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
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
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
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.