The National Research Council has issued a remarkable press release about a new report on HIT. The press release is at this link:
I reproduce the press release below, but please do read my rant before reviewing it.
My early mentor, Dr. Victor Satinsky, 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 qualifies for such a categorization.
Sadly, the release by the National Research Council outlines the “what” (what is wrong), but not the “why.” Perhaps that’ll be found in the full report, although many of the “whys” (that’s, why these health 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) can be found right here on Healthcare Renewal.
On the positive side for clinicians, life as a typical hospital CIO or other non medical executive might have just become a whole lot harder via forcing them to actually serve the needs of clinicians and patients, not the world of IT.
(In fact, if you’re a CIO who cares about to do deals with HIT vendors, hires typical business IT staff unknowledgeable and untried in anything medical to do clinical IT, along with lots of ham-fisted but hats-in-hand consultants who then try to clean up the mess they make, and who gets pleasure branding with a scarlet letter anyone (such as Medical Informaticists and other cross-disciplinary specialists who actually know what they’re doing in HIT) as a “troublemaker” while the latter actually try to protect the lowly “customers” also known as “patients”, your life has just become a bit more challenging.)
I’d thought the Joint Commission Sentinel Event Alert on Health IT, on the risks posed by improperly designed and implemented Health IT (see my post here) had been a one-up.
I thought it might have been a fluke, written and released by some young disgruntled employee like Justen Deal who would be fired, and that the Alert would be ignored by the players in the highly lucrative and often exploitative (of clinician ignorance and learned helplessness, that’s) HIT ecosystem.
I might have been mistaken.
Here’s news that is not really news to anyone who reads this blog.
And this was about a number of the best medical organizations in this country, not about the smaller less experienced hospitals where things are far, far worse.
In the words of abducted-by-aliens, ignored-by-the-experts pilot Russell Casse after several cities are destroyed by the aliens:
Read the whole thing below.
And weep for those patients who were harmed, or were denied care due to lack of funds while the IT industry sucked $$$ out of healthcare for “insufficient” HIT, or were denied their life, while the society’s gatekeepers ignored the Distant Early Warning Line of the HIT pioneers that all wasn’t well. (Anyone know of other sectors that crashed this past year where such warnings were ignored?)
This should be read in its entirety. I’ll not comment on it here further, other than to state that HC Renewal can be searched on the term “Medical Informatics”, “EMR” or similar for much more material on these issues.
Emphases in boldface are mine.
The National Academies
Date: Jan. 9, 2009
FOR IMMEDIATE RELEASE
WASHINGTON — Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be adequate to accomplish 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 put 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.
Even though 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 abilities, and huge-scale data management. Most importantly, current health care IT systems offer tiny cognitive support; clinicians spend a great deal of time sifting through huge 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 personal 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, personal 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.
Duplicates 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 might obtain a copy from the Office of News and Public Information (contacts listed above).
# # #
[ 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
Associate Vice Chancellor for Strategy and Transformation
Nashville , Tenn.
G. OCTO BARNETT 1
Professor of Medicine
Harvard Medical School , and
Senior Scientific Director
Laboratory of Personal Science
Massachusetts General Hospital
SUSAN B. DAVIDSON
Weiss Professor and Chair
Personal and Information Science
University of Pennsylvania
General Manager and Global Director
Hillsboro , Ore.
DEBORAH L. ESTRIN
Professor of Personal Science, and
Center for Embedded Networked Sensing
Department of Personal Science
University of California
Department of Engineering
DONALD A. NORMAN
Neilsen Norman Group
Northbrook , Ill.
Associate Professor of Medicine
Department of Medicine
School of Medicine
University of California
ALFRED Z. SPECTOR 2
Vice President of Research and Special Initiatives
New York City
PETER SZOLOVITS 1
Clinical Decision-Making Group
Computer Science and Artificial Intelligence Laboratory, and
Professor of Personal Science and Engineering
Massachusetts Institute of Technology
ANDRIES VAN DAM 2
University Professor of Technology and Education and
Professor of Personal Science
Providence , R.I.
Department of Personal Science
Stanford , Calif.
RESEARCH COUNCIL STAFF
Study Director1 Member, Institute of Medicine
2 Member, National Academy of Engineering
Finally, sometimes saying “I told you so” to those who place the scarlet letters upon those not afflicted with irrational exuberance is appropriate. This is one of those times.
“I told you so.”
And, to patients harmed or killed by the clouded vision and/or conflicts of interest of the pundits, I hereby apologize for the ignorance of the healthcare community.
[Source : Health Care Renewal]
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