National Research Council: Current Approaches to Health IT Insufficient
The National Research Council has issued a remarkable press release about a new report on HIT. The press release is at this link:
A prepublication PDF of the report itself is here.
I reproduce the press release below.
My early mentor, cardiothoracic surgery pioneer Victor P. Satinsky, M.D., used to become irritated when people or organizations presented views that qualified them as "Masters of the Obvious." I believe the following release by the highest scientific authorities in the land may qualify for such a categorization.
The release by the National Research Council outlines the "what" (what is wrong), but not the "why." That is, why these healthcare IT problems exist at all, and why the Joint Commission and NRC reports are even necessary, after 40+ years of Biomedical Informatics, IT-sociology and other research. Without understanding the “why”, remediation will be much more difficult. Of note, the report does call for social science research should help further elucidate the “why’s” of HIT industry dysfunction beyond the materials presented at this website.
On the positive side, the typical hospital CIO or other non-medical executive clearly needs to become substantially more aligned towards serving the needs of clinicians, via being compelled by this report and its aftermath to make major changes in the way HIT is pursued.
Significantly, the NRC report was about a number of the best medical organizations in this country, not about the smaller less experienced hospitals where HIT issues are likely more profound.
Finally, the report is not news to this author nor others who objectively observe HIT (especially those without financial or other conflicts of interest).
Perhaps medicine as a profession should feel for patients who were denied care due to lack of funds while the IT industry diverted capital out of healthcare for "insufficient" HIT, or were denied good care through malfunctioning HIT or non-functioning HIT, or who suffered outcomes that good HIT might have prevented.
There is a cost of lost opportunity. My own father died from medical malpractice as a result of informational confusion a good EHR might have prevented.
Emphases in boldface are mine:
The National Academies
Date: Jan. 9, 2009
FOR IMMEDIATE RELEASE
In 2001, the
Although the institutions showed a strong commitment to delivering quality health care, the IT systems seen by the committee fall short of what will be needed to realize IOM's vision. The report describes difficulties with data sharing and integration, deployment of new IT capabilities, and large-scale data management. Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient.
Ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models, "virtual patients," that depict the health status of the patient, including information on how different organ systems are interacting, epidemiological insight into the local prevalence of disease, and potential patient-specific treatment regimens. Although health care workers could still have access to the raw data if they needed it, clinicians would be able to work with models without drowning in data. This cognitive support would help clinicians more efficiently and effectively determine a course of action through improved understanding of a patient's status, says the report.
The report identifies several principles for improving health care IT. In the short term, government, health care providers, and health care IT vendors should embrace measurable improvements in quality of care as the driving rationale for adopting health care IT, and should avoid programs that focus on adoption of specific clinical applications. In the long term, success will depend upon accelerating interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering.
This report was sponsored by the U.S. National Library of Medicine, National Institutes of Health, U.S. National Science Foundation, Partners HealthCare System,
Copies of COMPUTATIONAL TECHNOLOGY FOR EFFECTIVE HEALTH CARE: IMMEDIATE STEPS AND STRATEGIC DIRECTIONS are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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[ This news release and report are available at HTTP://NATIONAL-ACADEMIES.ORG ]
NATIONAL RESEARCH COUNCIL
Division on Engineering and Physical Sciences
Computer Science and Telecommunications Board
COMMITTEE ON ENGAGING THE COMPUTER SCIENCE RESEARCH COMMUNITY IN HEALTH CARE INFORMATICS
WILLIAM W. STEAD 1 (CHAIR)
McKesson Foundation Professor of Medicine and Biomedical
Associate Vice Chancellor for Strategy and
G. OCTO BARNETT 1
Senior Scientific Director
Laboratory of Computer Science
Massachusetts General Hospital
SUSAN B. DAVIDSON
Weiss Professor and Chair
General Manager and Global Director
DEBORAH L. ESTRIN
Professor of Computer Science, and
Center for Embedded Networked Sensing
Department of Computer Science
University of California
Department of Engineering
DONALD A. NORMAN
Neilsen Norman Group
Associate Professor of Medicine
Department of Medicine
School of Medicine
University of California
ALFRED Z. SPECTOR 2
Vice President of Research and Special Initiatives
PETER SZOLOVITS 1
Clinical Decision-Making Group
Computer Science and Artificial Intelligence Laboratory, and
Professor of Computer Science and Engineering
Massachusetts Institute of Technology
ANDRIES VAN DAM 2
University Professor of Technology and Education and
RESEARCH COUNCIL STAFF
2 Member, National