As I wrote in 2010-12 at "Cart before the horse" posts at http://hcrenewal.blogspot.com/2010/10/cart-before-horse-again-institute-of.html and http://hcrenewal.blogspot.com/2012/06/cart-before-horse-part-3-ahrqs-health.html, rolling out health IT nationally before having a firm grasp of its risks was an abrogation of medical ethics and long standing treatises on medical experimentation, including the need for informed consent, dating back to the post-WW2 period.
|Ready, fire, aim: let's roll out health IT nationally, then figure out how to make it safe...|
The Role of Standards in Preventing & Mitigating Health IT Patient Safety Risks
Health IT Community Technical Workshop for all Stakeholders: Learn and Share Industry Best Practices.
Bring together all Health IT stakeholders to share best practices and review the fundamentals of risk prevention and mitigation that apply to Health IT. Health IT standards are part of the foundation needed to deliver high quality, patient-centric care. The industry continues to gain a better understanding of the relationship between managing risk and providing quality care through the safe use of Health IT.
This forum is an opportunity to receive updates on the latest standards development process related to risk prevention and mitigation, quality assurance and safety-related usability, to find out about recent findings from studies conducted on this subject, and to bring industry stakeholders together to share best practice, and define the path forward for risk prevention and mitigation that apply to Health IT.
Final Agenda (http://www.nist.gov/healthcare/usability/upload/NIST-Workshop-Agenda-7_7_16.pdf)
This workshop is an admission that the industry lacked in understanding "of the relationship between managing risk and providing quality care through the safe use of Health IT" at a time when rollout of bad health IT was pushed like a Miracle Cure by government and industry pundits, and became a national mandate,
To all the boneheads who did push this technology out the door prematurely before its risks and safety were reasonably understood, and/or ignored the "iconoclasts" as they were derogatorily known, thanks for harassing doctors and nurses to the point of exhaustion, harming patients via cybernetic experimentation without consent, and wasting billions of dollars of taxpayer money. (It would have been a very good thing, I note, if efforts like this had been mandated before my mother's demise of care continuity failure precipitated by bad health IT.)
NIST, this workshop is late, but better late than never.
However, I am increasingly of the belief that this technology is unsuitable for busy clinicians, as long as they bear the clerical burdens, and can never be fixed it that arrangement is not drastically changed.
"Best practices", I believe, call for a return to paper (specialized forms depending on the setting) for clinical data capture by busy doctors and nurses, and data entry into a computer via clerical personnel.
Why do I hold this belief?
I designed such a system for invasive cardiology (a highly complex, critical-care medical domain) 20 years ago that was highly successful and popular, even among busy invasive cardiologists, to replace a direct-computer-entry commercial product from hell. This is written up at this link: http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story
After modeling the dataset for the domain of cardiac catheterization to a high degree of granularity, the forms were designed and tested collaboratively with the invasivist leaders, as seen below.
The physicians recorded real-time onto the forms, or shortly after they de-gloved. There were also specialized forms for the cath lab technicians and nurses. Click to enlarge. Each section could be supplemented via dictation if needed, and the text transcribed and sent to the application server for inclusion on the full cath report, via a direct link from central transcription.
No wasting of clinicians' valuable time and limited cognitive energy navigating lousy EHR user interfaces, interacting with a multitude of mind-numbing icons and widgets, and other frustrations looking to enter critical data.
|Physician's data collection form, side 1. Click to enlarge.|
|Physician's data collection form, side 2|
|Cath technician/nurse's data collection form, side 1|
|Cath technician/nurse's data collection form, side 2|
Clerical employees were hired to perform data entry from the paper forms and inquire with the doctors when there were questions about data recorded during the cath.
Forms for less specialized medical domains would be significantly simpler.
Ca. 2007, (non-medical) Siemens Healthcare IT executives in Malvern, PA (a Siemens division now bought out by Cerner) were shown this project by me, still in use just a few miles south of them in Delaware, and deemed it "impractical" for commercialization. I thought that very sadly ironic considering the incredible engineering prowess and accomplishments world-wide of parent company Siemens A.G.
In my direct first-hand experience, non-medical IT executives are one of the biggest impediments to health IT progress (and safety), in both hospitals and the pharmaceutical industry.
Siemens is a global powerhouse focusing on the areas of electrification, automation and digitalization. One of the world’s largest producers of energy-efficient, resource-saving technologies, Siemens is a leading supplier of systems for power generation and transmission as well as medical diagnosis. In infrastructure and industry solutions the company plays a pioneering role. As of September 30, 2015, we had around 348,000 employees in more than 200 countries. In fiscal 2015, they generated revenues of €75.6 billion.