Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
Several Vignettes from a Healthcare IT Consultant/Informaticist

Several Vignettes from a Healthcare IT Consultant/Informaticist

Reproduced with permission. These vignettes and make one wonder whether health IT -- in its present form and with its current culture -- will ever be "meaningfully useful.”

  • A Michigan hospital system uses Cerner for their EHR. This hospital system 'supports' 2 ambulatory systems, eClinical Works and NextGen. Despite huge investments of time and money on all sides (physicians, hospitals, others), there's very little interoperability between these systems. People are 'pulling their hair out,' discouragement is growing, costs are skyrocketing, and some people are backing away from HIT vendors in general. Even doctors are realizing that it makes no sense to spend $100k (or more) to recoup $44k in 'incentives' for systems that don't work.
  • In a major NextGen deployment in a primary care setting we're finding that physicians who thought that they wanted structured data are now backing away from and actively avoiding the structured data. Instead they are opting for the 'free text' sections of the system (this is true for both the people entering the data, and the people who are reading and making sense of the data). The structured data have proven to often not be clinically meaningful.
  • On the medical-legal front, professional liability issues associated with structured data are increasing. [In a] recent newsletter (PDF) from a Michigan-based medical malpractice company ... note in the newsletter under "Additional Features Creating Risk" the patient safety and risk issues associated with structured data in a SureScripts approved eRx system. Surprisingly very little is said about the medical-legal dimension of HIT.
  • Most important are patient safety issues. Recently I surveyed 2 pharmacists and 12 physician leaders and asked them to interpret an Rx generated by a structured data eRx system (which is used by a number of Michigan-based CMHs). Both pharmacists and 9 of the 12 physicians INCORRECTLY interpreted the Rx. Currently colleagues [and I] are working on a much larger study of the flawed structured data associated with a SureScripts approved eRx system.


Will it take long for the U.S. to reach the levels of difficulty in clinical IT as the UK has experienced in its £12.7 billion national HIT program, under present assumptions and attitudes of irrational exuberance?