Thursday, March 20, 2014

Forbes contributor Nicole Fisher, claimed proponent of healthcare human rights, writes long article on EHRs that neglects to mention patient harm

The field of health IT lives a charmed life.

Even self-stated human rights advocates in healthcare won't seem to broach the topic of EHR-related harms and lack of informed consent processes regarding their use in a patient's care, even when authors openly state their concerns for patient and human rights.

This is despite known harms at potentially alarming levels as indicated by organizations including the IOM, FDA, ECRI Institute, AHRQ, Harvard Med Mal insurer CRICO, The Joint Commission, NHS in the UK, and others.

Forbes contributor Nicole Fisher ( published an article in Forbes dated 3/18/2014 and entitled "Electronic Health Records - Expensive, Disruptive And Here To Stay" (

You can read the article at the above link.  It focuses on physician distraction and dissatisfaction, poor usability and usefulness, expense, and related issues.  Of course, quotes from HHS figure prominently.

Nowhere, however, is mention of EHR-related harms to patients, such as reported by the aforementioned organizations mentioned - as in this very small sample list of posts, which contain links to source:

Patient Safety & Quality Healthcare: "CRICO Malpractice Claims Analysis Confirms Risks in EHRs"

Peering Underneath the Iceberg's Water Level: ECRI "Deep Dive" Study of Health IT "Events"

Internal FDA memorandum on HIT risks

IOM Report - "Health IT and Patient Safety: Building Safer Systems for Better Care"

EHRs and Deadly glitches (multiple posts)

Not to forget issues of breach of privacy: (multiple posts)

Nor are mentioned the issues of the experimental, unregulated nature of this technology, and the lack of any informed consent process regarding patient's rights to decide whether or not to have these systems used in their care.

The only mention of "unintended consequences" links to "Unintended ICD-10 Consequences: Inadequate Clinical Documentation Can Negatively Impact Physician Profiles."

This is in my view disappointing, and seems to be yet another extraordinary healthcare IT industry accommodation, remarkable for an author with the following bio (emphases mine):

Nicole Fisher is the Founder and Principal at HHR Strategies, a health care and human rights focused advising firm. Additionally, she is a Senior Policy Advisor and health policy expert on health economic analyses mainly focusing on Medicare, Medicaid and health reform, specifically as they impact women and children. Nicole runs a Health Innovation and Policy page at highlighting and advising companies, ideas and people that are changing the health care landscape. She is also currently pursuing her PhD at the University of North Carolina in the Health Policy and Management Department. Her writing has appeared in other publications such as Health Affairs, Wall Street Journal, Washington Post, Centers for Medicare & Medicaid Services Journal, Wright on Health, The Health Care Blog and Health Services Research. Before pursuing her PhD in health policy, Nicole earned her Master’s degree in Public Policy from the University of Chicago and her undergraduate degree from the University of Missouri. Her health care and policy work at those institutions had an emphasis on underserved populations, women's and children’s issues. She presides on several Boards for domestic and international health organizations and frequently speaks on health reform and human rights.

One might conclude the computer has more rights than the patient and the clinician via this Forbes piece.

Finally, although I am a domain specialist (, I am getting rather tired of having to point out the obvious to major media outlets and writers, in essence doing their homework for them.  I'm sure other bloggers feel the same way. 

The title of the Forbes piece should have been "Electronic Health Records - Expensive, Disruptive, Deadly."

To the author of the Forbes piece and other HIT writers, here is the face (and gravestone) of someone injured by this "disruptive" technology.

A few babies too:

A family man:

I know of others from my legal work supporting the EHR-related injured and deceased that I cannot mention.  And I am but one person.

If health IT were causing rapes** and child abuse, rather then merely causing mundane severe injuries and equally mundane deaths, would the media would pay more attention?

-- SS

** I sadly note that EHR's without proper security measures in force actually did enable rape-like behavior in 2011, as at "EHR as Molestation Candidate Selector: What was this Resident looking for in the EHR before 'examining' female patients?" at


Anonymous said...

I feel progressively stupider for reading that article. And Forbes tends to be one of those publications where "contributors" are self-marketers. But hey, EMRs are all great and they work wonderfully and nothing bad ever happens! *hops on unicorn, rides into sunset*

Anonymous said...

Biased. Flagrant journalism, if one could call the Forbes piece journalism and not an infomercial..