healthy4u: John Casillas

The Health Information Management Systems Society (<a href="http://www.himss.org/" target="_blank">HIMSS</a>) is the large health IT vendor trade group in the U.S.  At a Sept. 21, 2012 <a href="http://blog.himss.org/2012/09/21/will-health-it-increase-fraud-and-abuse/" target="_blank">HIMSS blog post</a>, <a href="http://blog.himss.org/author/jcasillas2/" target="_blank">John Casillas</a>, Senior Vice President of HIMSS Financial-Centered Systems and HIMSS Medical Banking Project dismisses concerns about health IT with the refrain: <blockquote class="tr_bq">... To argue that the existence of something good for healthcare in many other ways, such as having the right information at the point of care when it’s needed, is actually bad because outliers use it to misrepresent claims activity is deeply flawed. Through the best use of health IT and management systems, we have the opportunity to improve the quality of care, reduce medical errors and increase patient safety. Don’t let the arguments of some cast a cloud over the critical importance and achievement of digitizing patient health records. Surely, no one can argue paper records are the path forward. Name one other industry where this is the case. I can’t. Let’s not let the errors of a few become the enemy of good.</blockquote> The ethics of these statements from a non-clinician are particularly perverse. The statement "Don’t let the arguments of some cast a cloud over the critical importance and achievement of digitizing patient health records" is particularly troubling. When those "some" include organizations such as FDA (see FDA Internal 2010 memo on HIT risks, <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html" target="_blank">link</a>) and IOM's Committee on Patient Safety and Health Information Technology (see 2012 report on health IT safety, <a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html" target="_blank">link</a>) both stating that harms are definite but magnitude unknown due to systematic impediments to collecting the data, and the ECRI Institute having had health IT in its "top ten healthcare technology risks" for several years running, <a href="http://hcrenewal.blogspot.com/2012/03/ecri-institutes-top-health-technology.html" target="_blank">link</a>, the dismissal of "clouds" is unethical on its face. These reports indicate that nobody knows if today's EHRs improve or worsen outcomes over good paper record systems or not.  The evidence is certainly conflicting (see <a href="http://hcrenewal.blogspot.com/2011/02/updated-reading-list-on-health-it.html" target="_blank">here</a>). It also means that the current hyper-enthusiasm to roll out this software nationwide in its present state could very likely be at the expense of the unfortunate patients who find themselves as roadkill on the way to the unregulated health IT utopia. That's not medicine, that's perverse human subjects experimentation without safeguards or consent. As a HC Renewal reader noted: <blockquote class="tr_bq">Astounding hubris, although it does seem to be effective.  Such is PC hubris.  Who could ever call for reducing the budget of the NIH that is intended to improve health.  Has health improved?  No. So why does a group with spotty successes if not outright failure never get cut?  It’s not the results, it’s the mission that deserves the funding.  So it’s not the reality of HIT, it’s the promise, the mission, that gets the support.  Never mind the outcome, it’s bound to improve with the continued support of the mission.</blockquote> Is this HIMSS VP aware of these reports?  Does he even care? Does he believe patients harmed or killed as a result of bad health IT (and I know of a number of cases personally through my advocacy work, including, horribly, infants and the elderly) are gladly sacrificing themselves for the greater good of IT progress? It's difficult to draw any other conclusion from health IT excuses such as proffered, other than he and HIMSS simply don't care about unintended consequences of health IT. Regarding "Surely, no one can argue paper records are the path forward" - well, yes, I can.  (Not the path 'forward', but the path for now, at least, until health IT is debugged and its adoption and effects better understood).  And I did so argue, at my recent posts "<a href="http://hcrenewal.blogspot.com/2012/09/good-health-it-v-bad-health-it-paper-is.html" target="_blank">Good Health IT v. Bad Health IT: Paper is Better Than The Latter</a>" and "<a href="http://hcrenewal.blogspot.com/2012/09/a-reason-to-refuse-use-of-ehrs-in-your.html" target="_blank">A Good Reason to Refuse Use of Today's EHR's in Your Health Care, and Demand Paper</a>".  I wrote: <blockquote class="tr_bq">I opine that the elephant in the living room of health IT discussions is that bad health IT is infrequently, if ever, made a major issue in healthcare policy discussions. I also opine that bad health IT is far worse, in terms of diluting and decreasing the quality and privacy of healthcare, than a very good or even average paper-based record-keeping and ordering system.   This is a simple concept, but I believe it needs to be stated explicitly.  </blockquote> A "path forward" that does not take into account these issues is the path forward of the <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html" target="_blank">hyper-enthusiastic technophile</a> who either deliberately ignores or is blinded to technology's downsides, ethical issues, and repeated local and mass failures. If today's health IT is not ready for national rollout, e.g., causes harms of unknown magnitude (e.g., see <a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">this query link</a>), results in massive breaches of security as the "Good Reason" post above, and mayhem such as <a href="http://hcrenewal.blogspot.com/2012/09/in-addition-to-nurses-doctors-now-air.html" target="_blank">at this link</a>, then: The best - and most ethical - option is to slow down HIT implementation and allow paper-based organizations and clinicians to continue to resort to paper until these issues are resolved.  Resolution needs to occur in lab or experimental clinical settings without putting patients at risk - and with their informed consent. Anything else is akin to the medical experimentation abuses of the past that led to current research subjects protections such as the "<a href="http://grants.nih.gov/grants/policy/hs/ethical_guidelines.htm" target="_blank">Ethical Guidelines & Regulations</a>" used by NIH. -- SS

HIMSS Senior Vice President on Medical Ethics: Ignore Health IT Downsides for the Greater Good

The Health Information Management Systems Society (HIMSS) is the large health IT vendor trade group in the U.S. At a Sept. 21, 2012 HIMSS blog post, John Casillas, Senior Vice President of HIMSS Fina…

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