Wednesday, December 17, 2008

e-Doubts on Health Information Technology Part 2: Other e-Doubters Weigh In

What’s going on? Since the e-Doubt post, the Disease Management Care Blog is becoming aware of the beginning of a bloggy backlash against electronic health and medical health records. It doesn’t usually write about other blogs (preferring instead to read them) but it appears there’s a critical mass of skepticism in two of the more highly regarded independent health policy blogs.

In this erudite December 17 post in the Health Care Blog, Rick Peters likens healthcare information technology (IT) and its EHR mainframe mentality to the inept U.S. auto industry, only worse. There is one difference though: at least Detroit didn’t try to set up ‘standards’ that unfairly perpetuate their bloated business models. He offers up some extremely sensible, lean and targeted funding suggestions that go far beyond the generalities of the DMCB’s Dec 16 post. He proposes that the Obama Team resist the siren call of EHR zealots and create specific targeted challenge awards that promote scalable, ‘cloud-based’ web-based, secure and open source IT systems that separately accomplish a) insurance claims processing, b) eligibility and claims remittances, c) ePrescribing and order entry, d) laboratory and test reporting and e) decision support. The winners will be rewarded by having all insurers including CMS be mandated to use them. The DMCB says bravo.

In retrospect, the DMCB should have suspected something was up when even blogmaster and e-sage Matthew Holt in this post in the same Health Care Blog noted the electronic health record is ‘not the be all and end all.’ The DMCB likes his concept of limited, mutually supportive and swappable specific ‘applications’ that are designed to either record, personalize, analyze, provide decision support or enable transactions. The DMCB says he who is without the sin of second thoughts should throw the first stone.

And even the taciturn and laconic Maggie Mahr of the HealthBeatBlog wonders if it’s time to call a halt to the e-irrational e-exuberance. Quoting au correspondent several scarred veterans of the healthcare IT contretemps, she discovers real physicians, i.e., the ones that actually take care of patients, don’t necessarily like having EHRs. What’s more, there are a host of other problems including the lack of a business case for interoperability, logarithmic degrees of complexity and toxic levels of radiovendoractivity.

And it may not be just the blogs. According to the December 12 Health Care Renewal post, eternal e-skeptic Scot Silverstein (one of the experts quoted by Maggie Mahr above) points out that the Joint Commission doesn’t buy into the assertion that health information technology is synonymous with safety. In fact, it can be synonymous with mislabeled bar codes, confusing screen displays, poor adaptation to work flows and dysfunctional impacts from loss of professional autonomy. It recommends that safety programs for the EHR be established and has a series of specific suggestions ultimately designed to keep patients from being added to the 98,000 getting killed every year.

The DMCB supposes there may be merit (maybe not) to the overall notion of stimulus spending and, given the percent GDP footprint of healthcare, funneling some serious coin toward health care IT reform would be a heckuva jobs program. Given the insights of Rick Peters, Matthew Holt, Scot Silverstein and the Joint Commission above, perhaps it’s time to ask President Elect Obama and Secretary Nominee Daschle to pause and think again. Can they can really be so confident that $50 billion is a wise investment?


MedInformaticsMD said...

Thanks for mentioning my HC Renewal post on the Joint Commission report which is at this link.

I'm not an e-skeptic at all. I've seen the technology work, in various settings.

I'm in fact a skeptic of the way health IT is currently pursued, especially its leadership model and costs based on a management information systems paradigm in design, implementation and lifecycle. HIT is not MIS, and pursuit of HIT as if it is MIS will cause continued difficulties, increased expense, and impaired diffusion.

I'm also a skeptic of the shroud of mystery and in fact a form of censorship that goes on towards its failures, failures largely caused by a 'Bull in a China Shop' approach to HIT. That approach is mediated by false assumptions and underestimations of HIT sociotechnical issues by an inappropriate leadership.

Done right, HIT can succeed. See for example the text "Medical Informatics 20/20" for "best practices" that mean something.

The Joint Commission report should, in fact, be unnecessary. Much of what it states is obvious. That it needs to be stated at all is perhaps reflective of the above problems.

- Scot Silverstein

Jaan Sidorov said...

Thanks for the e-clarification, Scot. Maybe a better term would be 'e-gadfly' to those who continue to continue to promote or permit these dysfunctional approaches to HIT.

MedInformaticsMD said...

"HIT-management gadfly" would actually be a more precise phrase ... "HIT man" for short!

Greg Matthews said...

This is pretty interesting. I guess that I have been drinking the kool-aid about the value of EHR, but one of my own colleagues has just put his stake in the ground as well with a blog post earlier in the week . . .

Jaan Sidorov said...

Thanks Greg. You're colleague is not alone.

For a very good evaluation on the topic, check out what the CBO has to say about health information technology in the reports described in my post above.

Maggie Mahar said...

I think the public skepticism about EMRS is coming at a perfect time.

No doubt but what we need them, but before Medicare begins requiring them, or subsidizing them, we need to take an open look at past problems and learn more from the people who truly understand healthcare IT.

So far, I'm persuaded that too many of the IT vendors are selling systems that are needlessly complex (at least at this stage of the game) and expensive.

I'm going to be trying to learn more about this from the people I qouted in my initial post. I'm not a techie, but I suspect that everyone interested in healthcare reform and disease management needs to sit down and learn about health IT . Otherwise people who don't understand healthcare will be running the game.

Thanks for the compliment on my
taciturn style. I do take pride in that.

Maggie MahAr.

Jaan Sidorov said...

Well said as always.

Seriously, the style is always well written, on point and extremely educational. It's part of my regular diet of bloggery.

Thanks Maggie Mahar!