Monday, September 08, 2014

Does organized medicine need to "man up" on healthcare information technology risk and harms?

After reading a number of articles on healthcare IT problems over the past few years authored by leaders of organized medicine, please excuse me if I wonder out loud if organized medicine's leadership does not suffer from healthcare IT ignorance, low "T", or both.

Case in point, a article by Robert B. Doherty, Senior Vice President of Governmental Affairs & Public Policy, American College of Physicians that appeared in the Philadelphia newspapers blog site "The Field Clinic" today, Monday, September 8, 2014.

The article is entitled "Why doctors hate electronic health records" (no kindness in that title!) and is at

After an amusing and appropriate analogy to the autobile repair industry, the article makes some good points.

First, it attacks the canard about physicians being technophobes:

... It might be tempting to dismiss the doctors complaining about EHRs as technophobes who are unwilling to embrace new technologies, but the Rand investigators say that this isn’t the case: "... our study does not suggest that physicians are Luddites, technophobes, or dinosaurs.  Physicians recognized the important advances that EHRs have enabled, particularly in accessing information remotely (like checking a patient’s test results from home) and improving compliance with guideline-based care.”

The article, unfortunately, does not go far enough to point out that the real tension is between pragmatic clinicians and information technology hyper-enthusiasts and those who stand to profit from EHR diffusion, who ignore the downsides. (For more on that issue, see my March 11, 2012 essay "Doctors and EHRs: Reframing the 'Modernists v. Luddites' Canard to The Accurate 'Ardent Technophiles vs. Pragmatists' Reality" at

The article's author offers relatively standard and obvious "prescriptions":

... The solution isn’t going back to paper records, but designing EHRs that work for doctors and patients. Here are some obvious steps:
  • EHRs should provide physicians with abstracted, relevant clinical data in the most user-friendly way possible, rather than dumping reams of data on them that make it hard to extract the useful from the extraneous.
  • EHRs should supplement but not substitute for physician decision-making, providing doctors with evidence on the effectiveness of different drugs and tests in the least intrusive and least repetitive manner possible.
  • EHRs should facilitate face-to-face interactions between doctors and their patients not detract from them.  (In my most recent visit to my own primary care doctor. he spent almost the entire time looking at his EHR, rather than making eye contact with me). 
  • EHRs should make it as easy and quick as possible for physicians to document in the record the care provided to the patient.
  • EHRs must become fully interoperable, able to seamlessly exchange secure patient data with other EHRs.
The government has a lot of EHR standards, but the only one that really should matter is how useful EHRs are are in helping physicians take better care of patients.

That said, the failure to address the significant downsides, including compromised safety from bad health IT and actual harms, among others, is disappointing.  I have rarely if ever seen officials in organized medicine address that issue head-on.

Ironically, the author points out that RAND investigators wrote:

... The overarching problem, the authors contend, is that “no other industry, to our knowledge, has been under a universal mandate to adopt a new technology before its effects are fully understood...

Those "effects" happen to include not just clinician inconvenience, but direct patient harm, a phenomenon that in 2014 is poorly understood as admitted by FDA, the Institute of Medicine and numerous others.  That unacceptable state of affairs largely due to systematic impediments to understanding the magnitude of harms - that is, willful and deliberate blindness by those who know better (see the blog link below for more on these assertions if you are not a regular reader here).

My letter to Mr. Doherty at ACP speaks for itself:
From: Silverstein,Scot
Sent: Monday, September 08, 2014 2:43 PM
To: Robert Doherty, American College of Physicians
Subject: RE: "Why doctors hate electronic health records"
Dear Mr. Doherty,

Read with interest your piece "Why doctors hate electronic health records" at

Are you aware another reason for doctors, especially hospital-based ones, to "hate" EHRs (or, more correctly, the hyper-enthusiasts who push them and the industry that creates them) is due to the potential of these unregulated and poorly-engineered systems to contribute to or be causative of patient harms?

I have been expert witness on the Plaintiff's side in numerous cases where this has occurred...after my own mother was tragically and fatally injured in just such an accident.

These were cases where paper would have been more resilient.

FYI, in case you were unaware:

ECRI institute's voluntary 2012 "Deep Dive study of EHR" finding of 171 IT-related "incidents" in 36 member PSO hospitals in 9 weeks, resulting in 8 injuries and 3 possible deaths, is an example of why physicians ought "hate" the state of the health IT industry and its true lack of regulation, pre- and post-market surveillance, and other such factors prevalent in other mission-critical sectors.

More on these issues is at my blog post at the blog site of the Foundation for Integrity and Responsibility in Medicine, a 501(c)(3), at

I am educating the Plaintiff's Bar on these issues at AAJ national and state chapter meetings.

I have zero tolerance for bad health IT, and complacent clinical users of bad health IT.


Scot Silverstein, MD

In fact, it should be ACP, AMA, the state societies etc. performing the education on the issue of health IT harms, not just me and a small group of patient's-rights-minded "health IT iconoclasts."

One day, I hope organized medicine will start taking "T" supplements and do what needs to be done to compel this industry - and the government that should be regulating it effectively - to man up. 

-- SS


Steve Lucas said...

In a recent conversation I earned that a local surgeon has to deal with a different EMR at every hospital he operates and that none talk to each other or his office. This totaled five different systems.

The loss of productivity and opportunity for error are tremendous and this is only one doctor. Multiply this not only by the number of doctors in the county, but by the number of doctors in the country and you have a tremendous increase in cost and patient harm.

Steve Lucas

Anonymous said...

He truly misses the point that EHRs are associated with sudden, premature, and catastrophic death.