Thursday, August 31, 2017

Information technology-naive defense lawyers vs. "strident critic of electronic health records"

A tale from the trenches.

In recent years, as a result of the 2010 IT-related injury and 2011 death of my mother, I have engaged myself as an independent EHR forensic expert regarding evidentiary and patient harm issues in medical malpractice litigation. 

Interestingly and disappointingly, I still often find that hospital attitudes towards health IT safety and information transparency have changed little since 2010 or, for that matter, the 1990s when I did my postdoc in medical informatics.  Hospitals and defense attorneys often (ab)use the lack of technology experience of judges to delay or prevent evidentiary transparency.  I'm thus frequently retained by injured patient's attorneys (or attorneys representing the executors of deceased patients' estates) to help overcome this phenomenon.

In doing so, I can find myself under attack in deposition, even before any proceedings begin.

For instance, I was recently asked in a deposition, as an attack geared towards injuring my credibility, if an assessment of me published in the literature, that I was a "strident critic of electronic health records" was fair.

I replied that it was not a fair assessment, that I was a critic of bad health IT, but juries potentially will hear only the one-liner.

I'd formally defined bad health IT in these pages and at my Drexel medical informatics teaching site as follows:

Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or evidentiary fitness, or otherwise demonstrates suboptimal design and/or implementation.

It appears the attorney attacking me in this manner found the phrase "strident critics of electronic health records" online in a Feb. 18, 2013 Kaiser Health News Article by Jay Hancock (that also appeared in the Philadelphia Inquirer) entitled "Health Technology’s ‘Essential Critic’ Warns Of Medical Mistakes." 

That article is at http://khn.org/news/scot-silverstein-health-information-technology/.  It is unfortunate that cherry-picking in an attempt to neutralize a proponent of caution and evidentiary fairness in health IT still occurs in 2017.   That 2013 article itself centers on my patient safety-centered critique of bad health IT.  At the heart of the article is this: 

... Silverstein “is an essential critic of the field,” said Dr. George Lundberg, editor at large for MedPage Today and former editor of the Journal of the American Medical Association. “It’s too easy for those of us in medicine to get excessively enthusiastic about things that look like they’re going to work out really well. Sometimes we go too far and don’t see the downside of things.”

A growing collection of evidence suggests that poorly designed software can obscure clinical data, generate incorrect treatment orders and cause other problems. Cases include the Lifespan glitch; a data-entry error that led to the 2010 death of a baby at Advocate Lutheran General Hospital in Illinois; and computers at Trinity Health System, a major Midwest chain, that logged doctors’ orders on the wrong patients’ charts.

Computer mistakes voluntarily reported to the Food and Drug Administration include those that researchers said were linked to 44 injuries and six deaths at unidentified institutions. Those problems included tiny fonts causing caregivers to click on the wrong medication; flipped images that led a surgeon to operate on the wrong side of a patient’s head; and lost or misdated test results that caused unnecessary surgery or delayed treatment.

The FDA’s Dr. Jeffrey Shuren has said that such cases “likely reflect a small percentage of the actual events that do occur.”

I'd also thought this attack vector - painting me as some sort of fanatical anti-EMR Luddite - obsoleted by the remarkable Jan. 2015 complaint letter about health IT from appx. 40 major medical societies to HHS at http://mb.cision.com/Public/373/9710840/9053557230dbb768.pdf.  I commented upon that letter in my Jan. 28, 2015 post "Meaningful Use not so meaningful: Multiple medical specialty societies now go on record about hazards of EHR misdirection, mismanagement and sloppy hospital computing" at http://hcrenewal.blogspot.com/2015/01/meaningful-use-not-so-meaningul.html.  Sadly, I was wrong. 

I perhaps should have asked counsel if they were a supporter of bad health IT that injures and kills people.  If the matter comes up again, I very well might.

I felt sorry for that attorney, however.  I was also asked if I still "kept records" on my 1977 Heathkit H8 computer or words to that effect, with a possible implication that maybe I was hiding things on that machine.  This is a computer I still have which said attorney must have seen on my web page of technology interests at http://cci.drexel.edu/faculty/ssilverstein/medinformatic1/ham.htm.

I replied to the attorney that I last used the H8 to teach Yale informatics postdoctoral fellows (about computer architecture) in the mid 1990's when I was faculty there, and that it has not been turned on since. 

I didn't go into how doing so would require me to carefully clean approximately 500 small tin-plated (a costs saving by Health by not using gold) pins and sockets that connect the daughtercards to the motherboard, and probably replace long-unused power supply electrolytic filter capacitors before even applying power.


My late 1970's Heathkit H8 computer, Intel 8080 CPU @ 2 MHz, 64K RAM

I also was not permitted the time to relate to the counselor that the computer is quite primitive, having 64 kilobytes of RAM, with its main mass storage being special hard-sectored (and now nearly unavailable, as opposed to the more common soft-sectored) single-density, single-sided 5.25" floppy disks, each holding about 80,000 characters of information.  80 kilobytes.  By comparison, the common cellphone today has 2,000,000 kilobytes = 2 Gb of built-in storage...

It's sad, but I almost broke out laughing at the bizarre technology-naive question.  These are the type of folks who are defending bad health IT and taking advantage of the lack of knowledge of many judges about the technology.

The attorney also for some reason demanded me to affirm that the health IT-related medical malpractice case in which I am substitute plaintiff, that of my late mother, had been dismissed.  He didn't ask me the case status, but instead in a declarative manner stated "and that case has been dismissed, is that right?"

God only knows where that misinformation came from.  IT industry/defense lawyer Listserv gossip perhaps?

It was my pleasure to inform him that he was entirely incorrect.  After many years of delay, pretrial conference is scheduled for early October, and trial sometime after that, regarding a travesty caused by bad health IT and careless clinicians.  In a gross medication reconciliation failure, my mother's critical cardiac medication, Sotalol hydrochloride was inexplicably terminated, resulting in cascading problems leading to disaster.

-- SS

1 comment:

Live IT or live with IT said...

Bless your soul...