Wisdom from the Medical Journal of Oz: "Good HIT and bad HIT"

The recognition and partitioning of <b>"good health IT"</b> from <b>"bad health IT"</b> is now a mainstream meme.  I have few comments about this new article; it reflects views frequently expressed here at Healthcare Renewal (indeed, one of its references is to this blog and this author):<br /><br /><blockquote class="tr_bq"><b><a href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit" target="_blank">Good HIT and bad HIT</a><br />Jon D Patrick and Susan Ieraci<br />Medical Journal of Australia 2013; 198 (4): 205.</b></blockquote><div class="ui-tabs-panel ui-widget-content ui-corner-bottom" id="article"><blockquote></blockquote><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><blockquote><div class="Intro"><i>First and foremost, do no harm. Second, do some good</i></div><div class="Intro"><br /></div></blockquote><div class="field field-name-field-provenance field-type-text field-label-above"><blockquote><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_elementId-1140662" name="0_elementId-1140662"></a><br /><div class="P"><span class="DropCap">O</span><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1140078" name="0_pgfId-1140078"></a>ne of the key issues for high-volume, high-risk workplaces like hospital emergency departments (EDs) is the struggle of conflicting aims. While hospital managers need information systems for data collection and storage, clinicians need efficient clinical documentation, data retrieval and order-entry systems that save time rather than steal it from the patient. The work of clinicians is aided by reliable data but impaired by the delays of real-time input, difficult system navigation, suboptimal presentation of information, and other problems in the user experience of health information technology (HIT).<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#1">1</a></div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139847" name="0_pgfId-1139847"></a>Mohan and colleagues’ study of the impact of an electronic medical record information system on ED performance had some limitations.<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#2">2</a> It was retrospective and unable to control for all confounders, and therefore could only show a correlation with ED delays, not causation. However, the premise for the study delivers an important message — the work required to use the information system was perceived by the ED staff to directly conflict with time spent with patients.</div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139851" name="0_pgfId-1139851"></a>Another study has shown that the same electronic medical record information system is perceived to have had a negative impact on the care of patients, as well as the productivity and morale of staff, in six EDs in New South Wales.<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#3">3</a> The need to be hypervigilant about the accuracy of the information supplied by the electronic health record compounds an already stressful clinical environment, which in turn leads to resentment towards the technology and the people who have imposed it. This makes it “bad” HIT. Unless this is corrected, HIT efforts will overuse precious health care resources, will be unlikely to achieve claimed benefits for many years to come, and may actually cause harm.<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#4">4</a><span class="Sp">,</span><a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#5">5</a></div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139861" name="0_pgfId-1139861"></a>The large HIT corporations produce a type of technology that is best categorised as enterprise resource planning (ERP), which has its roots in the manufacturing industry. It is based on the idea that all processes within an organisation can be standardised, and that all processes of the same type should have their information modelled and processed in the same manner. If this high degree of standardisation were considered the best way to process and model information derived from clinical activity, then ERP would be a favoured technology to adopt, as has happened in many places.</div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139862" name="0_pgfId-1139862"></a>However, there is an alternative, almost contradictory, perspective on the nature of clinical work: that it is non-deterministic and performed by a group of diverse staff working in an ecologically stable network of people that has to respond to diverse medical needs and diseases. The ecology model accommodates staff joining and leaving the process, with differing needs emerging at different times, so that the other individuals in the network have to adapt and modify their behaviour and improvise in an unpredictable manner. Amid all this variability is the ever-demanding imperative to improve the processes of care and attention to the patient, while also increasing staff productivity.<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#6">6</a></div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139866" name="0_pgfId-1139866"></a>Where the ERP model has been imposed in the clinical setting, staff may be coerced into an approach to their work that is at odds with established best practices. This could only be considered “good” HIT if it brought greater staff productivity with at least no loss (and, preferably, improvement) of patient safety and services and staff morale.</div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139867" name="0_pgfId-1139867"></a>It is not enough just to identify problems: effort must be invested in transforming bad HIT into good HIT. This process must identify and optimise all the operative factors: human behaviour, system design, equipment performance, skills of the IT participants, and the operational policy framework.<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#7">7</a> Good HIT should include clinician control of the interface design for content, dataflow and workflow. It includes the ability to change the system in real time, and it incorporates inbuilt data analytical capability, natural language processing, and native interoperability and clinical coding.<a class="SupXRef" href="https://www.mja.com.au/journal/2013/198/4/good-hit-and-bad-hit#8">8</a> Finally, there must be an appropriate opportunity to test systems for useability, effectiveness and suitability before their release.</div><div class="P"><br /></div><div class="P"><a href="http://www.blogger.com/blogger.g?blogID=9551150" id="0_pgfId-1139874" name="0_pgfId-1139874"></a>There must be a move away from standardised processing models and towards improving the user experience in the clinical setting. Clinicians should not have to shoehorn their activity into predefined, externally imposed work processes that do not reflect actual activity and will not improve efficiency. A true patient-focused system aligns all its components towards the same aim. Like a good clinician, good HIT does no harm — to patients <span class="Italic">or</span> staff.</div></blockquote></div><div class="field field-name-field-provenance field-type-text field-label-above"><br />American medical / HIT journals are perhaps a bit too beholden to industry to directly commit such health IT heresy.  Thank the stars those Down Under are a bit more bold.</div></div></div></div><div class="field field-name-field-provenance field-type-text field-label-above"><br /></div><div class="field field-name-field-provenance field-type-text field-label-above">-- SS</div></div><br />

Wisdom from the Medical Journal of Oz: "Good HIT and bad HIT"

The recognition and partitioning of "good health IT" from "bad health IT" is now a mainstream meme.  I have few comments about this new article; it reflects views frequently expressed here at Healthca…

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New York Times: "The Ups and Downs of Electronic Medical Records"

The "downs" of health IT have rarely been presented in a prominent public forum.<br /><br />After a recent <a href="http://www.publicintegrity.org/health/medicare/cracking-codes" target="_blank">Center for Public Integrity series</a> and <a href="http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitals-with-electronic-records.html" target="_blank">New York Times story</a> on EHR-related upcoding, the New York times does so again.  This blog is cited:<br /><br /><blockquote class="tr_bq"><b>October 8, 2012<br /><a href="http://www.nytimes.com/2012/10/09/health/the-ups-and-downs-of-electronic-medical-records-the-digital-doctor.html" target="_blank">The Ups and Downs of Electronic Medical Records</a></b><br /><b>New York Times<br />By MILT FREUDENHEIM</b><br /><br />The case for electronic medical records is compelling: They can make health care more efficient and less expensive, and improve the quality of care by making patients’ medical history easily accessible to all who treat them.<br /><br />Small wonder that the idea has been promoted by the Obama administration, with strong bipartisan and industry support. The government has given $6.5 billion in incentives, and hospitals and doctors have spent billions more.<br /><br />But as health care providers adopt electronic records, the challenges have proved daunting, with a potential for mix-ups and confusion that can be <b>frustrating, costly and even dangerous.  </b></blockquote><br />"Dangerous" is the concept that has been most lacking in public debate.  Through my many years of writing on health IT difficulties and more recently my legal work, I know of injuries and deaths caused or contributed to by bad health IT (e.g., see <a href="http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html" target="_blank">here</a> and <a href="http://hcrenewal.blogspot.com/2011/09/sweet-death-that-wasnt-very-sweet-how_24.html" target="_blank">here</a>).  I experienced a tragedy in my own family as well.<br /><br />The New York Times has done a significant public service in mentioning this critical issue, long hushed by the <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html" target="_blank">hyper-enthusiasts</a> to whom computers seem to hold more rights than people, and to whom plans for a "cybernetic healthcare utopia" override long held principles and standards for <a href="http://www.hhs.gov/ohrp/archive/index2.html" target="_blank">human subject research protections</a>.<br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">Some doctors complain that the electronic systems are clunky and time-consuming, designed more for bureaucrats than physicians. Last month, for example, the public health system in Contra Costa County in California slowed to a crawl under a new information-technology system. </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Doctors told county supervisors they were able to see only half as many patients as usual as they struggled with the unfamiliar screens and clicks. Nurses had similar concerns. At the county jail, they said, a mistaken order for a high dose of a dangerous heart medicine was caught just in time. </div></blockquote><div itemprop="articleBody"><br /></div><div itemprop="articleBody">That scenario, not at all unique (e.g., see New York Times, "<a href="http://www.nytimes.com/2010/11/19/us/19bcavatar.html?_r=2&src=twrhp">Designed for Efficiency, New Computer Software at Health Dept. Misfires</a>", Nov. 2010 and my comments <a href="http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html" target="_blank">here</a>), is a warning that the technology needs significant work and cannot just be rammed into place.</div><div itemprop="articleBody"></div><blockquote class="tr_bq"><div itemprop="articleBody">The first national coordinator for health information technology, Dr. David J. Brailer, was appointed in 2004, by President George W. Bush. Dr. Brailer encouraged the beginnings of the switch from paper charts to computers. But in an interview last month, he said: “<b>The current information tools are still difficult to set up. They are hard to use. They fit only parts of what doctors do, and not the rest.” </b></div></blockquote><br />Refreshing candor that should be coming from the <i><b>present</b></i> ONC leader, not the two-generations-ago former incumbent.<br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">Like all computerized systems, electronic records are vulnerable to crashes. Parts of the system at the University of Pittsburgh Medical Center were down recently for six hours over two days; the hospital had an alternate database that kept patients’ histories available until the problem was fixed. </div></blockquote><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Those crashes are also not uncommon.  See for instance my posts on the common refrain when that happens that <b>"patient care has not been compromised" </b>(<a href="http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised" target="_blank">query link</a>). </div><div itemprop="articleBody"><br /></div><blockquote class="tr_bq"><div itemprop="articleBody">Even the internationally respected Mayo Clinic, which treats more than a million patients a year, has serious unresolved problems after working for years to get its three major electronic records systems to talk to one another. Dr. Dawn S. Milliner, the chief medical informatics officer at Mayo, said her people were “working actively on a number of fronts” to make the systems “interoperable” but acknowledged, “We have not solved that yet.” </div></blockquote><br />Perhaps the worst example of that phenomenon is the DoD-VA interface debacle.  See my apparently popular (based on "hits") March 2010 post "<a href="http://hcrenewal.blogspot.com/2010/03/will-it-take-luminosity-of-dozen.html" target="_blank">VA / DoD EHR Interface Debacle: Will It Take the Luminosity Of A Dozen Supernovas To Shed Light On The Obvious About Healthcare IT?</a>"<br /><br /><blockquote class="tr_bq">Still, Dr. Milliner added that even though there a lot of challenges, the benefits of information technology are <b>“enormous”</b> — improved safety and quality of care, convenience for patients and better outcomes in general. </blockquote><br />Enormous?  It is quite clear that this has not been proven in the real world with large scale health IT, especially in its present form.  It may be the case that the improvements will be modest at best.  Many if not most healthcare problems may not be related to documentation at all (see my Dec. 2010 post "<a href="http://hcrenewal.blogspot.com/2010/12/is-healthcare-it-solution-to-wrong.html" target="_blank">Is Healthcare IT a Solution to the Wrong Problem?</a>" for instance).  Also, as I've written, <a href="http://hcrenewal.blogspot.com/2012/09/good-health-it-v-bad-health-it-paper-is.html" target="_blank">a good or even fair paper record system is better for patients than BHIT (bad health IT)</a>.<br /><br /><blockquote class="tr_bq">In the rare event that a large-scale system goes down at Mayo, backup measures are ready, teams are called in to make rapid repairs, and if necessary “everyone is ready to go on paper,” Dr. Milliner said.  </blockquote><br />Paper records do not unexpectedly "go down" en masse.<br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">Reliable data about problems in the electronic systems is hard to come by, <b>hidden by a virtual code of silence enforced by fears of lawsuits and bad publicity.</b> A recent study commissioned by the government sketches the magnitude of the problem, calling for tools to report problems and to prevent them. </div></blockquote><div itemprop="articleBody"><br /></div><div itemprop="articleBody">"<span dir="auto"><a href="http://en.wikipedia.org/wiki/Omert%C3%A0" target="_blank">Omertà</a>"</span> is perhaps the best term of art for this form of silence...</div><div itemprop="articleBody"><br /></div><blockquote class="tr_bq"><div itemprop="articleBody">Based on error rates in other industries, the report estimates that if and when electronic health records are fully adopted, they could be linked to at least <b>60,000 adverse events a year. </b></div></blockquote><br />My own estimates are much higher if the technology and its industry are not first drastically reformed, as in my April 2010 post "<a href="http://hcrenewal.blogspot.com/2010/04/if-benefits-of-hit-can-be-guesstimated.html" target="_blank">If The Benefits Of Healthcare IT Can Be Guesstimated, So Can And Should The Dangers</a>."<br /><br /><blockquote class="tr_bq">The Obama administration will issue a report on patient safety issues in early November, the current national coordinator, Dr. <a href="http://healthit.hhs.gov/portal/server.pt/community/organizational_description_/1249/farzad_mostashari,_md,_scm/18220" title="Web site">Farzad Mostashari</a>, said in an interview. That report was requested last year by a panel on health I.T. safety at the <a href="http://www.iom.edu/" title="Web site">Institute of Medicine</a>, a unit of the National Academies of Science. </blockquote><br />Considering the available data is limited, as per the FDA and IOM itself (see addendum <a href="http://hcrenewal.blogspot.com/2012/10/honesty-and-good-sense-on-electronic.html" target="_blank">here</a>), the report should be immediately suspect for underestimation/cheerleading if not whitewashing.<br /><br /><blockquote class="tr_bq">... Elisabeth Belmont, a lawyer for the MaineHealth system, based in Portland, advises hospitals to <b>reject contract language that could leave them responsible for settling claims for patient injuries caused by software problems. </b> </blockquote><br />The IT industry is quite mature and no longer merits such special accommodation.  As in other industries, liability should be covered by the industry itself, not by customers (and patient victims).  See "<b><a href="http://digitalcommons.law.scu.edu/cgi/viewcontent.cgi?article=1390&context=chtlj" target="_blank"><span class="st"><i>No More Soft Landings for Software</i>: <i>Liability</i> for <i>Defects in an Industry That Has Come of Age</i></span></a></b>", Frances E. Zollers, Andrew McMullin, Sandra N. Hurd, and Peter Shears, Santa Clara Computer & High Technology Law Journal, May 2005.<br /><br /><blockquote class="tr_bq">The institute also recommended that software manufacturers be <b>required</b> to report deaths, serious injuries or unsafe conditions related to information technology. So far, however, neither a new safety agency nor such a reporting system has been adopted.  Some of the largest software companies have opposed any mandatory reporting requirement. </blockquote><br />Post market surveillance is standard for other medical device sectors and the pharma industry, as well as other mission critical IT sectors.  The continuing, remarkable special accommodation for health IT is unearned, unjustified and ethically inexplicable.<br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">Critics are deeply skeptical that electronic records are ready for prime time. “The technology is being pushed, with no good scientific basis,” said Dr. Scot M. Silverstein, a health I.T. expert at Drexel University who reports on medical records problems on the blog <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a>. He says testing these systems on patients without their consent “raises ethical questions.” </div><div itemprop="articleBody"><br /></div></blockquote>In other words, while I am an advocate for good health IT, the technology is not yet ready to be pushed nationally.  Bad health IT prevails.  From my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">Medical Informatics teaching site</a>:<br /><br /><blockquote class="tr_bq"><b>Good Health IT ("GHIT")</b> is defined as IT that provides a good user experience, enhances cognitive function, puts essential information as effortlessly as possible into the physician’s hands, keeps eHealth information secure, protects patient privacy and facilitates better practice of medicine and better outcomes.<br /><br /><b>Bad Health IT ("BHIT")</b> is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.  </blockquote><br />(I would replace the term "critic" with "realist" and/or "patient rights advocate.")<br /><div itemprop="articleBody"><br /></div><blockquote class="tr_bq"><div itemprop="articleBody">Another critic, Dr. Scott A. Monteith <span style="color: red;"><i><b>[who has guest-posted at this blog - ed.]</b></i></span>, a psychiatrist and health I.T. consultant in Michigan, notes that <a class="meta-classifier" href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier" title="Recent and archival health news about Medicare.">Medicare</a> and insurance companies generally do not pay for experimental treatments that have not proved their effectiveness ... Dr. Monteith said the electronic systems were “disrupting traditional medical records and, beyond that, how we think” — the process of arriving at a diagnosis. For example, the diagnosing process can include “looking at six pieces of paper,” he said. “We cannot do that on a monitor. It really affects how we think.” </div></blockquote><br />The systems are disruptive due to the paradigm changes, made far worse by their also often being <a href="http://www.tinyurl.com/hostileuserexper" target="_blank">mission hostile</a> in design.<br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">“The problem is each patient is an individual,” said Ms. Burger, who is president of the California Nurses Association. “We need the ability to change that care plan, based on age and sex and other factors.” She acknowledged that the system had one advantage: overcoming the ancient problem of bad handwriting. “It makes it easier for me to read progress notes that physicians have written, and vice versa,” she said. </div></blockquote><br />While this is true, it is also true that the loss of context and structure produces <a href="http://hcrenewal.blogspot.com/2011/02/electronic-medical-records-two-weeks.html" target="_blank">legible gibberish that does not relate the patient narrative well</a>.  Also, the same legibility improvement could be obtained via word processors - or typewriters - that cost far less than the tens of millions of dollars or more per organization that clinical IT commonly costs.<br /><br /><blockquote class="tr_bq">Some experts said they were hopeful that the initial problems with electronic records would be settled over time. </blockquote><br />I'm one of them.  Without major health IT industry reforms, however, including strict adherence to <i>evidence-based practices</i> (as that selfsame industry sector demands of medicine and ironically and hypocritically claims its products will enable), I don't expect to see the problems settled in my lifetime.<br /><br /><blockquote class="tr_bq">Dr. Brailer, who now heads Health Evolution Partners, a venture capital firm in San Francisco, said that “most of the clunky first-generation tools” would be replaced in 10 years. “As the industry continues to grind forward, costs will go down,” he said.  </blockquote><br />One should ask - why are 'first generation' tools still in abundance, decades into the healthcare information technology industry?  Further, as the industry "grinds forward" without oversight and patient protections, people will be injured.<br /><br /><blockquote class="tr_bq"><div itemprop="articleBody">Mark V. Pauly, professor of health care management at the Wharton School, said the health I.T. industry was moving in the right direction but that it had a long way to go before it would save real money.  “Like so many other things in health care,” Dr. Pauly said, “<b>the amount of accomplishment is well short of the amount of cheerleading.” </b></div></blockquote><br />That is an understatement.<br /><br />(Not covered in this article perhaps due to limited space are the issues of <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy" target="_blank">information security, privacy and confidentiality</a> that are compromised by current clinical IT.)<br /><br />In conclusion, it is good that the New York Times has brought the downsides into the public eye.  While the technology's not "ready for prime time", a story like this is ready for prime time, and is in fact long overdue:<br /><br />-- SS

New York Times: "The Ups and Downs of Electronic Medical Records"

The "downs" of health IT have rarely been presented in a prominent public forum.After a recent Center for Public Integrity series and New York Times story on EHR-related upcoding, the New York times d…

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Good Health IT (GHIT) v. Bad Health IT (BHIT): Paper is Better Than The Latter

<span style="font-size: small;"><span style="font-family: inherit;">An unspoken running assumption of the health IT enthusiast crowd seems to be that any health IT is better than no health IT, because using paper results in mistakes.</span></span><br /><span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span><span style="font-size: small;"><span style="font-family: inherit;">I offer a different view.</span></span><br /><span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span><span style="font-size: small;"><span style="font-family: inherit;">At the introduction to <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">my Medical Informatics teaching site</a> I've defined good health IT and bad health IT as follows:</span></span><br /><br /><blockquote class="tr_bq"><span style="font-size: small;"><span style="font-family: inherit;"><span style="color: black;"><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;"><b><b><span style="color: black; font-family: Arial;">Good Health IT</span></b><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;"> ("GHIT") </span></b><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;">is defined as IT that provides a good user experience, enhances cognitive function, puts essential information as effortlessly as possible into the physician’s hands, keeps eHealth information secure, protects patient privacy and facilitates better practice of medicine and better outcomes.<span style="mso-spacerun: yes;"> </span></span><b><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><br /><br /><b>Bad Health IT</b> ("BHIT") </span></b><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;">is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.<span style="mso-spacerun: yes;">  </span></span>.<span style="mso-spacerun: yes;">  </span></span><b><span style="color: black; font-family: Arial; mso-bidi-font-weight: bold;"></span></b>   </span></span></span></blockquote><br /><span style="font-size: small;"><span style="font-family: inherit;"><span style="font-size: small;"><span style="font-family: inherit;">There are also good paper systems and bad paper systems.</span></span></span></span><br /><br /><span style="font-size: small;"><span style="font-family: inherit;">I opine that the elephant in the living room of health IT discussions is that <b>BHIT is infrequently, if ever, made a major issue in healthcare policy discussions.</b></span></span><br /><span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span><span style="font-size: small;"><span style="font-family: inherit;"><i>I also opine that BHIT 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.  </i></span></span><br /><span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span><span style="font-size: small;"><span style="font-family: inherit;">This is a simple concept, but I believe it needs to be stated explicitly. </span></span><br /><br /><span style="font-size: small;"><span style="font-family: inherit;"><span style="font-size: small;"><span style="font-family: inherit;">In today's healthcare world, where health IT is dominated by <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html" target="_blank">hyper-enthusiasts</a> of one motive or another, such an axiomatic statement will probably be viewed as controversial if not heretical.  </span></span></span></span><br /><span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span><span style="font-size: small;"><span style="font-family: inherit;">This blog has numerous postings about health IT debacles, e.g., query links <a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">here</a> and <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy" target="_blank">here</a>, that could not occur with paper systems.  The defects of just one company's products, the only one that publicly reports them to FDA (<a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html" target="_blank">link</a>) are frightening in terms of potential consequences. </span></span><br /><br /><span style="font-size: small;"><span style="font-family: inherit;">GHIT needs to be promoted and </span></span><span style="font-size: small;"><span style="font-family: inherit;"><span style="font-size: small;"><span style="font-family: inherit;">BHIT needs to be eliminated</span></span>.  That implies a major transformation of the health IT industry and its oversight.</span></span><br /><span style="font-size: small;"><span style="font-family: inherit;"><br /></span></span><span style="font-size: small;"><span style="font-family: inherit;">-- SS </span></span>

Good Health IT (GHIT) v. Bad Health IT (BHIT): Paper is Better Than The Latter

An unspoken running assumption of the health IT enthusiast crowd seems to be that any health IT is better than no health IT, because using paper results in mistakes.I offer a different view.At the int…

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