Sunday, March 03, 2013

Michael Millenson and "the adamant refusal by hospitals and doctors to adopt electronic records no matter what the evidence"

Over at Health Beat by Maggie Mahar appears a piece critical of NYT reporter Julie Creswell's Feb. 20, 2013 article "A Digital Shift on Health Data Swells Profits in an Industry."  (The piece was also cross-posted at The Health Care Blog.)  There have been several responses highly critical of the NYT article recently in various venues.

The Health Beat piece "The Health IT Scandal the NY Times Didn’t Cover" is by Michael L. Millenson, president of Health Quality Advisors LLC in Highland Park, IL, and the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age published in 2000.

I bought and read that book at the time.

The posting at Health Beat contains the following statement:

The actual scandal is more complicated and scary. It has to do with the adamant refusal by hospitals and doctors to adopt electronic records no matter what the evidence. 

I am profoundly disappointed by this statement in view of issues (frequently written about here and elsewhere) such as:

  • The conflicting literature by credible and responsible parties on health IT's real-world value and risks as it exists today;  
  • Fiduciary obligations of hospital executives to maintain safe operating conditions; 
  • Legal and ethical obligations of physicians to resist technology they find or believe harmful without rigorous proof of its beneficence and efficacy (which includes the absence of major evidence conflicts); 
  • The evidence of major and frequent flaws, bugs and "glitches", some of which are alarming;
not to mention:
  • The 500+ reader comments in response to Creswell's article, many by clinicians describing why they don't like today's health IT; 
  • Examples of unintended adverse consequences such as here (plus at least 5 other IT-related crippling injuries and/or deaths of infants I know of but cannot speak about), and here, and here;
  • Other factors as at this blog and at my teaching site here.

I am trying to find a polite term for the statement, and struggling to do so in view of the author's prior work, which I admired.

The statement really is saying:

... It [the "scandal"] has to do with the adamant refusal by hospitals and doctors to adopt electronic records no matter what the evidence ... which is all exceptionally robust and positive, leaving no room whatsoever for reasonable doubt or caution.

Regrettably, here is the most polite term I can come up with describing the statement:


If anyone takes offense to that term, please suggest a more precise one.

Perhaps a book needs to be written entitled "Demanding Information Technology Excellence: Health IT and Accountability in the Information Age."

-- SS

Mar. 4, 2013 addendum:

In a response to a reader's comment to the cross-posting of this piece at The Health Care Blog (link), Millenson responds:

"platon20: my point, that EMRs were available in the 1970s but never changed their interface because doctors never cared enough to demand it, is not refuted by your argument, but confirmed."

This is bizarre and inconsistent with my experience and that of other Chief Medical Informatics Officers I've mentored or spoken with.  Since my entry into the domain of Medical Informatics 21 years ago I've heard many physicians, myself included [1], demand that health IT sellers and/or hospital IT departments "improve the user interface", among other areas for improvement. 

Based on my own observations and that of others (e.g., via reader comments at my teaching site dating to at least 1999), these pleas have often fallen on the deaf - and in some cases ill-informed and/or incompetent - ears of hospital senior and IT executives and industry pundits.  The latter have often responded by accusing the physicians of being "Luddites" or technophobes, and the advocates for change such as myself "anti-health IT."

The most stunning example regarding this phenomenon is the industry pushback against Prof. Jon Patrick at U. Sydney, and the ignoring of his work (on both the user experience and the fundamental software engineering quality) sitting on a University server for several years now, regarding a major U.S. ED EHR slated for rollout in an entire state of Australia.  

With usability issues now being forced of the industry for reconsideration by HHS via NIST, the industry response has been to claim that "usability is in the eye of the beholder" and other frivolous claims, up to and including interference in the the public comments period on Meaningful Use via ghostwriting, and possibly outrageous statements (although that issue became anechoic), to get their way, which is to do little or nothing on that score.

I remind Millenson that "improving the user experience" of health IT cuts into the bottom line.

[1] e.g.,  in a project initiated 20 years ago by the clinicians themselves - in a critical care area no less - in which I had to take over through force of will from the hospital's own IT department and COO and  re-engineer not just the commercial user interface but the entire dataset itself.  The project ultimately proved successful after my intervention, but the mid-level executive who facilitated my takeover to do that, and I, were punished by our superiors for our efforts.

-- SS


Anonymous said...

Doctors and hospitals are being coerced, under penalty, to purchase and use shoddy medical devices to manage the care of there patients. The industry has zero accountability, since, it has a captive audience and market.


Steve Lucas said...

My comments often reflect my personal view on several subjects. One that reoccurs is that medicine, all of medicine, reflects a corporate culture driven in great part by pharma. In the business world you find people very willing to imitate another’s success in their own field.

Thus we will find the use of KOL’s and who knows how many COI’s in the sale and implementation of EMR’s. The billions of dollars are too much of an incentive not to use the drug companies’ model to cash in on those sales.

We are just now learning of the ghostwriting, phony trials, and general criminal activity involved in some of our greatest selling drugs. Can we expect any less of the IT companies?

I see this ending the same way with patients harmed, doctors held responsible, billions of the publics money wasted, and a few making vast sums of money. Law suits will be filed, fines will be levied, and a few will walk away telling everyone how smart they were to make theirs and then get out before the mess they created collapsed.

Steve Lucas

InformaticsMD said...


A dire view indeed. But seeable by anyone not caught up in the current bubble.

-- SS

Anonymous said...

Mahar's words smack of solutionism. It could well be that a blogger knows nothing about HIT.