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Scot Silverstein's Good Health IT and Bad Health IT

Scott Mace, for HealthLeaders Media, January 8, 2013

What Silverstein is cautioning against—in a very timely fashion in my opinion—is a generally held belief that any health IT, even poorly designed or implemented system, must be better than a paper-based system. "The physicians have a moral and ethical obligation," he says. "They've taken an oath. They have all the responsibility. They have the obligations. They have the liability. They're the ones who have to deal with the downsides of the technology. The hospital or clinic is not a software beta-testing shop," Silverstein says.

The current healthcare IT ecosystem, with its rush to implement meaningful use and grab the limited government incentive dollars being doled out by HHS, is arranged to suppress reporting of bad outcomes, Silverstein says, with the health IT industry given extraordinary regulatory accommodation compared to other healthcare and technology sectors. For example, he echos previous claims that hospitals have signed "gag clauses" so that defects in health IT cannot be reported to anyone but vendors. "Because of numerous impediments to information flow such as this, as reported by FDA, IOM, and others, we do not know the magnitude of harms, and we need to study it further," Silverstein says.

Silverstein says a likely reason some doctors, such as those at the Contra Costa Medical Center in Martinez, Calif., have been able to speak out is that they are unionized. Non-unionized doctors who raise concerns can face reprisal, for example in the form of sham peer reviews, where hospitals can "pickle them for minor problems and blow things out of proportion," he says. Fearing such retaliation, many of these doctors stay silent.

"In summary, physician resistance to health IT is not due to backwardness, and physicians' resistance to hyper-enthusiasts pushing bad health IT without concern for the potential and actual downsides needs to be considered," Silverstein says.

Undoubtedly, there is a lot of good health IT doing good things. But Silverstein believes, and I agree, that not enough attention is being paid to bad health IT. I'm eager to hear your comments.


Scott Mace is senior technology editor at HealthLeaders Media.
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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.