Healthcare IT Failure and Difficulties Case Examples: Medical Informatics Perspectives on Clinical Information Technology

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

CURRENT APPROACHES TO U.S. HEALTH CARE INFORMATION TECHNOLOGY ARE INSUFFICIENT

WASHINGTON -- Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.

In 2001, the Institute of Medicine -- which with the Research Council, National Academy of Sciences, and National Academy of Engineering make up the National Academies -- laid out a vision of 21st century health care that involves care which is safe, effective, patient-centered, timely, efficient, and equitable. Many aspects of this vision involve information technology, such as having access to comprehensive data on patients, tools to integrate evidence into practice, and the ability to highlight problems as they arise. To see how leaders in U.S. health care use computing and information management in providing care, the committee that wrote the new report visited eight medical centers -- University of Pittsburgh Medical Center; Veterans Affairs Medical Center in Washington, D.C.; HCA TriStar and the Vanderbilt University Medical Center, both in Nashville, Tenn.; Partners HealthCare System in Boston; Intermountain Healthcare in Salt Lake City; University of California-San Francisco Medical Center; and Palo Alto Medical Foundation in California.

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, Vanderbilt University Medical Center , the Commonwealth Fund, and the Robert Wood Johnson Foundation. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine , and National Research Council are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. A committee roster follows.

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
Informatics, and
Associate Vice Chancellor for Strategy and Transformation
Vanderbilt University
Nashville , Tenn.

G. OCTO BARNETT ¹Professor of Medicine
Harvard Medical School , and
Senior Scientific Director
Laboratory of Computer Science
Massachusetts General Hospital
Boston

SUSAN B. DAVIDSON
Weiss Professor and Chair
Computer and Information Science
University of Pennsylvania
Philadelphia

ERIC DISHMAN
General Manager and Global Director
Intel Corp.
Hillsboro , Ore.

DEBORAH L. ESTRIN
Professor of Computer Science, and
Director
Center for Embedded Networked Sensing
Department of Computer Science
University of California
Los Angeles

ALON HALEVY
Research Scientist
Department of Engineering
Google Inc.
Seattle

DONALD A. NORMAN
Co-Founder
Neilsen Norman Group
Northbrook , Ill.

IDA SIM
Associate Professor of Medicine
Department of Medicine
School of Medicine
University of California
San Francisco

ALFRED Z. SPECTOR ²Vice President of Research and Special Initiatives
Google Inc.
New York City

PETER SZOLOVITS ¹Head
Clinical Decision-Making Group
Computer Science and Artificial Intelligence Laboratory, and
Professor of Computer Science and Engineering
Massachusetts Institute of Technology
Cambridge

ANDRIES VAN DAM ²
University Professor of Technology and Education and
Professor of Computer Science
Brown University
Providence , R.I.

GIO WIEDERHOLD
Professor Emeritus
Department of Computer Science
Stanford University
Stanford , Calif.

RESEARCH COUNCIL STAFF

HERB LIN
Study Director

1 Member, Institute of Medicine
2 Member, National Academy of Engineering