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Scot Silverstein's Good Health IT and Bad Health IT

Scott Mace, for HealthLeaders Media, January 8, 2013

Inevitably, when the subject turns to the pitfalls of bad health IT, you will find Scot Silverstein, MD, ready to comment. He has been writing about health IT difficulties since 1998.

Silverstein is an adjunct professor at Drexel University who I recently interviewed for an upcoming HealthLeaders magazine story on physician resistance to health IT.

A recent Silverstein blog post caught my eye for the following statement: "It is impossible for people, especially medical professionals, to be 'ready' for a system that 'is not ready for them.'"

I wanted to learn about the good doctor's thinking and so I gave him a call. We spoke for two hours and it felt like scratching the surface of issues that healthcare will be facing for a good while to come.

If health IT has a canary in the coal mine, it is Silverstein. His Drexel website and contributions to the Health Care Renewal blog are the places to go to examine the voluminous literature about health IT's many shortcomings, errors, and challenges.

Silverstein completed a postdoctoral fellowship in medical informatics at Yale School of Medicine 20 years ago, but his experience with IT goes back to the 1970s, when building a computer involved using a soldering iron. His technology interests are diverse; he is also a ham radio enthusiast licensed at the highest level ("extra" class) by the FCC. In the 1990s, after years of practicing medicine and the post-doc, he joined Yale's faculty and began building electronic health record systems, including for King Faisal Specialist Hospital in Saudi Arabia, "even though my name's Silverstein," he notes.

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6 comments on "Scot Silverstein's Good Health IT and Bad Health IT"


Tim Cook (1/10/2013 at 5:34 AM)
You can find my comments in the Healthcare IT community on Google Plus at gplus.to/HealthcareIT

Bob Coli, MD (1/9/2013 at 3:04 PM)
Dr. Donald Berwick's famous observation that in healthcare, "The excellence of the status quo is a sentimental illusion", accurately describes the chronic, dangerous and costly problem of poorly designed and implemented health IT systems. One of the most glaring examples of defective health IT design is the antiquated formats still being used to report the results of patients' diagnostic tests to physicians and patients. This is a user interface problem which has been overlooked or ignored since medical computing began in the 1960s with Homer Warner (1) and Octo Barnett. (2) The tsunami of test results data is important because it constitutes more than 80 percent of the objective data in an individual's medical record and it directly impacts at least 65 percent of all critical patient care decisions. (3) The basic "job" that American physicians and patients need to get done is efficiently viewing and sharing the billions of annual diagnostic test results. The basic problem confronting them is the user interfaces of EHR, PHR and HIE platforms are still using variable reporting formats to display results as incomplete and fragmented data. The adverse patient safety, workflow and redundant testing effects produced by this poor user interface design and unclear data display are very familiar to clinicians and nurses, but until recently, they have not yet been recognized by researchers, journalists, policy makers or the vendors of bad health IT systems. Fortunately, there is a relatively simple solution, which will require the development and adoption of an intuitive, easy-to-use, standard reporting format that can display the results of all 7,500 available tests as clinically integrated, actionable information. Accomplishing this may be finally becoming feasible because of unsustainable healthcare costs, disruption of "HIE 1.0" by ONC's emerging portfolio of open source interoperability standards, national expansion of consumer-centered, value-driven financing and delivery reforms and a recently more crowded and more competitive health IT system vendor marketplace. In addition to improving patient safety, by collaborating to overcome this major barrier to information visualization and full interoperability, government and the private sector can also support MU Stages 2 and 3 by helping physicians engage patients and their families, minimize unnecessary testing and improve physician workflow, practice efficiency and care coordination. (4) (1) http://ihealthtran.com/wordpress/2013/01/the-man-who-brought-computers-into-medicine (2) http://www.seaislandsystems.com/Hardhats/HistoricDocs/OctoBarnett-History.pdf (3) http://leadgen.darkdaily.com/Media.aspx?id=32&recordView=1 (4) http://www.nationalehealth.org/HITWeek-Standards

canary keeper (1/8/2013 at 8:42 PM)
This comment system here is worse than the HIT computers managing the patients. Kudos to Dr. Silverstein for expposing the sham of HIT.