Tuesday, February 19, 2013

Are the health IT hyper-enthusiasts inept, or merely insane?

From a psychiatrist, partially in response to the article about me in Kaiser Health News, on the travails of health IT.

They write:
... In psychiatry we screen for certain medication side effects using a tool called "DISCUS."  [Dyskinesia Identification System Condensed User Scale - ed.] In a paper and pen world, we (1) reviewed a single page; (2) circled a score; (3) signed and (4) dated.

In [redacted] EHR, we need to do the following to complete one DISCUS…
DISCUS Completion in [redacted] EHR:
  • 1.  Log in;
  • 2.  Acknowledge to do items by choosing “ok”;
  • 3.  Go to “my to do list.”
  • 4.  Double click specific date of to do items to complete (this reveals the specific to do items)
  • 5.  Right click specific patient’s name
  • 6.  Choose “enter option”
  • 7.  Review all 3 pages under “assessment” tab (click through each page)
  • 8.  Then choose “evaluation” tab
  • 9.  Review “evaluation” (keeping in mind the total score from last page of “assessment”)
  • 10.  Choose your “conclusion” in item 5
  • 11.  Add “comments” as indicated (item 6)
  • 12.  Under “name/ID number” type in the first characters of your last name (or your ID number)
  • 13.  Select your name
  • 14.  Go to the bottom under “select physician to notify” and UNcheck your name
  • 15.  Click “yes” under “is evaluation section complete and ready to be locked?”
  • 16.  Confirm above choice by choosing “ok”
  • 17.  Press “submit” button across the top
  • 18.  Now go back to “my to do list” and you’ll see that the item you just processed above is still there -- double click the same to do item that you just finalized (and processed in item 5 above)
  • 19.  Then check “reviewed”
  • 20.  Then press “submit”
  • 21.  Then press “refresh” and the item will be completed (refresh does not need to be done after each DISCUS)
  • 22.  For processing of additional DISCUS for a given “sign on," go back to step 3, 4 or 5 (as needed), and repeat.

And this is just the easy stuff.

I'm not a psychiatrist, but I can opine with confidence that anyone who expects human-computer interaction such as this to "revolutionize medicine" is insane.

Perhaps this helps explain city-wide debacles such as this in San Francisco.

-- SS


Ryan said...

Health IT is not merely EHRs. There are plenty of Health IT companies that are focused on providing products that truly improve clinician efficiency. I am a part of one of those companies, and we built our product not just with the clinician in mind, but with the clinician in our ear. We rolled out a simple minimum viable product, got clinicians to start using it, and focused on their suggestions to adjust features and improve efficiency.

Please don't lambaste the entire HealthIT movement because of your disdain for EHRs and Meaningful Use. There are a lot of clinicians working in Health IT, with the goal of 'scratching our own itch', rather than making millions.

InformaticsMD said...

Ryan anonymous said:

Please don't lambaste the entire HealthIT movement because of your disdain for EHRs and Meaningful Use.

My credulity is strained when I see deviously distorted comments such as yours, as you've misrepresented my plain and oft-stated view that it is bad health IT - as I've defined multiple times - and the bad medicine that results I am "against".

There is indeed good work going on in health IT - I've done some myself, for a desert Kingdom where people of my tribe rarely go - but as the New York Times and its reader comments yesterday showed, they are not dominant.

As for "meaningful use"...my thoughts on that are very clear, too. I would have preferred it to have been called "good faith use", and its proponents not to proffer unsubstantiated claims that amount to self-serving propaganda.

That said...what part of this post do you challenge, other than making inaccurate characterizations of my views, and what studies/resources can you provide to back your views?

If you cannot or will not make logical arguments...you are in the wrong place and before the wrong audience.

-- SS

Ryan said...

My point remains that the title of this post is a bit sensational in my opinion. You start off by calling "Health IT hyper-enthusiasts" insane and/or inept, but then you only focus in on EMRs and meaningful use. I made a simple statement that there are a lot of people that are working to provide Health IT that is focused on increasing provider efficiency, cutting costs, and improving quality of care.

Listen, I think you're spot on in your critique of EMRs, but I don't think you can generalize that critique to the entire Health IT movement.

Lastly, blogs should be a place for fostering discussion and civilized discourse, especially when the blog is specialized and caters to a select set of readers. If you want your opinions to be better heard, shooting down reader comments and discouraging them from commenting in the future is the exact opposite strategy you should have. When your article is compelling enough to make someone comment, you have an opportunity to have a meaningful conversation that could potentially drive more readers to your blog. I thought your points were salient enough to write a reply, which is complementing your work more than anything else.

InformaticsMD said...

Re: the title of my post

How is it "sensational" to write of the foibles of hyper-enthusiasts for health IT?

They are, in fact, in my view either inept, conflicted ... or maybe just a bit 'crazy' by the very nature of their hyper-enthusiasm. I then cite an example of HIT foolishness, as just one example of the state of technology being pushed on caregivers...in this case an exampleof the type of problem that has disrupted care of the the indigent/impoverished/mentally ill for an entire city.

See definitions of hyper-enthusiasts at this post.

Lastly, blogs should be a place for fostering discussion and civilized discourse

According to whom? You?

I believe they are places where critical thinking and frank language should have a home.

In fact, considering what is discussed concerns matters of life, injury and death, I think your priorities are seriously disordered.

Let me ask you this: (hypothetically of course) ... if some criminal with a track record a mile long cruelly murdered your mother and raped your sister, then got off with another slap on the wrist...would you start a blog for "civilized discourse" on the problems with the justice system, or would you raise hell?

If the former, I can only feel sorry for you.

I was faced with a dilemma, in fact, regarding my mother and the suffering she endured at the hands of the IT hyper-enthusists, despite my very polite written warnings about bad HIT years, months and then weeks before the accident, directly to the hospital's leadership.

That approach did not work well.

If you want your opinions to be better heard, shooting down reader comments and discouraging them from commenting in the future is the exact opposite strategy you should have.

Really? I haven't noted a lack of attention to my views. In fact, it's increasing. The 500 or so comments, mnay by physicians and nurses, at the recent NYT story on the health IT lobby were not exactly polite, either.

Let's see.. by way of another example, a 'polite discourse' on matters that could harm and kill thousands worldwide, goes completely ignored for several years. See item 3 here. Instead, its writer was penalized. What do you think of that?

Finally, nothing is preventing you from starting your own blog, of course, where you can enforce your own peculiar views on citizen journalist "propriety."

-- SS

InformaticsMD said...

One more point.

Why is it that criticism such as yours is posted anonymously?

What are you hiding?

Your views are not too far from what an industry "spin control" operative would proffer - an implied ad hominem attack on this author - e.g., "I'm too harsh."

We've heard those lines of reasoning here before many times, as well as other perversities by anonymous posters, including health IT industry shills.

-- SS

InformaticsMD said...

Readers - See this by Joe Conn of Modern Healthcare:

"My kind of cranky"


-- SS