Al Borg wrote me from vacation with the following regarding what Congress is doing about Health IT legislation:
My response:
See my post at http://hcrenewal.blogspot.com/2008/06/end-to-whitewashing-of-healthcare-it.html on the proposed House bill. As for HIT vendors spending their dollars on political lobbying, the "HIT ecosystem" is unhealthy, and consists of several groups that break down roughly like this:
The opportunists and the blind idealists seem to be in the limelight right now... and can be seen coming from both parties. (sigh) Obama, for example, is stating that McCain will represent "another 4 years of Bush", but when it comes to HIT he plans to make CCHIT certified EMRs the centerpiece of his socialized medical plan. He's totally sold on the theory that EMRs will not only save patients but save money for big government- neither of which have been proven to date, and which in some papers have shown to have the OPPOSITE effect. (see my slideshow)
This kind of stuff will set back HIT a great deal, as many physicians are beginning to view EMRs not as a great tool, but as a tool that can be used by 3rd parties to control their medical practice and incomes.
Al Borges, M.D.
● Oncologist in a Small Group Practice in Virginia
● My website URL: http://msofficeemrproject.com/
scotsilv: And somewhere in there are doctors, other clinicians and patients; perhaps they should be labelled "beta testers" and/or "prey." -- SS
heh.
I feel that selling Hurricane Katrina as the reason for Digitizing Medicine is more smoke and mirrors than evidence.
Never allow rare exceptions to make rules.
90% /10% rule is the guiding principle to useful Health IT. You want to develop systems that do a excellent job 90% of the time.
Using Katrina to make healthcare decisions is part of the 0.01%/99.99% rule.
Hi house.gov,
Your idea:
The Patient-Controlled HealthIT Act would: - Provide incentives for physicians to utilize that data in the course of treating their patient;
is a good one.
Just to make sure you understand health IT ... physicians would need a 50% premium per visit to cover "HealthIT costs". Please ask the patients if they are willing to increase their Health Premiums by 50% . Thank you.
alborg: many physicians are beginning to view EMRs not as a great tool, but as a tool that can be used by 3rd parties to control their medical practice and incomes.
That's what's fueling the leap from experimental clinical aid to revolutionary tool (link), especially by the "opportunists" in the HIT ecosystem. The Realists are in the minority.
Dr, Murdoch wrote: "90% /10% rule is the guiding principle to useful Health IT."
More like the 80/20 rule.
I believe most (> 80%) of clinician needs can be met by paper,plus document imaging systems and a small number of coded fields. In industry (merck), I could instantly call up almost any administrative document using a massive document imaging repository.
Unfortunately, someone would have to code and transcribe the notes to make the data useful to third parties. That costs. Let's face it. It's cheaper to just have the docs do it.
scotsilv: As for HIT vendors spending their dollars on political lobbying, the "HIT ecosystem" is unhealthy, and consists of several groups that break down roughly like this: the optimists or idealists (who believe HIT will "revolutionize" medicine without seeming to care much about potential political or societal downsides or potential unwelcome effects on the medical professions and their practitioners, and relentlessly promote only HIT virtues, real and imagined -- "Pollyannas cheerleading for health care information technology", as put by one of my colleagues), the opportunists (who come in two flavors - the industrialists, who will leverage the enthusiasm generated by the optimists to make money, e.g., payers, vendors, without caring about other issues; and the ideologues, who will use the enthusiasm to advance their ideological goals such as increasing control over clinicians and/or ushering in nationalized healthcare); the technicians - the IT people who design and implement HIT, who probably act as a negative feedback or inhibitory force through not understanding medical culture and the "hiding in plain sight" complexities of healthcare and HIT; and the realists (a minority) who see HIT as a facilitative tool to clinicians if done right, done well, with consideration to downsides and unexpected consequences, and not overdone and oversold. Many Medical Informaticists fall into the latter group. And somewhere in there are doctors, other clinicians and patients; perhaps they should be labelled "beta testers" and/or "prey." -- SS
As for HIT vendors spending their dollars on political lobbying, the "HIT ecosystem" is unhealthy, and consists of several groups that break down roughly like this:
This is one of the best, most coherent, and accurate descriptions of the current players in the HIT industry that I have seen. This synopsis is so right on the mark it is almost uncanny. It is an absolute bulls-eye. The industry sorely needs a lot more "realists" that can hopefully prevent many of the "beta testers" and "prey" from becoming mere road kill and casualties of the "optimists" and "opportunists". In many ways the "optimists" are the scariest players in this scenario. Any group that feels they have the "moral high ground" has the potential to do a lot more harm than good.
Regards,RoyF
RoyF:This is one of the best, most coherent, and accurate descriptions of the current players in the HIT industry that I have seen. This synopsis is so right on the mark it is almost uncanny. It is an absolute bulls-eye. The industry sorely needs a lot more "realists" that can hopefully prevent many of the "beta testers" and "prey" from becoming mere road kill and casualties of the "optimists" and "opportunists". In many ways the "optimists" are the scariest players in this scenario. Any group that feels they have the "moral high ground" has the potential to do a lot more harm than good.
Thanks for the compliment. I arrived at that taxonomy through simple observation - just as a physician arrives at a diagnosis of disease.
What's of increasing concern is that the 'opportunists' - the 'industrialists' and 'ideologues' just don't want to give the realists an "in" ... it might spoil their country club!
I've noted an increasing level of on-the surface craziness regarding applied HIT positions. However, I wonder if that's what it really is as opposed to "crazy like a fox." I and other Medical Informatics-trained colleagues are experiencing the same issues, including colleagues with even more clinical expertise than myself and with informatics education from organizations of even better reputation than where I did my postdoc in MI.
It seems hospitals and vendors and pharmas want lesser, not more qualifications for HIT leadership positions, and tell those who've completed formal education in Medical Informatics that we "don't have enough experience" (to our faces!) or that there's such a thing as "too much experience" in informatics for an organization (even more bizarre!) Perhaps what the opportunists mean is that we might spoil the use of EMR as a tool to further marginalize the medical profession because we've "got their number!"
I don't make this up...
For example, this story of muddled management. Kind of reminds me of that story we learned as kids about dinosaur's brains being too small for the critters to ever learn that sticking their feet into fire results in painful burns. Also see examples here , here , here , here , here , here , here and here not to mention here.
I report, you decide!
-- SS
I've posted an expanded version of this essay on the HIT Ecosystem at this link.