2009 a pivotal year in healthcare IT

 

2009 is proving to be a pivotal year in healthcare IT.  Recent authoritative articles and reports on health IT problems largely validate the issues at this website, started in 1998.  These reports have ultimately led to a U.S. Senate investigation of the healthcare IT industry initiated in Oct. 2009 (link below).

 

2009 may be the year that healthcare IT vendors will finally begin to understand that not lending credence to decades of teachings of medical informatics-based research on healthcare IT design, implementation, lifecycle support, involvement of end users, and sales and marketing has been harmful to their businesses and to their investors.  Instead, the commercial health IT companies took a simplistic management information systems-based approach to building medical devices in an incomparably complex environment they did not -- or did not care to – understand. 

 

These devices are, in fact, virtual medical devices that happen to reside on a computer, not business computing systems that happen to be used by clinicians.  These medical devices are soon to undergo regulation as such in the EU (pdf report from the Swedish Medical Products Agency here), Canada, the U.S. and other countries as well.

 

The teachings of Medical Informatics about such devices have been documented in the extensive literature of Medical Informatics.  For example, the book “A History of Medical Informatics in the United States, 1950 to 1990” by informatics pioneer Morris F. Collen (published in 1995) explicitly demonstrates the progression of the field and the wisdom of the pioneers dating back to the 1950’s, as in the bons mots here.

 

The articles and reports below demonstrate numerous undesirable outcomes of the management information systems approach to development and implementation of virtual clinical devices:

 

The Joint Commission’s “Sentinel Event Alert on Healthcare IT” is here. 

 

The U.S. National Research Council’s "Current Approaches to U.S. Health Care Information Technology are Insufficient" and link to a full report on an investigation of healthcare IT lack of progress is here. 

 

The UK Public Accounts Committee report on disastrous problems in their £12.7 billion national EMR program is here.  

 

The Washington Post’s article on the influential HIT vendor lobby “The Machinery Behind Healthcare Reform” is here. 

 

Hoffman and Podgurski’s paper from Case Western entitled “e-Health Hazards: Provider Liability and Electronic Health Record Systems” on EHR medical and legal risks is here.

 

My commentary on the May 2009 AMIA workshop report on healthcare IT failure with free  PDF is available here.

 

My commentary on a sentinel Mar. 2009 JAMA article by University of Pennsylvania researchers Ross Koppel and David Kreda “Health Care Information Technology Vendors' Hold Harmless Clause: Implications for Patients and Clinicians” on unsafe contract terms demanded by healthcare IT, and the violations of Joint Commission safety standards and fiduciary responsibilities committed by hospital governance personnel who agree to such terms, is here.

 

A link to the Oct. 25, 2009 Washington Post article “Electronic medical records not seen as a cure-all” and my commentary are here.

 

A Nov. 15 New York Times report “Little Benefit Seen, So Far, in Electronic Patient Records” on Jha’s research at the Harvard School of Public Health, that compared 3,000 hospitals at various stages in the adoption of computerized health records and found little difference in the cost and quality of care, is here.

 

A Nov. 20 American Journal of Medicine paper “Hospital Computing and the Costs and Quality of Care: A National Study” by Himmelstein and Wololhandler at Harvard Medical School, that also concluded “as currently implemented, hospital computing might [very] modestly improve process measures of quality but not administrative or overall costs”, is here.

 

Most importantly, the Oct. 16, 2009 letter to major healthcare IT vendors from Senator Charles E. Grassley (ranking member of the United States Senate Committee on Finance) initiating a Senate investigation of corporate practices is here (PDF).

These reports and events should reasonably lend skepticism to the wishful thinking and irrational exuberance about healthcare IT that currently prevails, at least to anyone who cares to apply the scientific rigor of medicine itself to the field of healthcare information technology.