- "Evidence Summary: Electronic Health Records (EHRs)" at http://www.ohri.ca/kta/docs/KTA-EHR-Evidence-Review.pdf ;
- "Electronic Health Records Software Often Written without Doctors' Input" at http://www.scientificamerican.com/article/electronic-health-records-software-often-written-without-doctors-input/ ; and
- "Avoiding Expensive And Consequential Health Care Decisions Based On Weak Research Designs" [e.g., EHR expansion - ed.] at http://healthaffairs.org/blog/2015/08/31/avoiding-expensive-and-consequential-health-care-decisions-based-on-weak-research-designs/.
These can be read at the links above, and are self-explanatory.
A new Politico investigation and article, however, is worth writing about:
Doctors barred from discussing safety glitches in U.S.-funded software
President Barack Obama’s stimulus put taxpayers on the hook for $30 billion in electronic medical records, many of which have turned out to be technological disasters.
But don’t expect to hear about the problems from doctors or hospitals. Most of them are under gag orders not to discuss the specific failings of their systems — even though poor technology in hospitals can have lethal consequences.
[Change the "can" to "does", e.g., ECRI Deep Dive, http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html - ed.]
A POLITICO investigation found that some of the biggest firms marketing electronic record systems inserted “gag clauses” in their taxpayer-subsidized contracts, effectively forbidding health care providers from talking about glitches that slow their work and potentially jeopardize patients.
[E.g., see http://hcrenewal.blogspot.com/search/label/glitch - ed.]
POLITICO obtained 11 contracts through public record requests from hospitals and health systems in New York City, California, and Florida that use six of the biggest vendors of digital record systems. With one exception, each of the contracts contains a clause protecting potentially large swaths of information from public exposure. This is the first time the existence of the gag clauses has been conclusively documented.
I note this Politico article appears six years after the seminal JAMA article on hold harmless and defects nondisclosure clauses:
- "Health Care Information Technology Vendors' "Hold Harmless" Clause - Implications for Patients and Clinicians" by Koppel and Kreda, JAMA 2009;301(12):1276-1278), http://medecon.pbworks.com/f/IT%20Accountability%20JAMA09.pdf,
as well as:
- this author's followup JAMA Letter to the Editor "Healthcare IT, Hospital Responsibilities, and Joint Commission Standards" (can be seen in its entirety at http://jama.jamanetwork.com/article.aspx?articleid=184302) pointing out that such clauses and those who signed them were in violation of Joint Commission safety standards.
- (I published a longer version at http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=koppel_kreda. Also see my 2009 post at http://hcrenewal.blogspot.com/2009/03/health-care-information-technology.html).
In that 2009 JAMA Letter to the Editor I observed:
... In their Commentary, Dr Koppel and Mr Kreda made clear the problems associated with applying the customs and traditions of business software contracting and sales (where “hold harmless” and “keep defects secret” clauses are commonplace) to health care information technology (HIT) as if they are the same. I believe that ignoring their differences has likely created an epidemic of violations of hospital governing body responsibilities and Joint Commission standards for health care organization leadership.
In 2015 I stand by these assertions. Computer and business personnel - through arrogance, selfishness, narrow-mindedness and other issues - have made a mess assuming that business software practices apply to clinical medicine and healthcare IT. In the latter domain, however, increased clinical stress and hypervigilance due to bugs clinicians have to work around (that might have been fixed sooner), lessening their performance and increasing risk, and patient injury and death has been the result of a belief that clinical computing is just a niche area of business computing. (I've been making this point for at least 15 years, I might add.)
Such contractual practices endanger patients, and in 2015 are reckless, negligent and inexcusable.
Recklessness means the person knew (or should have known) that his or her action were likely to cause harm. Negligence means that the person acted in violation of a duty to someone else, with the breach of that duty causing harm to someone else.
More from the Politico article:
Vendors say such restrictions target only breaches of intellectual property and are invoked rarely.