Caution on HIT

This is from Greg Scandlen’s newsletter:

The stimulus bill appropriated some $20 billion to roll out a national HIT system that would reward clinicians for “meaningful use” of Washington-dictated information systems. When there is that kind of money on the table, all restraint is thrown out the window in the rush to grab it.

Published in the Journal of the American Medical Informatics Association, a new paper cautions against hubris as we go forward.  It is dense reading and includes 113 footnotes, but it highlights some fundamental fallacies of the current frenzy to wire up the whole health care system.

Here are just a few of the concerns:

  • Far from being “risk free,” HIT when deployed in high-pressure environments with critically ill patients poses significant risks. The authors note that it took over a hundred years to fully understand and mitigate the risks involved in building such systems as bridges, skyscrapers, and cars. HIT systems are likely to not only fail, but to fail catastrophically, in part because they are not well-understood by the people using them. Very little is being done to guard against these problems.
  • While the FDA and others do exhaustive testing on medical devices and drugs, HIT systems are rarely subject to similar scrutiny.
  • It is supposed that humans will be able to catch any problems that crop up in HIT systems, but in fact humans are changed by the presence of such a system. Their judgment may be impaired by the demands of the system. Further, one of the main reasons for adopting HIT is to override human error, so it is contradictory to rely on these fallible humans to correct the technology.

The authors examine 12 similar “fallacies.” As I say, it is a tough read and we need people who can express it in plain English. Let’s just say that we are in the middle of building a catastrophe that will make the BP oil spill look puny.

Comments (8)

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  1. Ken says:

    As Paul Harvey would say, here’s the rest of the story…

  2. Bret says:

    Ken, good association. And the rest of the story isn’t pretty.

  3. Devon Herrick says:

    In our study, John, Linda and and I found that HIT systems can cause some medical errors while preventing others. See

  4. Neil H. says:

    Good post. We should approach this whole area cautiously.

  5. Am I hyperventilating if I draw the obvious comparison between health IT and the gropey scanney stuff going on at the airports? The manufacturers of scanners have doubled their lobbying investments in the last five years ( and cultivated members of the political class, like former DHS Secretary Michael Chertoff, as spokesmen.

    Just like the scanners, health IT investments will be made by politically connected manufacturers with the best lobbyists money can buy. The most successful adoptions of technology are done by consumers on our own. Nobody complains about being forced to use an iPod or a Blackberry: They are each individual’s choice.

    Government-dictated health IT will have the same effect as government-dictated airport scanning: Loss of privacy, increase in hassle, and another obstacle blocking your ability to get what you need!

  6. Virginia says:

    I just had this debate with some of my friends in industry. Without exception, they all support allowing the government to regulate, fund, and oversee their HIT. No amount of objection about inefficiencies, implementation problems, or misallocation of investment is enough to convince them that Big Brother is not good at IT.

    My response was: if you think that government should pay for IT, why not have them come in and run everything? It is arbitrary to let government pick up the tab on IT when hospitals still pay for other expenses.

    Walmart never said, “It’s too complicated to put in an inventory control system. We need the government.”. Why does the health care field get all of this special treatment?

  7. Joe S. says:

    @ John Graham

    Good insight. It’s probably a very good time to be in the airport scanning business.

    @ Virginia

    Don’t count on the business community to protect us. They are usually totally self interested — in the most narrow, shorted-sighted way.

  8. mdb says:

    As someone that installs these systems, I can say the FDA treats these like a medical device when in health care. These are different from the configurable systems that go into other lab/data processes outside of health care. The HIT systems can not be altered (data can be altered) except by the vendors. That said the much of the hype surrounding this is utterly insane and yes there will be errors, and the bigger and more complex the system, the more and bigger the errors will be. I would be less concerned about errors that a human would make with these systems, than with technical errors. The way these systems work to eliminate human error is to limit choices to correct ones, limit checking, single data entry and then selecting the data after that (transcription errors), etc. This is all fairly straight forward and is the biggest benefit of any data entry system (that is all this is). Also, a research hospital does not have the same requirements as a small community hospital and trying to get one system to work with and serve everyone, is moronic at this point.
    Finally, allowing the government to regulate this is pretty stupid. Just look at the cost of CFR 21 Part 11. You want to control costs, regulation along those lines is not intelligent. I would also add that I have seen many processes in pharma/biotech that were old and MORE dangerous to the patients than current technology, but were kept in place due to the high cost of validation of the new process.