Will The True Incidence of Healthcare IT-Caused Patient Adverse Outcomes Please Stand Up?

The article Health Care Information Technology Vendors' "Hold Harmless" Clause - Implications for Patients and Clinicians, Ross Koppel and David Kreda, Journal of the American Medical Association, 2009; 301(12):1276-1278 (JAMA) has caused much discussion in healthcare IT circles.

I have become aware of discussions centered on issues such as:

• The factors besides vendor design flaws and defects that contribute to the unsafe and ineffective use of health information technology,

• The degree of effect caused by end user organization customizations,

• whether a focus on legal or regulatory action is misplaced

• Whether such regulation could "stifle innovation", and

• Other interesting and stimulating related issues.
  

These discussions miss the forest for the trees, unfortunately.

They are all speculation.

I could just as easily - as a thought experiment - argue and rationally support a point of view that vendor defects, shortcomings, ill conceived user interfaces etc. are the greatest cause of HIT problems, that a sole focus on regulatory action is the best path, and that regulation would not stifle innovation but promote it by forcing complacent, lazy companies protected by the current status quo to become competitive, to hire the very best and brightest and most experienced who they now forgo as "too disruptive, too expensive, lack the latest programming skills", etc.

None of this speculation really matters in the big scheme of things.

What does matter is the fact that we now have before us a "grand confounder" - the anechoic effect caused by vendor contracting - that throws into doubt existing assumptions about HIT-caused errors.

Who among us can now say what the number of physician observed defects really is, what the rate of HIT error really is?

I've had several of my colleagues already tell me since the Koppel article that they know of HIT caused errors and even patient adverse consequences, but they are afraid to speak out. What is the morbidity and mortality change associated with use of HIT vs. paper?

Who really knows?

There is a significant, perhaps high likelihood that the current state of HIT contracting, and the muting effect it creates, combined with fear of retaliation by potential objective HIT reporters (a.k.a. whistleblowers) makes any such estimation highly questionable at best.

Speculation is irrelevant. What we need is a return to the rigor of medicine - to science - in HIT itself.

That can only happen in an environment where users are free(er) to share their observations and findings about HIT problems.

Such one-sided, safety adverse HIT contractual clauses must end.

-- SS