As the KevinMD blog is exceptionally well-read, I expected the HIT pundits to come in with "see no evil, hear no evil, speak no evil" accolades for the technology.
I was right, even early on.
Keep in mind that Dr. Lundberg specifically quotes me in his article:
... However, there is another harsh critic worth listening to.
His name is Dr. Scot Silverstein, and he seems to have made it his life's work to call attention to really bad problems that he discovers in this mass move to automation.
Heed his cautions. They are real.
My writings and opinions are known of by the following pundit, including the fact that my relative was injured as a result of the technology, who commented on KevinMD's reposting of the Lundberg essay. The comment is here (I do not personally know the commenter, only having exchanged numerous back-and-forth comments on a few health IT blogs in the past):
Margalit Gur-Arie [a partner at EHR pathway, LLC and Gross Technologies, Inc. - ed.]
Wow! There's something to be said for extreme statements, whether right or wrong.
... do EHRs kill people? Probably, but every single item used in medicine can be shown to have killed people at one time or another, depending on how you define "killed" [1]. Do more people get harmed where EHRs are present, compared to where they are not? There are no conclusive studies to that effect and there are no conclusive studies showing the opposite either. There are not very good studies at all, but if mass murder was occurring, we would have probably known by now.
The appeal to ridicule and/or argumentum ad ignorantiam-like statement "if mass murder was occurring, we would have probably known by now" is both fallacious and egregious. Is that a criteria medicine uses, in the explicitly admitted situation where conclusive studies are lacking, to promote diffusion of some new treatment or tool? That is, since we don't note catastrophic levels of toxicity, the toxicity is of minor import?
On other logical fallacies, the statement that "every medical intervention can kill", implying that any morbidity and mortality due to EHRs is just a foregone conclusion, is doubly fallacious.
One fallacy is the absolute nature of the statement itself. It isn't true that 'all medical interventions can kill.' Another fallacy is the cavalier lack of distinction between a small vs. large risk of injury or death.
That said, even without considering 1) the literature aggregated here, 2) the context of the IOM Committee on Patient Safety and Health Information Technology's report that states the technology has risks, and worse, that impediments to information diffusion prevent the magnitude of the risks from being known (PDF available here), and 3) the context of my relative's travails, this is perhaps the most wishy-washy, ethically unsatisfying, cold-hearted excuse for health IT's problems -- and for reneging on fixing those problems before national rollouts -- that I have ever seen.
The argument is so bad, it's difficult to parse out the precise nature of all the logical fallacies contained within.
COI disclosure: I note that I have no associations with, receive no payments or royalties from, or have any other relationships with healthcare IT vendors, consultants or customers. I decided to offer my services as an expert witness for attorneys on health IT-related injuries and records tampering as a result of my relative's travails, however.
Note:
[1] "Depending on how you define "killed"? Let me take a stab at that (it should be easier than defining what the meaning of the word 'is' is). How about "resulted directly or indirectly in the termination of all biological functions, as in, the patient's dead?"
-- SS
Hyperbole is the coin of the realm for many trying to sell a product. What you see in HIT is pretty much that. What you see in hospital advertising also succumbs to flights of fancy, and overclaims (or underreporting of problems).
ReplyDeleteNot saying it fits in healthcare, just saying it is to be expected without appropriate regulation.
I like that Margalit also states: "The problem with EHRs is that, currently, they don't deliver on the "better, faster, cheaper" goal very well. At least not from the perspective of those who are asked to pay for them. That said, I agree that EHRs have become part of the cost of doing business whether you like them or not. The only reasonable question to ask is how to go about minimizing the cost and the trouble." ANSWER_WORKAROUNDS!!!!
ReplyDelete"BETTER, FASTER, CHEAPER" Not even close.
On the subject of BETTER: Injuries and deaths from HIT devices are covered up and obfuscated by hospitals and vendors, while the users are invariably blamed.
On the subject of FASTER: These devices are impediments to efficient care, contaminating otherwise straight forward work flows with mind numbing complexity.
On the subject of CHEAPER: The enumerable misidentifications, missed lab data, duplicate medications, upcoding fraud, turning doctors into typists, to mention a few are radically increasing the cost of EMR run medical care. That, my friends, is a no brainer.
Afraid said...
ReplyDeleteHyperbole is the coin of the realm for many trying to sell a product.
Hyperbole has no place in medicine, but the comment to which I refer in my post is not hyperbole. It is something else entirely, but what it is, I leave to the reader to decide.
-- SS
Anonymous December 1, 2011 10:48:00 PM EST said:
ReplyDeleteThe only reasonable question to ask is how to go about minimizing the cost and the trouble." ANSWER_WORKAROUNDS!!!!
You should not have to work around that which is not in your way.
If we are uncertain that EMR's do any/all of the following: reduce costs, reduce time, reduce risk, improve outcomes, then we ought not be embarking on a "National Programme for IT in the HHS" at this time.
-- SS
'Sebelius noted that as personal tech has revolutionized virtually every other industry, “healthcare has stubbornly held on to its cabinet and hanging files.”'
ReplyDeleteSee Washpo @ http://www.washingtonpost.com/business/on-small-business/in-health-technology-an-enthusiasm-gap-between-startups-and-doctors/2011/12/06/gIQANFzXaO_story_1.html
Re: WaPo story
ReplyDeleteSebelius noted that as personal tech has revolutionized virtually every other industry, “healthcare has stubbornly held on to its cabinet and hanging files.
Her and Topol's knowledge of crucial areas such as Medical Informatics and Social Informatics clearly is inadequate.
-- SS