Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
2009 is proving to be a pivotal year in healthcare IT

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 will perhaps be the year in which the healthcare IT industry internalizes - per the National Research Council report referenced below - that its current approaches to building clinical information systems, in an incomparably complex medical environment, are “insufficient to achieve medical leaders' vision of health care in the 21st century.”


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 (Swedish Medical Products Agency report is here), Canada (see here), the U.S. (see here) and other countries as well.


The findings of Medical Informatics research about these devices have been documented in extensive literature dating back decades.  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 healthcare IT industry has largely ignored this research, unfortunately.


The articles and reports below demonstrate numerous undesirable outcomes of the approaches currently in vogue for development and implementation of virtual clinical devices:


The Joint Commission’s “Sentinel Event Alert on Healthcare IT” is here (full PDF is here).  Notably, the alert states: "There is a dearth of data on the incidence of adverse events directly caused by HIT overall.”  We are implementing national health IT in an information vacuum regarding the risks.


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


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


Gateway reviews of the UK National Programme for IT from the Office of Government Commerce (OGC) are here (released under the UK’s Freedom of Information Act), and a summary of 16 key points is here.


A report on the serious problems with the Department of Defense’s AHLTA system, Electronic Records System Unreliable, Difficult to Use, Service Officials Tell Congress, is here.  My commentary is here. 


An American Medical Informatics Association (AMIA) report Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop is here.  My commentary on the report with a history of its origins is here.


A sentinel 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 vendors is here.  My JAMA letter to the editor on violations of Joint Commission safety standards and fiduciary responsibilities committed by hospital governance personnel who agree to such terms is here, and additional commentary 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.


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


A 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.


An 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.


A Milbank Quarterly article “Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method" by Greenhalgh, Potts, Wong, Bark and Swinglehurst at University College London, is here. My commentary 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.