Wednesday, November 23, 2011

Magical Thinking on Health IT from

Annette M. Boyle, MBA has an article in the journal that exhibits a severe form of fallacious thinking, approaching magical thinking. It's this type of thinking that gets patients injured and killed:

Health information technology: Better in long term despite short-term safety risks

Responding to a new report that says health information technology (HIT) is creating some short-term safety issues, technology experts say physicians should remember one immutable fact: The new systems are far less dangerous than the old paper-based systems still in use in many practices.

Consider that first paragraph in light of the second:

Although the magnitude of the problem remains unknown, “serious errors involving these technologies—including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to poor human-computer interactions or loss of data—have led to several reported patient deaths and injuries,” the Institute of Medicine (IOM) said in a news release.

So, "technology experts" proffer that a technology where the "magnitude of the problem remains unknown" are "far less dangerous than the old paper-based systems still in use in many practices."

Because they say so, right?


This is why "technology experts" need to be kept on a very short leash. They cannot think logically, even regarding such a simple issue such as this.

They claim as an "immutable fact" (that "physicians should remember") a comparison that has very little data underlying it? This is risible, shameful, patronizing in the extreme, insulting, and an example of the dangers of the invasion of medicine by computer technicians and salespeople.

The only "immutable fact" is, if you don't know the magnitude of risk, because it's - ah - unknown, you cannot (or should not) make statements about that very magnitude of risk. (This is K-12 level logic, and more towards the "K" than the 12.)

Actually, the evidence for significant risks beyond paper - far beyond paper - come from incidents like I've described on this blog. A very recent example is my Nov. 4, 2011 post "Lifespan (Rhode Island): Yet another health IT "glitch" affecting thousands - that, of course, caused no patient harm that they know of - yet."

Doctors are not in the habit of leaving off suffixes for slow release or long acting drugs (e.g., XR, SR), but a few lines of code can - and did - affect thousands at just one healthcare system. This was a potentially lethal error. Health IT can greatly amplify risk in a manner that paper simply cannot.

People who proffer gross illogic in medicine need to do society a big favor and simply remove themselves from any roles that affect medical care, patients, and medical ethics. If they know better, and are simply spinning their statements to promote sales, the need for such individuals to be distanced from healthcare is even more acute.

If they don't clean up their act, either way, they may find themselves on the defendant's witness stand, where such illogic will be ripped to shreds by plaintiff's attorneys.

-- SS


Anonymous said...

What is she smoking?

Live IT or live with IT said...

I am not an MD, but I learned how to use basic research methodology, including design of experiments and statistical testing on well managed data. I now read lots of research papers and understand them.

There seems to be very few in HIT or any business related healthcare position who can make it through reading a research paper. I have heard very few comment from them about the paper's content, if the comparisons are thorough and valid, and experiment well formed.

I think one has to actually write a research paper to understand how to understand them.

Anonymous said...

In an article I found earlier today, a computer expert who led the development of the first commercially available microprocessor at Intel shared his perspectives on the digital revolution that followed. Even this pioneer expressed amazement at all the technological feats, with computer technology, that
have been performed in just a few decades.

Feats of magicians tend to bring out similar reactions of amazement in their audiences, except for maybe a few who are critically observing the magician's every move for reality-based explanations underlying this so-called magic. The ones who don't critically analyze the magician's act are going to be duped into magical thinking.

Maybe the hype surrounding the potential for computer technology
(including HIT) to transform our lives is also grounded in magical thinking - promoted by marketers. Even the marketing power of the word 'magic' is used in branding of some HIT software such as Iatric Systems' "Clinical Document Exchange Magic" and MEDITECH's "MAGIC". There is even a company named EHRMagic, Inc. (

I believe there are a lot of very talented computer professionals who, with the right education in medical and business ethics and appropriate commitment, can do healthcare a better service with
its software - if the thinking that goes into the software
development process is not overly influenced by marketing-related hype. Because critical analysis of software products for quality and safety take a back seat
in marketing messages, software developers overly influenced by marketing hype may get the mistaken impression that if the marketing department and corporate leadership can instill magical thinking about software products in the customers' view, it is less
important that the software has to work really well when it is time to ship it. Not only does this application of magical thinking hinder development of anything reliably safe from a medical ethics perspective. It's just bad business ethics.

I am a software developer, not a magician. I would never want to work for a company going by the name of EHRMagic, Inc., or be a patient at a hospital running EHRMagic products.

Anonymous said...

She obviously attended the "Sarah Palin School of Word Salad."


uptown eye doctor said...

I agree... What was she thinking?!

Luckyema said...

Here's the article as originally written. Not quite the unquestioning promotion of HIT implied in the post:

Health information technology promises to improve care, but existing safety issues may be endangering patients, says a new report from the Institute of Medicine (IOM).

While the magnitude of the problem remains unknown, “serious errors involving these technologies—including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to poor human-computer interactions or loss of data—have led to several reported patient deaths and injuries,” said the IOM in a release.

“Just as the potential benefits of health IT are great, so are the possible harms to patient safety if these technologies are not being properly designed and used,” said Gail Warden, chair of the committee that wrote the report and president emeritus of Henry Ford Health System. “To protect patients, industry and government have a shared responsibility to ensure greater transparency, accountability, and reporting of health IT-related medical errors.”

“We must focus on the integrity and accuracy of data so clinicians can trust the information,” health IT systems provide, Michelle Dougherty, director of practice leadership for the American Health Information Management Association (AHIMA), told Medical Economics e-Consult. “Hold harmless and confidentiality clauses prevent independent review of systems and problems. As an industry, we must recognize that there are serious problems and that fixing them has taken too long,” she added.

To motivate industry to address these issues, the IOM report recommends several steps to improve safety. These include creating a mechanism for providers and vendors to use to report health IT-related deaths, injuries, or unsafe conditions and establishing an independent federal entity to investigate the reports and ensure health IT vendors support the free exchange of information, particularly regarding patient safety issues. These oversight and reporting systems would cover electronic health records, secure patient portals, and health information exchanges. Software for medical devices would not be included.

If those steps fail, the IOM ups the ante: If “progress toward improving safety is insufficient within a year, the U.S. Food and Drug Administration should exercise its authority to regulate these technologies,” said the report.

“There’s no question that the option of coming under FDA regulations is a stick; it relays the seriousness of the issues and the need to address them immediately,” said Dougherty. “Today, problems are buried in code, outside the reach of provider organizations. Clinicians trust their vendors and rely on them to fix problems quickly, but industry has been too slow to respond, in part because of this cloak of secrecy,” she added.

The Healthcare Information Management Systems Society (HIMSS) agreed that health information technology can be made safer and better for healthcare providers and patients,” but emphasized that the alternative is worse. “The paper-based health system, still in use in many clinical practices and hospitals across our nation, has profound deficiencies in failing to portray a full and up-to-the minute picture of patients’ conditions and care. The paper-based health system kills.”