Monday, September 20, 2010

Health IT: On Anecdotalism and Totalitarianism

At the article Blumenthal on EMRs: Debate "raging" over competition vs. standards (, ONC czar David Blumenthal is cited as saying several interesting things:

... EMRs make him a better physician, he said, recounting personal anecdotes of discovering patients' allergies through automated EMR alerts and using stored image date to more quickly get a diagnosis for a patient without subjecting them to more radiation and toxic radiation agents ...

It's the EMR "anecdotalists"
(as opposed to the "Markopolists") who say that "anecdotes" of HIT-related injury are meaningless. They deem reports of safety issues and HIT-related misadventures and risk as simply "anecdotal", and that "anecdotes don't make evidence" (or "anecdotes don't make data").

Yet anecdotal reports of EMR "saves" are used by a czar to justify tens of billions of dollars of expenditures?

To the anecdotalists, I say: you can't have it both ways.

That same article concludes with this concerning statement:

... Blumenthal, adamantly pro-EMR, said there is a move afoot to add technical fluency into certification for healthcare providers. "Boards of certification, all the primary care boards of medicine have adopted principles that will lead them to create requirements for the use of electronic health systems as a research requirement, and even the medical licensing boards are beginning to think about whether the maintenance of licensure should be dependent, to some degree, on using electronic health systems," he said. "Information is the lifeblood of medicine, and unless physicians and other healthcare professionals are capable of using the most modern technology available for managing information, I think they will have trouble claiming, in the 21st century, the unique competence that entitles them to being licensed and board certified. I think they'll have trouble holding up their heads as professionals and claiming that they are at the top of their game and capable of providing the best care that technology allows."

It appears that my observation ten years ago of a cross-occupational invasion on Medicine by the IT domain (and its purveyors) was prescient. They've continued the march, and now they're now literally at the castle gates.

I commented on this issue in more detail a few weeks ago at my post "American Board of Medical Specialties to "incorporate tools to promote meaningful use of health IT into its maintenance-of-certification program".

I have two questions:

1) Was it the intention of the Medical Informatics pioneers to prohibit physicians from being licensed and/or board certified on the basis of using health IT? If such a seemingly totalitarian intention existed, that's fine, I just want to hear it debated.

2) Is the mere consideration (let alone enactment) of such a restriction, for all specialties, truly evidence based?

(Note some merely skimming-the-surface "evidence" at my post "
Science or Politics? The New England Journal and "The 'Meaningful Use' Regulation for Electronic Health Records".)

-- SS


Anonymous said...

This gets more oppressive as each day goes by. It is abhorrent that the doctors' license depends on using devices that have not been approved for safety.

Live it ... said...

Do you think Blumenthal's next job will be the CEO of a Health Care IT company?

Anonymous said...

No, back to Harvard like Lawrence Summers.