Monday, March 14, 2011

Why The Overambitious, Cavalier Approaches of the Healthcare IT Industry Are Harmful To Health: Guest Post by Dr. Jon Patrick, U. Sydney

Apparently Holland is now veering away from a national project for health information exchange. From a researcher at Erasmus University Rotterdam:

While failures of IT implementation in the UK and more recently the Cerner implementation in Australia has been dissected by [U. Sydney Professor] Jon Patrick, the Dutch initiative for a national health IT infrastructure for exchanging patient data that would start with a medication record and a summary record is about to be voted down in the upper house (Senate) of the Dutch parliament. It means that the trajectory to get this infrastructure and which lasted thirteen years will grind to a halt. Unfortunately this implementation has been poorly documented in scientific journals (to my knowledge only one paper describing the infrastructure was published in Methods of Information in Medicine).

I wrote about the exposé by Prof. Jon Patrick of U. Sydney of poor software engineering practices, poor usability, unreliability, and dangers posed by a commercial health IT product slated for the ED's of the Australian state of New South Wales (NSW) at my Mar. 5, 2011 post
"On an EMR Forensic Evaluation by Professor Jon Patrick from Down Under: More Thoughts".

Prof. Patrick offers the following additional pithy and highly insightful commentary, reposted here with his permission (emphases mine):


Since the publication of my long report on the discontent with and weaknesses of Cerner Firstnet/Millenium in Australia (see I have been pondering the issue of how we can better define the "EMR" and its functions.

I certainly think that the notion of an EMR in terms of current popular discussions in AMIA-WGs [American Medical Informatics Association work groups - ed.] and blogs [such as this one - ed.], government policy and vendor publicity is defined at too high a level of generalisation for analysts to create an adequate specification of it and likewise for the engineers to understand the requirements so that they can build such a system.

This position is further justified by the failures to create such systems in the UK, NSW and Victoria (Australia) and the loss of political support in Holland. A counterpoint to this are the successes in New Zealand, Denmark and Scotland with systems of smaller ambition and scale targeted at particular problems.

I offer this thesis for deliberation: that large scale enterprise software implementations are an over generalisation of the EMR problem so that their lack of ability to capture local context and their intrinsically weak engineering base demonstrate that the advocates of large scale EMR don't know how to do it, have failed to do it in the past at great cost to various communities, and will continue to fail until they understand and define the task properly and in great detail of what has to be done and how to do it.

In other words, the healthcare IT industry itself - starting with its leadership - does not know what it's doing and may itself be ill-suited to purpose, the purpose of facilitating better healthcare. Its overall brute-force, mass-scale, ham-fisted ideologies and approaches cannot succeed except in wasting billions of healthcare dollars. Or, more precisely, transferring that wealth to the IT sector and leaving little to show for it in the health sector.

I agree with Prof. Patrick's "thesis."

At my own HIT website now at years ago I wrote similar words:

Healthcare information technology (HIT) holds great promise towards improving healthcare quality, safety and costs ... however, this potential has been largely unrealized. Significant factors impeding HIT achievement have been false assumptions concerning the challenges presented by this still-experimental technology, and underestimations of the expertise essential to achieve the potential benefits of HIT. This often results inclinician-unfriendly HIT design, and HIT leaders and stakeholders operating outside (often far outside) the boundaries of their professional competencies. Until these issues are acknowledged and corrected, HIT efforts will unnecessarily over-utilize precious healthcare resources, will be unlikely to achieve claimed benefits for many years to come, and may actually cause harm.

Once again, you heard it here first.

I also reiterate, our own "National Program for Health IT in the HHS" needs the same treatment that Prof. Patrick recommends for his own state of NSW, as at my Mar. 8, 2011 post "
The Future Pathways for e-Health in NSW."

-- SS


Anonymous said...

Health IT is dismal for patients in the US. It is a money maker for the industry vendors. Cerner was issued a "buy" with an outrageously high price target today. Something does not fit.

Scot M Silverstein MD said...

Something does not fit.

The Australian study is being ignored as it does not fit the health IT "narrative."

This will have future implications, probably of the legal variety. "Knew, or should have known..."

-- SS

Moshe Sharon said...

We used to say the two biggest lies are “The check is in the mail” and “It won’t hurt a bit.” Now, there is a third biggest lie, which is, “We have the best health care system in the world,” as Bill Clinton and George Bush uttered repeatedly during their respective terms. On the other hand, all of the standard measures of health care quality points to ours as being “the best substandard price-gouging health care system in the world”. We need to find out what's really wrong and why no one wants to fix it. Http://

Roy M. Poses MD said...

Moshe Sharon,

The "best health care system in the world meme" appears to have been invented by US health insurance company public relations people to try to forestall meaningful health care reform.

See Wendell Potter's Deadly Spin (p.1-2).

"But as one of the industry's top public relations executives and media spokesmen, I also helped create and perpetuate myths that had no other purpose but to sustain these [insurance] companies' extraordinarily high profitability."
"For example, if you are among those who believe that the United States has 'the best health care system in the world' despite overwhelming evidence to the contrary - it's because my fellow spinmeisters and I succeeded brilliantly at what we were paid very well to do with premium dollars."

Scot M Silverstein MD said...

We indeed do have the very best healthcare system in the world - if you have a medical advocate like me tracking your physicians' every move.

It saved my mother's life.

-- SS

Live IT or live with it said...

I also agree with Dr. Patrick's assessment. Part of the proof comes from looking at the opposite. It is quite obvious that any silo system implementation with a five year plan will result in an obsolete system. The benfits that justify the system are overwhelmed by the future cost of keeping a continuous huge system reimplementation department in place. Not to mention the periodic full system disruption of upgrading a single large system.

Yet every time an EHR is considered, there is no consideration for obsolescence after or even during the implementation project.

The EHR industry, which includes the workers as well as the vendors, are building themselves into an ever larger slice of what may be a reduced size pie.

Totally unsustainable. Ask any lawmaker or pundant though and they are unaware of this problem.

Oh well, live and learn I guess. Maybe Watson can figure it out.

Anonymous said...

Fourth biggest lie, uttered by hospital administrators after an HIT breakdown: "but patient care and safety was not affected".

Scot M Silverstein MD said...

but patient care and safety was not affected"

Miracle, no?

-- SS