harry Lieber is telling a LIE, and is also ignorant. LIEber has no clinical or technical knowledge or training. LIEber is just a suit, and an ill fitting one ar that. LIEber is protecting his cash cow (HIMSS annual circus), the EHRVA's interest (a popup org LIEber created in conjunction with CCHIT), and C$HIT (LIEber still refuses to step down as the self-appointed C$HIT Trustee Chair).

LIEber is the most dangerous type of person, whose team of soldiers have infiltrated ONC and other Fed govt agencies. Go the the Federal Register under Meaningful Use comments: Comment # 89abcc9a, former HIMSS employee. Many doctors and Senator Grassley are aware of this comment. LIEber has the Feds, IRS, Grassley looking at HIMSS infiltration of govt offices and influence in govt. LIEber has absolutely no right to dictate policy for 310 million Americans.

Take a tour, Scot, of the C$HIT virtual office in Chicago that Karen Bell MD inherited. I took the tour. C$HIT is a ghost ship. LIEber paid big big $$$$ to convince Bell to sell her soul to the devil. I hope she has can sleep at night. There is no going back after she signs those non disclosure forms. Trade secrets stay with her forever.

InformaticsMD said...

Re: HIMSS Insider said...

These are certainly interesting claims. Perhaps someone friendly towards these organizations would like to respond.

Anonymous said...

Looking strictly at the opportunity for fraud and abuse in the future business aspect of health care reform I find this scenario plausible, and driven in great part by the HIT industry.

We will have a large number of people added to the Medicaid roles; many doctors have commented they cannot financially support these patients in their private practices. We have also seen an EMR requirement that will also burden private practices.

In steps the local hospital. They open a clinic using their current computer system, and sign up large numbers of new patients. As the patients work through the system their standard of care is geared towards maximizing profits for the hospital, supported by a computer system that schedules test based on insurance, not need.

Likewise, prescription policies are standardized on medications the hospital has a financial relationship with the providing drug company.

All of this is just a click away, so why bother with trying to input something that will only be rejected.

ER use is not diminished since the ER is an extension of the clinic, and is billable at a higher rate.

The result of this is skyrocketing cost for Medicaid. Sometime ago there was the story of a California hospital that would pick up street people and keep them for a few days in the hospital. The resulting charges were exorbitant. We really do not have to look hard or far to find the opportunity for abuse, all driven by our friendly computer vendor.

Steve Lucas

Anonymous said...

I am concerned that my patients are exposed to unpredictable dangers when cared for by doctors who have to use this unproven systems. People like Lieber (I like his red high heels, by the way) make self serving statements belittling the physicians who have to establish work arounds to protect their patients from the defects of the devices he is promoting.

Something is wrong with this picture.

Anonymous said...

Lieber is lying, pure and simple. I worked for a Canadian EHR vendor for 3 years and it was understood that hospitals and big practices were very keen and interested to have software tools to help with billing and administrative tasks above everything else.

It's logical when one thinks about it; the purchase deciders are very rarely health care professionals veterans formed in the fire of the trenches, but accountants and MBAs who learned bits and pieces (nano bits and pieces mind you) about health care.