A comment posted to the website "Doctors Helping Doctors Transform Healthcare", Peter Basch, William Bria et al.

A new website has appeared that purports to be:

A collaborative effort led primarily by doctors for doctors to provide a "trusted resource" for physicians as they work to transform health care - initially through the use of health IT.

The site is entitled "Doctors Helping Doctors Transform Health Care" and is at this link. (I note that when one encounters such platitudinous and potentially highly ideological titles, one should ask "transform how, and into what, exactly?" I presume "transform" means, in part, to reduce risk and improve safety and outcomes - while protecting patient and physician rights.)

The site has a significant number of people on their advisory board (link), but no information on compensation. I note there are industry people involved, representing a potential conflict of interest.

According to one of the principals, Peter Basch, MD, Medical Director, Ambulatory EHR and Health Information Technology Policy, MedStar Health, Washington, DC, on funding:

A Few Words About Our Supporters

It takes resources to create and maintain this site, to make the work of Doctors Helping Doctors possible. We have solicited unrestricted contributions from individuals and organizations who believe in our mission and are able to support its work. In particular, we wish to thank Patrick Soon-Shiong of the Chan Soon-Shiong Family Foundation, John Glaser of Siemens Health Services; and Andy Slavitt of Optum’s Institute for Sustainable Health.

To my knowledge, I've never met Dr. Basch, but at meetings I have met one of the other principals of the new website, William Bria, III, MD, Chief Medical Information Officer, Shriners Hospitals for Children; President and Co-Founder, Association of Medical Directors of Information Systems (AMDIS), St. Petersburg, FL.

Dr. Basch's writing has appeared at Healthcare Renewal before, such as at the Jan. 2009 post "Throwing The National Research Council Report On Health IT Under The Bus, Part 1: MedStar Health."

In the new site, Dr. Basch states that:

As early adopters, EHR implementers, and practicing physicians, we have seen the “bad and the ugly” as well as the promise of health IT. We understand how health IT can and should be used to make care better, safer, and more value-laden. As such, we believe that unnecessarily harsh criticism of Meaningful Use—which we have heard from some quarters—and uncritical cheerleading—which we have also heard—are equally unhelpful.

We see physician “extremism” essentially marginalizing what is needed now more than ever—a clear and constructive physician voice, articulating not for compliance with Meaningful Use, but rather leveraging the opportunity that Meaningful Use presents, and consistently inserting the highest ideals that led us all to choose a career in medicine.

While on the surface this is not an unreasonable position, I fear the word "extremism" is used as a metaphor for those who express genuinely critical appraisals of the state of health IT as it now exists, on issues regarding safety, efficacy, usability, need for regulation, vendor, buyer and user liability, and other "unpleasant" topics.

I do note precious little on the site about educating physicians on the considerable downsides of health IT as it currently exists, nor on the scientific literature expressing doubts about its safety, efficacy, usability, ROI and other issues (such as here).

There is, it would seem obvious, no ethical excuse for introducing medical devices and other technology of unknown benefit and of unknown risk magnitude (as recently reported by the IOM, see this post), that is unregulated, into life-critical domains such as medicine without explicit acknowledgement of experimentation. Human subjects experimentation requires, of course, explicit informed consent under the many guidelines formulated as a result of past systemic abuses. Also, users need to be fully aware of the risks.

Such informed consent cannot be accomplished, and awareness attained by physicians regarding the dangers of use of health IT in its present form, through simple "best practices" protagonism.

For instance, health IT can be inherently defective and/or mission hostile (worse, the industry is unregulated), and can injure or kill. Several illustrative examples just off the top of my head are at:

• "FDA Recalls Draeger Health IT Device Because This Product May Cause Serious Adverse Health Consequences, Including Death";

• "Lifespan (Rhode Island): Yet another health IT 'glitch' affecting thousands";

• "FDA MAUDE Database: Patient Outcome - Death" and "FDA Manufacturer and User Facility Device Experience (MAUDE) database - case reports of EHR defects";

• "ECRI: Healthcare IT In Top Ten Health Technology Threats to Patient Safety";

• "Bad Health Informatics Can Kill" [European Federation for Medical Informatics];
  

• "A Study of an Enterprise Health information System" [Australia - severe deficiencies in software engineering noted in major U.S. vendor ED EHR system that cause user confusion as well as data corruption/loss];

• "Health informatics — Guidance on the management of clinical risk relating to the deployment and use of health software" [ISO/UK NHS - with an accounting of EHR-related medical errors in Annex A];
  

• and a personal account "A Diary of EHR-Initiated Tragedy."

Not even including privacy and confidentiality issues (see this query link on those issues), should physicians, nurses, patients and other stakeholders not be explicitly educated on the issues of risk, that can be greatly replicated/amplified across hundreds or thousands of patients by EHRs as opposed to paper, and on actual injuries and deaths that have occured? If not, why not?

Are not these issues and the issue of the lack of a culture of safety in the health IT field at least as important, if not more important for clinicians, patients, healthcare executives and other stakeholders to be strongly aware of than "best practices" and "meaningful use?"

(I note that the "negative reports are mere anecdotes" argument commonly used by health IT pundits only shows, as in the Aug. 2011 essay by a senior clinician in Australia "From a Senior Clinician Down Under: Anecdotes and Medicine, We are Actually Talking About Two Different Things", that those making that argument need to attend revision courses in research methodology and risk management.)

In consideration of the "Doctors Helping Doctors" site's seemingly uncritical pro-HIT advocacy, I have posted the following note at the end of Dr. Basch's introductory essay. The comment appears at this link and is awaiting moderation.

The comment's remaining online would be a sign that the site is not another attempt to "control the channel", and is truly serious about being "trusted." It would be a sign of a site truly concerned with "physicians helping physicians transform health care" while not sacrificing patients as unconsenting test subjects of unregulated, experimental software-based medical devices in the process.

S Silverstein MD says:

December 17, 2011 at 10:29 pm

Doctors,

One way to help doctors transform healthcare would be to educate them on the downsides of information technology in healthcare, how to avoid them, and the conflicting literature on benefits (e.g., as at http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=readinglist).

I do not see such information here yet.

I do expect some such information will follow.

Sincerely,

Scot Silverstein

---------------------------------------------------
Scot M. Silverstein, MD
Consultant/Independent Expert Witness in Healthcare Informatics (May 2010-present)
Adjunct faculty in Healthcare Informatics and IT (Sept. 2007-present)
Assistant Professor of Healthcare Informatics and IT, and Director, Institute for Healthcare Informatics (2005-7)

Drexel University
College of Information Science and Technology
3141 Chestnut St., Philadelphia, PA 19104-2875

Email: sms88 AT drexel DOT e-d-u
Bio: http://www.ischool.drexel.edu/faculty/ssilverstein/biography.htm
Common Examples of Healthcare IT Difficulties: http://www.ischool.drexel.edu/faculty/ssilverstein/cases/

Note: I am cross-posting this comment on Healthcare Renewal blog under the title "A comment posted to the website 'Doctors Helping Doctors Transform Healthcare, Peter Basch, William Bria et al.'"

It is my hope the comment stays, and receives a reasoned reply.

-- SS

Dec. 23, 2011 addendum:

My comment appears to have disappeared. I leave it to the reader to determine what that means about the site "Doctors Helping Doctors Transform Healthcare."

-- SS