After reading letters and reports such as:
- The Jan. 15, 2015 Complaint Letter about EHRs to ONC from this country's major medical societies (http://hcrenewal.blogspot.com/2015/01/meaningful-use-not-so-meaningul.html),
- The 2015 Joint Commission Sentinel Events Alert on Health IT risk (http://www.jointcommission.org/assets/1/18/SEA_54.pdf),
- The stunning mishap and injury figures in the ECRI Institute Deep Dive study of EHR risk and the ECRI annual "Top Ten Technology Risks in Healthcare" reports (http://www.healthit.gov/facas/sites/faca/files/STF_Deep_Dive_Health_Information_Technology_2014-06-13.pdf),
- The FDA Internal Memo on HIT risk (http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html)
- and others (e.g., http://hcrenewal.blogspot.com/search/label/glitch):
One might ask the question:
"How did things get so bad?"
I believe one needs to look to the culture of medicine and to the culture of IT, specifically, the culture of IT recruiting in medicine by exclusive retained recruiters hired by hospitals to secure IT leadership (the predominant model used, with the contractual agreement that jobs will only be filled through the recruiter).
The culture of medicine is one of demanding education and proof through repeated testing and licensure that some fundamental level of competence exists. This cultire arose, in part, as a result of the Flexner Report of 1910 (http://www.medicinenet.com/script/main/art.asp?articlekey=8795) that called out abuses in medical education and practice where anyone from the "school of hard knocks" could call themself a physician and hang a shingle, with disastrous results:
... The Flexner Report triggered much-needed reforms in the standards, organization, and curriculum of North American medical schools. At the time of the Report, many medical schools were proprietary schools operated more for profit than for education. Flexner criticized these schools as a loose and lax apprenticeship system that lacked defined standards or goals beyond the generation of financial gain. In their stead Flexner proposed medical schools in the German tradition of strong biomedical sciences together with hands-on clinical training. The Flexner Report caused many medical schools to close down and most of the remaining schools were reformed to conform to the Flexnerian model.
The culture of health IT recruiting? Perverse.
Having posted many times on the issue of "expertise not needed" relative to HIT, the mother of all statements on health IT talent management has to be this from the major HIT recruiters of the late 20th century.
From the article "Who's Growing CIOs?" in the journal “Healthcare Informatics", November 1, 1998, see http://www.healthcare-informatics.com/article/who-s-growing-cios?page=3:
... In seeking out CIO talent, recruiter Lion Goodman doesn’t think clinical experience yields IT people who have broad enough perspective. Physicians in particular make poor choices for CIOs, according to Goodman. "They don’t think of the business issues at hand because they’re consumed with patient care issues." ... Instead of healthcare organizations looking just outside their IT divisions to recruit IT management, Goodman advises, "Look for someone who has experience outside healthcare as well as inside healthcare," in particular people with IT experience from industries such as banking and manufacturing, which use more advanced information system technology.
When I first saw this in 1998, I was stunned by its abject stupidity and feared for the future implications. My fears in 2015 are now realized, in spades.
Lion Goodman was an idiot, and a dangerous idiot at that in my opinion. "Patient care issues" ARE the business of hospitals.
Experience in banking and manufacturing IT is not helpful because medicine is not a mercantile or banking activity. Also, "advanced technology" was not the issue as today's usability, interoperability, crashes and other failures demonstrate. Banking and manufacturing IT personnel understood the more critical issues of human factors engineering supporting healthcare provision like a fish understood nuclear physics.
More importantly, medicine is far different and in fact the IT culture in those environments is anathema to the flexibility and understanding of the poorly bounded, high tempo, high risk practice of medicine (see "Hiding in Plain Sight", Nemeth & Cook, http://www.researchgate.net/publication/7738740_Hiding_in_plain_sight_what_Koppel_et_al._tell_us_about_healthcare_IT, click on "full text" image on right).
That health IT is now nearly universally reviled by physicians and nurses and is harming and killing people and even bankrupting healthcare systems trying to fix 10,000 bugs (e.g., "In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red", http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html) is a predictable outcome of hiring patterns for today's health IT leaders that resulted from such a perverse and ignorant talent management ideology.
Even worse, in the same article from Goodman and another major IT recruiter of the day with whom I was very familiar is this gem:
I don't think a degree gets you anything," says healthcare recruiter Lion Goodman, president of the Goodman Group in San Rafael, California about CIO's and other healthcare MIS staffers. Healthcare MIS recruiter Betsy Hersher of Hersher Associates, Northbrook, Illinois, agreed, stating "There's nothing like the school of hard knocks."
Ms. Goodman and Ms. Hersher must have been transported to the late 20th century from the Dark Ages.
Oh wait ... even Medieval monks in monasteries believed in the value of scholarship.
These attitudes are completely alien to medicine, and for good reason. The damage done to health IT by the hiring practices of the past is incalculable, but likely considerable. I was shocked even then by the qualifications and abilities of the health IT leaders I encountered, most of whom I had to clean up after, one way or another in order to protect patients from their abject medical recklessness and ignorance (e.g., http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=clinical%20computing%20problems%20in%20ICU , and http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story as just two examples).
One wonders just how many "from the school of hard knocks" HIT leaders were pushed by these recruiters onto healthcare organizations, and the harm such leadership may have done to healthcare, healthcare IT, and to patients in the intervening years.
Such an ideology widened the pool of candidates and likely increased the recruiter's profits ... the ultimate in parasitism considering, in 2015, the waste of hundreds of billions of dollars on terrible technology, reviled by most users and causing harm, in part due to being designed and implemented by leaders from "the school of hard knocks."