Thursday, October 03, 2013

Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As "Advised" At The University Of Arizona Health Network

When clinicians are told to promote a technology in no uncertain terms, that puts a chilling effect on critical thinking and discourse.  In effect, when under orders to only speak positively about a hospital or its technology, saying anything bad could very likely get clinicians labeled as 'troublemakers' or 'disruptive clinicians.'  Sometimes - in a sadly real example at Affinity Health - it may even get threats of having complaints plastered to one's forehead (see, a threat answered to by a judge.

The 'disruptive' label usually does not have a good effect on one's evaluations and job (or, for doctors, even career) longevity.  See, for example, the resources at on sham peer review.

At University of Arizona Health Network (UAHN), clinicians are being told to promote the EPIC EHR.

The campaign is under the aegis of executives who know, should know, or should have made it their business to know the mayhem caused at other medical centers by EPIC and other major clinical IT systems (see for example query links and

Here's what clinicians are bring told in the Oct. 3, 2013 "Weekly update for UAHN employees":

Words that Work 

Talking positively to our patients about our new Electronic Health Record system is important! Here are some key words and phrases you can use to emphasize the many benefits of the new system:
  • Electronic health record (not ‘Epic’ or ‘EHR’)
  • One comprehensive record
  • Coordinated care
  • Improves patient safety & quality
  • Convenient, easy patient portal 
  • Private and secure
Click here for more words and behaviors to inspire confidence in our patients (and ourselves) as we transition to this new system.

The link to "more words" produced this PDF:

"Words that Work" - If I worked there, I would be concerned that that using "words that don't work" about a project that probably cost hundreds of millions of dollars would likely injure my career.  Click to enlarge.

This is shameless.  Many of these claims are unsubstantiated or in significant doubt in the literature.


They left out issues such as these:

• The software is tested and validated for safety by nobody, including traditional medical device safety testers.

• No postmarket surveillance for problems, either.

• Transparency about problems that can cause patient harm is severely impeded by systematic impediments to information flow (as per IOM's 2012 study of health IT safety at, FDA via their leaked Internal Memo on HIT safety as at, the Joint Commission in their Sentinel Events Alert on Health IT as at, and others.)

• Problems known are only the "tip of the iceberg" (FDA, ECRI Institute), as at and 
(Mar. 2014 addendum: add to that list the revelations of med mal insurer CRICO, that EHR technology has contributed to a substantial fraction of the medical malpractice suits in Massachusetts:

Of the claims they do make:

Efficient - see aforementioned links as well as "Common Examples of Healthcare IT Difficulties" at

Convenient - as above.  According to whom?  Compared to what?  Pen and paper?

Improves patient safety and quality - see IOM report post at .  We as a nation are only now studying safety of this technology, and the results are not looking entirely convincing, e.g. ECRI Deep Dive Study of health IT safety at  171 health IT mishaps in 36 hospitals, voluntarily reported over 9 weeks, with 8 reported injuries and 3 reported possible deaths is not what I would call something that "improves patient safety and quality" without qualifications.

The Cadillac of its kind - according to whom?

Patients at hospitals using this system love it -  Do most patients even know what it, or any EHR, looks like?  Have they provided informed consent to its use?

Exciting - clinician surveys such as by physicians at and by nurses at shed doubt on that assertion. 
(Addendum: also see what nurses think about these systems at "Another 'Survey' on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications Only a Matter of Time in Open Letter",

The best thing for our patients - again, according to whom?

Sophisticated new system - "New"?  Not so much, just new for U. Arizona Health.  "Sophisticated", as if that's a virtue?  Too much "sophistication" is in part what causes clinician stress and burnout, raising risk; see this summary of a new, not-free JAMIA article "Electronic medical records and physician stress in primary care: results from the MEMO Study", J Am Med Inform Assoc amiajnl-2013-001875 at   From that summary:

... Compared with physicians at clinics with low-function EMRs, physicians at clinics with moderate-function EMRs experienced significantly more stress and had a higher rate of burnout. Additionally, physicians at clinics with moderate- or high-function EMRs felt less satisfied with their current position overall.
... Results also showed a significant relationship between time pressure and physician stress in the cohort with high-function EMRs, and only in this cohort, suggesting physicians at these clinics may be particularly pressured for time during patient encounters in the face of a large number of EMR functions. "This 'made sense' to us in thinking about the possibility that those in the high-use group had more to do in the EMR" [say the authors].

Smartest program out there - "Smartest" meaning what, exactly?  According to whom?  Who performed the comparison?

Streamlined - compared to what?

Thank you for your patience - even if the effects on clinicians gets you or your loved ones maimed or killed?

Safe and secure network - really?  No break ins, ever, considering multiple breach stories like those at

Keeping you informed is our priority - informed of what?

Specially trained staff - like these:

and this:

Take Responsibility - I ask, should clinicians "take responsibility" for IT-related disruptions that impair care such as "use error" (as opposed to user error), i.e., what the National Institute of Standards and Technology has called operator error due to poor usability and other features of bad health IT?  (See "NIST on the EHR Mission Hostile User Experience" at  What about "glitches" and bugs that corrupt or lose data?  Should clinicians also 'take responsibility' for those?  (See for example the posts on the wild things that happen when IT malpractice leads to clinical mayhem at

It appears to me that this vendor is using its client hospitals' management to enforce an "acceptable point of view" clinicians must proffer to patients about EHRs (which they must call "health" records), despite well-known contradictory findings.  This is, in effect, forced marketing of a device.

Trying that for a drug or a conventional medical device (e.g., a particular stent) would be on its face unethical and likely illegal.

Finally, critical thinking is what keeps patients alive and safe.  Marketing measures like this (some might call it "propaganda"), espousing and enforcing 'EHR exceptionalism', in my opinion, damage critical thinking and expression, and are thus unacceptable to push on clinicians and on patients.

I add that requiring clinicians to promote deceptive propaganda the clinicians themselves know is untrue, from painful experience, is degrading, intimidating and destroys morale.  It is axiomatic that clinicians (or anyone) operating under such conditions cannot perform at their best.

Thus the management geniuses who came up with these instructions (if not outright vendor-ghostwritten as at the Aug. 2012 "Health IT Vendor EPIC Caught Red-Handed: Ghostwriting And Using Customers as Stealth Lobbyists", are by their actions increasing risk of patient harm.

The nurses' unions at at have it right, in my view:  complain about the disruptions this technology causes, and complain loudly, if at the very least to make sure the problems are out in the open.

-- SS

Note: also see the followup Nov. 2013 post "We’ve resolved 6,036 issues and have 3,517 open issues: extolling EPIC EHR virtues at University of Arizona Health System" at


Anonymous said...

False claims of benefit has always been a serious violation and addressed by the FDA with letters to those making the claim to desist.

But in the case of HIT, the vendors and the Congress have eliminated the FDA from vetting these devices.

I susoect that the hospital is under contractual obligation to keep the spin strongly positive, and threaten anyone telling the truth about the dangers of these devices.

Anonymous said...

Fraudulent ! And it should be a crime to even publish! I notice that at least they are half honest (by omission) about the out of controls costs to implement EHR.

Anonymous said...

Guess you have to be old enough to remember television commercials showing a doctor standing up from behind his desk, approaching the camera, and assuring his audience that "Most doctors smoke [Doral, Kool, Marlboro]?"

And that worked out so well, didn't it?


Roy M. Poses MD said...

Here is what amounts to a deceptive ( marketing campaign by corporate health care using health care professionals as disguised marketers. However, unlike key opinion leaders ( used to sell drugs or devices, the health care professionals are not being paid to be positive towards the product. Instead of getting a positive incentive, albeit analogous to bribery, to sell the product, they are implicitly threatened if they do not sell the product, a negative incentive analogous to extortion. Furthermore, while medical schools and hospitals have historically enabled the use of health care professionals to sell drugs and devices, in this case the hospital and medical school are directly implicated in the deceptive marketing.

I suppose given all the bad trends in health care, their merger in this way was to be expected. It is high time for doctors and other health care professionals to rise up against this latest abuse, and realize that only slightly lesser abuses abound.

John said...

Fraudulent ! Everything seems like a business. Even Doctors are business oriented. There is no oath which they follow anymore.

Anonymous said...

A few years back, Fortune Magazine had an article about HIT and the influence of the vendors on the doctors.

They featured Cerner, referring to the doctors who presented favorable reviews at trade conventions, eg HIMSS, as "Booth Bunnies". Favors in return for the positive press are subtle.

Anonymous said...

If these defective systems of HIT devices that control care and disrupt work flow were the standard for decades and were being replaced by hand written orders, hand written progress notes, transcribed summary and consultation reports, w digital data limited to imaging and test results, there would be accolades claiming that this was a briliant innovation in care that saves lives and improves efficiency.

Anonymous said...

"Words that work" = Words to live your life by.