Wednesday, November 04, 2009

2009 a Pivotal Year in Healthcare IT

2009 is proving to be a pivotal year in healthcare IT. Recent authoritative articles and reports on health IT problems largely validate the issues presented at this blog and others focusing on health IT issues, and at my academic website on HIT difficulties started over a decade ago, in 1998, freely available to the industry.

These articles and reports have ultimately led to a U.S. Senate investigation of the healthcare IT industry initiated in Oct. 2009 (link below).

2009 may be the year that healthcare IT vendors will finally begin to understand that not lending credence to decades of teachings from Medical Informatics professionals on healthcare IT design, implementation, lifecycle support, involvement of end users, and sales and marketing has been harmful to their businesses and to their investors. Instead, the commercial health IT companies took a simplistic management information systems-based approach to building medical devices in an incomparably complex environment they did not -- or did not care to – understand.

These devices are, in fact, virtual medical devices that happen to reside on a computer, not business computing systems that happen to be used by clinicians. These medical devices are soon to undergo regulation as such in the EU (pdf report from the Swedish Medical Products Agency here), Canada, the U.S. and other countries as well.

The teachings of Medical Informatics about such devices have been documented in the extensive literature of Medical Informatics. For example, the book “A History of Medical Informatics in the United States, 1950 to 1990” by informatics pioneer Morris F. Collen (published in 1995) explicitly demonstrates the progression of the field and the wisdom of the pioneers dating back to the 1950’s, as in the bons mots here.

The 2009 articles and reports below demonstrate numerous undesirable outcomes of the management information systems approach to development and implementation of virtual clinical devices:

  • The Joint Commission’s “Sentinel Event Alert on Healthcare IT” is here.
  • The U.S. National Research Council’s "Current Approaches to U.S. Health Care Information Technology are Insufficient" and link to a full report on an investigation of healthcare IT lack of progress is here.
  • The UK Public Accounts Committee report on disastrous problems in their £12.7 billion national EMR program is here.
  • The Washington Post’s article on the influential HIT vendor lobby “The Machinery Behind Healthcare Reform” is here.
  • Hoffman and Podgurski’s paper from Case Western entitled “e-Health Hazards: Provider Liability and Electronic Health Record Systems” on EHR medical and legal risks is here.
  • My commentary on the May 2009 AMIA workshop report on healthcare IT failure with free PDF is available here.
  • My commentary on a sentinel Mar. 2009 JAMA article by University of Pennsylvania researchers Ross Koppel and David KredaHealth Care Information Technology Vendors' Hold Harmless Clause: Implications for Patients and Clinicians” on unsafe contract terms demanded by healthcare IT, and the violations of Joint Commission safety standards and fiduciary responsibilities committed by hospital governance personnel who agree to such terms, is here.
  • A link to the Oct. 25, 2009 Washington Post article “Electronic medical records not seen as a cure-all” and my commentary are here.

Finally, and perhaps most importantly, the Oct. 16, 2009 letter to major healthcare IT vendors from Senator Charles E. Grassley (ranking member of the United States Senate Committee on Finance) initiating a Senate investigation of corporate practices is here (PDF).

I have used this medieval illustration in a prior post on these pages, but sadly in this case it is probably even more highly appropriate:

"Margaritas ante Porcos" - click to enlarge

Not to be gratuitously impolite, but hard truths are often an unpleasant medicine, especially when ignoring those truths results in adverse consequences to patients and their caregivers.

-- SS


Anonymous said...

Comprehensive review. All told, it will be discovered that the Congress of the United States has been deceived by the HIT vendors and their supporting cast of "independent" appearing trade groups.

This is worse than the tactics of the tobacco industry that used the intellect and wisdom of the so called "Tobacco Institute" to spread the word that cigarettes were not harmful.

JohnLloydScharf said...

If health care is the problem, insurance is not the cause and government is not the answer.

Of those "50 million," that lack insurance there were 45,000 who died without health care.

WITH health care, 98,000 died FROM health care because of malpractice.

The question is do we want to trust that largest corporation in the world, the U.S. Government. Do not expect house calls anytime soon.

We have seen how well the government delivers on its promises and its bureaucracies pursue the money without giving us benefits on so many levels.

Imagine another 111 bureacracies that only ultimately must listen to the Secretary of the Treasury - another "service" of which is the IRS.

That blog of mine above has several .pdf connections (HR. 3962 and two summaries, a few videos, and page references for new taxes and other mandates).

If you cannot use the link, google "Progressive Capitalist H.R. 3962."

If you believe the promises of this bill, you have to deal with the lie that it fosters competition with a government option called the "Public Option" and establishes the government as a monopoly making its own rules.
Don't worry. You'll run out of "rich" soon enough.

We have at least a $12 trillion economy of which at least $1.8 trillion is spent on health care.
If you read the bill, there are plenty of opportunities to soak the middle class, if you do not mind the 1.6 million made jobless.

REPUBLICAN Affordable Health Care For America Act
MAKING HEALTH Care Affordable For EVERY AmeriCAN

InformaticsMD said...

Note: The above comment is a bit off topic, but since the national EHR programs demonstrate the inefficiencies of both the HIT vendors and the governments running such programs, I will leave it up.