healthy4u

Google Health: helping you better coordinate your care

We continue to learn a tremendous amount since <a href="http://googleblog.blogspot.com/2008/02/google-health-first-look.html">launching Google Health</a> in the spring of 2008. We're listening to feedback from users every day about their needs, and one issue we hear regularly is that people want help coordinating their care and the care of loved ones. They want the ability to share their medical records and personal health information with trusted family members, friends, and doctors in their care network. I can relate to this. Just a few years ago, my father suffered a minor heart attack and was sent to the ER. I arrived on the scene in a panic, and was asked what medications he was taking. To my surprise, I had no clue. If my father had a Google Health account, and had shared his profile with me, I would have been up-to-date on his current medications. I'm happy to announce today Google Health has addressed this issue with the release of a new "Share this profile" feature enabling Google Health users to invite others they trust (whether it's a family member, a trusted care network provider, friends, and/or a doctor) to view their medical records and personal health information. Log into Google Health, click on "Share this Profile," and type in the email address of the person with whom you'd like to share your profile. Google Health will send an email to them with a link to view your profile. The link will only work in connection with the email address of that person — your profile can't be accessed if the link is forwarded on. You can stop sharing at any time, and you can always see who has access to your information. Those who are viewing your profile can only see the profile you share — not any other one in your account. We've also built in some extra protections to make sure your health information stays safe, private, and under your control: <ul><li>The sharing link in the email expires after 30 days, but the sharing access itself does not expire — it will stay in place until the user decides to stop sharing</li><li>Viewers can only see — not edit — your Google Health profile</li><li>You can review a user activity report to see who has viewed your profile</li></ul><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjidmi9avwx4Z4aXx9tQSJVkTKBBXQ6dbJUG2UfhDXzitDa1Qo12_fpop-PoSCJI42hpT-9gh5_RuZ6iSZwOOs4Z6OMbaJ4t2ruB5SaUcVJ66F3_myA1gE_nu4K4CdSpU392DIZfQ_GtyNh/s1600-h/sharing.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309409644659295042" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjidmi9avwx4Z4aXx9tQSJVkTKBBXQ6dbJUG2UfhDXzitDa1Qo12_fpop-PoSCJI42hpT-9gh5_RuZ6iSZwOOs4Z6OMbaJ4t2ruB5SaUcVJ66F3_myA1gE_nu4K4CdSpU392DIZfQ_GtyNh/s400/sharing.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 230px;" /></a>For doctors and family members who are not yet online, we've also made it easier to share a hard copy of your information via our new printing feature. The wallet format prints a wallet-sized card that includes a user's medications, and allergies; the PDF format prints a letter-sized copy of a user's profile, including medications, allergies, conditions, and treatments. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicrv7vwEncDU_cBIiLtm5_l88z5czVOSfgxAAAzIIefQJMKpqLjHwkbV_NGu3nKxwBoODBWfT_uzukGhndqz2qB8Z7W3kIopQDV27peSqKugKFjGY2iMcxeMUeogHE9q2i_riAKfW9iBrh/s1600-h/print_idcard.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309409648087240866" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicrv7vwEncDU_cBIiLtm5_l88z5czVOSfgxAAAzIIefQJMKpqLjHwkbV_NGu3nKxwBoODBWfT_uzukGhndqz2qB8Z7W3kIopQDV27peSqKugKFjGY2iMcxeMUeogHE9q2i_riAKfW9iBrh/s400/print_idcard.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 185px;" /></a>Finally, we've launched a new graphing feature that helps patients visualize their medical test information. This is great for, say, someone who has high cholesterol. They can use Google Health to enter their lab results on a monthly basis and see the trend over time. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjByU6klWufGCsf06dKu5pB6ExTBN6Lsu6Q-TJ9bGfx_qE_tJ-1jYLtg5qrGf1OrHej4Lq33NfJAP0Ep-8HuwwJQSlPy8SgCCbCxAkFPsMoOVcBZzEPPSmod3JSXBKBkT8qIRJNa1UoL7Yh/s1600-h/viz_tour.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309409656275993522" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjByU6klWufGCsf06dKu5pB6ExTBN6Lsu6Q-TJ9bGfx_qE_tJ-1jYLtg5qrGf1OrHej4Lq33NfJAP0Ep-8HuwwJQSlPy8SgCCbCxAkFPsMoOVcBZzEPPSmod3JSXBKBkT8qIRJNa1UoL7Yh/s400/viz_tour.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 178px;" /></a>There is still a lot more work to do on Google Health, and we're excited to <a href="http://www.google.com/support/health/bin/request.py?contact_type=suggest">keep hearing from you</a> so we can continue to make improvements. For now, we hope this <a href="http://www.google.com/intl/en/health/whatsnew.html">new sharing feature</a> makes coordinating your care, or the care of loved ones, a little easier. Update on 3/6: Clarified the first bullet point. Posted by Sameer Samat, Director, Product Management</div>

Google Health: helping you better coordinate your care

We continue to learn a tremendous amount since launching Google Health in the spring of 2008. We're listening to feedback from users ev...

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IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans Medical Centers

Bill Gates's company, Microsoft, touts the <a href="http://www.interaction-design.org/encyclopedia/user_experience_or_ux.html">User Experience</a> as the Sine Qua Non of computing. Billions of dollars have been spent tweaking every little nuance of Windows, with version 7.0 soon to appear. Apple has done likewise with Mac OS X. (The various X-windows managers for Linux, less so). I respect these efforts and use both mainstream OS's in my daily work. In HIT, however, the "user experience" as I outlined in my eight part series <a href="http://tinyurl.com/hostileuserexper">starting here</a> is deemed an issue to solve once the sale is made and physicians are scrambling to avoid harming or killing patients. After all, the HIT industry is unregulated, shielded from liability based on the "learned intermediary" doctrine (a.k.a., clinicians are the bank and insurance company for IT vendors, in that they are the creative implementors of workarounds to IT mismanagement and misdesign), and contractual gag clauses against public disclosure of product defects. This arrangement makes the pharmaceutical industry look like kids in a sandbox. In the article "<a href="http://jama.ama-assn.org/cgi/content/extract/301/9/919">IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans' Medical Centers</a>", Journal of the American Medical Association 2009;301(9):919-920, author Bridget M. Kuehn illustrates the risk of improperly implemented or managed HIT, even in the VA. The VA is probably the finest environment in the world for HIT, its development of clinical IT over the past few decades being largely driven by experts from within, and being dedicated to patients and not profits. Yet its HIT is subject to the same issues as HIT in the for-profit HIT sector. Kuehn writes in JAMA: <blockquote style="font-family:arial;">Medical errors and software malfunctions that were linked to changes in the electronic medical records system used at Veterans Affairs (VA) medical centers across the country are drawing attention to the potential vulnerabilities of such systems. Although many advocates of electronic medical records systems promote them as a means to reduce mistakes affecting patient care, the recent problems in the VA system and other evidence suggest that malfunctions of these systems or problems with the way they are implemented have the potential to lead to medical errors. </blockquote> Drawing attention after how many years of physicians observing such problems in the commercial HIT sector and being muted by HIT companies on such issues, I ask? How many times will we need to see such articles in print before physicians and patient advocates wake up? How many times would we need to see in print "chiropractors performing neurosurgery is harming patients" before we put a stop to that practice? How many medical centers have lists and databases of known HIT defects, waiting to be fixed, that their patients and the public do not know of? How many physicians have been threatened with litigation for airing the dirty laundry? <blockquote>Understanding how such problems occur as well as how they might be prevented is particularly critical as the Obama administration considers health care reforms that include more widespread adoption of electronic records systems in health care. </blockquote> Indeed, although I would add "... as the Obama administration also moves from a suggested timeline of 2014 to a coercive 'do this or else' timeline." As I've written, such a change is cavalier and suffers from the misinformation fed the administration by both the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=ecosystem">HIT ecosystem industrialists and opportunists</a>, and those suffering from the utopian Syndrome of Inappropriate Overconfidence in Computing. <blockquote style="font-family: arial;" face="arial">After a software update of the electronic medical records system at VA hospitals in August, health care workers at these facilities began to report that as they moved from the records of one patient to those of a second patient, they would sometimes see the first patient's information displayed under the second patient's name. </blockquote> If not for the diligence of the users, that type of error could lead to dead patients. <blockquote> This records-scrambling problem was reported at 41 of the 153 VA medical centers, said Gail Graham, deputy chief officer of Health Information Management at Veterans Health Administration Headquarters in Washington, DC. Graham explained that the jumbling of records was an uncommon occurrence that only occurred after a particular sequence of events. </blockquote> As I mentioned above, the VA is an example of the finest environment, probably in the world, for HIT, being dedicated to patients and not profits (see the book "<a href="http://books.google.com/books?id=JivKd9gTA5cC&pg=PT55&lpg=PT55&dq=%22scot+silverstein%22+medical+informatics+20+20%22&source=bl&ots=mAH8ZWDvYo&sig=RV5RI6AKTLZNoTfpmjq2TkrWAUE">Medical Informatics 20/20</a>" by Goldstein et al., and my linked quote, on that culture). Imagine what goes on in commercial products where vendors' first priority is to profit margin. <blockquote style="font-family:arial;">Health care workers at the VA medical centers were notified about this potential problem in October, and on December 20, the centers received a software "patch" to fix the problem. Nine VA medical centers reported another type of problem related to their electronic records system: physician orders to stop medication were missed, causing some patients to receive intravenous medications longer than necessary. The problem occurred because after the software upgrade, physician orders to discontinue such medications, which had previously appeared at the top of the screen, were not displayed. In 3 cases, patients received infusions of drugs such as heparin for up to 11 hours after their physician had ordered the drug to be discontinued. Graham said the affected patients were not notified because they had not been harmed by the oversights. This software problem was corrected on December 8. </blockquote> Again, this type of error occurs once too often, your patient's dead. <blockquote style="font-family:arial;">There are hundreds of types of problems that can occur as a result of such technology, and those experienced by the VA medical centers are not uncommon, according to Ross Koppel, PhD, professor of sociology at the School of Medicine at the University of Pennsylvania in Philadelphia. For example, the scrambling of two different electronic records is a common problem that is not limited to systems used in health care settings, he said. Additionally, research indicates that poor layout of information in electronic medical records and related health information technology systems is the most common type of flaw (Koppel R et al. JAMA. 2005;293[10]:1197-1203). He explained that when health care workers have to look at several different screens or scroll through pages to access the information needed to make medical decisions, mistakes can occur. </blockquote>My <a href="http://tinyurl.com/hostileuserexper">eight</a><a href="http://tinyurl.com/hostileuserexper"> part series</a> came to the same conclusions. In fact, I reached those conclusions and started <a href="http://www.ischool.drexel.edu/facuty/ssilverstein/medinfo.htm">writing publicly about them</a>, in 1998. Was anyone listening? How many patients have been harmed, or died, in those past ten years due to industry inattention to these issues and leadership of HIT projects by unqualified personnel? <blockquote style="font-family: arial;" face="arial">Additionally, medical errors also may arise from poor communication between electronic medical records and related technologies (such as computerized physician order entry systems) or between software applications created by different companies. Other types of errors are caused not by flawed software but by how workers use that software in real medical settings. For example, an electronic medical record system may require a physician to enter a weight for a patient before prescribing a drug, even if a precise weight is not needed for that particular drug. A physician in a rush may enter an estimate of the patient's weight, but another physician who subsequently views the record might use that estimated weight to prescribe a medication that does require an accurate weight, potentially causing a dosage error. Detecting such problems requires careful observation of how systems are being used in real clinical settings and interviewing clinical staff about their experience, noted Koppel.</blockquote> I claim these types of errors are due to flawed software. The flaw is in the ill-conceived, management information systems (MIS) inventory-system-mentality, mission hostile user experience the software presents to clinicians. <blockquote style="font-family:arial;">Although makers of electronic medical records software test it to detect problems that may lead to errors, federal oversight of such testing is lacking. The Certification Commission for Healthcare Information Technology, which is composed of health information technology industry organizations, has a certification program, but critics argue that such oversight is not sufficient and that the US Food and Drug Administration, the Centers for Medicare & Medicaid Services, or a new governmental agency should be given the authority to oversee these systems (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/regulation_and_oversight_hoffman.pdf">Hoffman S and Podgurski A. Harv J Law Tech. 2008;22[1]:104-165</a>). "The bar on certification has to be raised to a level that ensures real safety, not just minimal compliance," Koppel said.</blockquote> The CCHIT process is merely a specifications check or qualification of features, and is nearly useless by their own admission regarding most of the issues discussed in these articles. Worse, CCHIT has significant conflicts of interest with the HIT industry, having <a href="http://www.cchit.org/about/organization/commission/index.asp">senior people</a> who also hold senior industry positions and thus have fiduciary responsibilities to their employers (whether that is acceptable for a "certifying" organizations is open to debate, but the conflicts exist as fact). On a more minor point, this organization c<a href="http://hcrenewal.blogspot.com/2009/02/cchit-dissolved-involuntarily-in-april.html">an't even manage its books properly</a>, failing to file its required reports and temporarily being dissolved, involuntarily. In fact, let me state that the lack of oversight of this industry amounts to, at best, governmental negligence, and at worst a complete dereliction of obligation to protect the public. Imagine this type of arrangement in pharma or the (physical) medical device industry. Almost ten years ago I wrote HIT is a clinical tool for unforgiving medical environments that happens to involve computers, not a management information system that happens to involve doctors. In other words, HIT systems are virtual medical devices that affect every aspect of care, and can cause the "learned intermediaries" to commit error as the JAMA article illustrates. <blockquote style="font-family:arial;">Koppel also urged caution as electronic records are rolled out. Although these technologies offer great promise in providing data for research and quality-improvement initiatives, he said more work is needed to make these systems work effectively in the context of health care. "We should encourage [the technologies' development, but we should not force doctors to use them until they are shown to be more responsive to the needs of physicians and other clinicians," he said.</blockquote> As to the "they", I believe Ross Koppel was referring to the computer artifacts themselves. I would extend the "they" to mean the healthcare IT vendor industry itself, to most of whose leaders I've probably give an "F" regarding these issues and knowledge of Biomedical Informatics. Excluding <a href="http://www.nextgen.com/">NextGen</a>, whose AVP for Government Relations holds the vaunted and much coveted "<a href="http://hcrenewal.blogspot.com/2009/02/nextgen-and-vendordoctor-dialog-yet.html">American Medical Informatics Certification for Health Information Technology</a>." Finally, the VA is going to embark on <a href="http://linuxmednews.com/1194419534">upgrades to its laboratory components</a> not by relying on its internal expertise, but by engaging the services of a private HIT company, <a href="http://www.cerner.com/public/">Cerner</a>, a company with a troubled record regarding the national IT initiatives in the UK (see <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=granger_speaks_out">here</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=UK">here</a>). Considering that company's issues, and the internal complexities, dependencies, intra-component messaging, and other idiosyncracies of a system as complex as VistA, I opine that this is a major error. Based upon my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinformatic1/gw-pdp8s.htm">decades of knowledge about IT</a>, biomedical informatics training, my analytical abilities and my own informed judgment, it is my deep fear that the VA will not "luck out" as in the above JAMA article. Patients will be harmed as a result somewhere down the line, I fear. -- SS Addendum 3/5/08: I am promoting a user comment and my response to the body of this post itself, as I think they exemplify a central issue regarding HIT: Paul Trossel on March 5, 2009 5:05:00 AM EST said... <blockquote style="font-family: arial;">Computer software in the Health industry are tools to use. Often the user thinks they are the ‘law’ in what they have to do. As long as people don’t understand the way they have to use their tools (eg surgical scalpel, machines, software etc.) mistakes will be made. Always check the outcome of the computer with your own judgement. As long as supervisors, bosses etc. help their people to understand that the use of the mind of a qualified professional is the outmost important and that the outcomes of the tools are the next, mistakes that lead to the death of a patient, will keep occurring!</blockquote> My reply: <blockquote style="font-family: arial;">Mr. Trossel, Forgive me for saying so, but you sound like an apologist for the Health IT medical device industry, which rightly fears increased scrutiny of its design, development, QC and lifecycle practices. HIT is a medical device that happens to involve computer automation. My apologies if I am incorrect, but it appears you're not taken care of a patient in the "fog of war" known as the ED, ICU or busy hospital floor. Tools that distract, tools that mislead, tools causing cognitive overload are simply dangerous in such an environment. That is a clinical reality. It is also clear you've not read my post [as above] in its entirety, nor my <a href="http://tinyurl.com/hostileuserexper">multi part series on the mission hostile user experience</a> presented by HIT. It appears even the most highly trained experts, especially when distracted, can be misled by faulty devices. The recent crash of the Turkish airliner seems a case of just that. See "<a href="http://blogs.wsj.com/middleseat/2009/03/05/turkish-airlines-amsterdam-crash-altimeter-crew-cited-as-causes/" rel="nofollow">Altimeter, Crew Cited in Dutch Crash</a>" in the Wall Street Journal. It is the primary responsibility of the manufacturer of a medical device such as HIT to assure it is the best device possible, accounting for the very well known realities of the clinical workplace. It is not the responsibility of the end user to be the bank and insurance policy for cavalier software design through tiring improvisation and workarounds to software device mismanagement and design decisions made by incompetents and HIT amateurs. </blockquote> There is no excuse for ill conceived, designed and implemented HIT devices. None whatsoever, most especially depending on busy human users to compensate for the flaws on a 100% reliability basis. <a href="http://www.resilience-engineering.org/">Resilience engineering</a>, a term I learned when presenting these HIT issues to the <a href="http://www.ieeeusa.org/volunteers/committees/mtpc/">IEEE Medical Technology Policy Committee</a> in Dec, 2007 (PPT <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/IEEE_12102007.zip">here</a>), is not about depending on busy people to cover for your device's defects. Regarding a meta-issue: It's absolutely a sign of our culture being in great distress when physicians have to answer to IT personnel about why the physicians best not be the "workarounds" and safety valves to ill conceived IT. -- SS

IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans Medical Centers

Bill Gates's company, Microsoft, touts the User Experience as the Sine Qua Non of computing. Billions of dollars have been spent tweak...

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Outrageous extremely overpriced ridiculously simple EMR interfaces

This in from a 2005 college graduate working in healthcare IT for almost 3 years, with a technical background only, who has found my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">site on HIT difficulties</a>. This person's been working with several hospitals and hospital groups to create interfaces to practices and labs as well as master patient index services. This HIT worker writes: <blockquote style="font-family:arial;">"...one other thing that I think should be covered is the outrageous extremely overpriced ridiculously simple (I opted to use as many adjectives that came to mind) task of creating an interface in an EMR. After doing a few interfaces myself and working with about a dozen or so EMR vendors the cost is ridiculous for the amount of work they actually do. The average cost that I've seen is about $4,000 to $6,000 USD, I've seen some that are 'free' I'll explain this one later, some upwards of $40,000+ and some in the realm of a few hundred. Under this secret shroud of "everything is complicated and takes tons of people and costs an arm and a leg" is really a two person job that takes about three to four hours, or even less if you know what you're doing. To create an interface between two systems one person configures their application to listen on a socket, and the other to configure the application to connect to an IP and a specific socket. This of course assumes the two systems are maintained by two different people. There is more that goes into creating an interface sure, but from an EMR point of view its two people. I've configured a [Big Vendor] interface with the vendor in 30 minutes. [Big Vendor] charges I think the number was $3,500 to $4,000 for the "Labor charge", [Big Vendor] is the 'free' one once you purchase the application you can create as many interfaces as you want. I've yet to meet a physician, nurse or office assistant that have the know-how to create an interface. Other EMR's charge per interface as if paying $15,000 for the application wasn't enough a physician must spend another $4,000 to $6,000 for a stinking interface! Yes its important that they have it but WOW! - $4,000 to $6,000 for 30 minutes of work? Some are longer, some interfaces require more configuration's which isn't much, most any worthwhile application already has default configurations and interfaces so one could load those and not go too far over 30 minutes of work, certainly not longer than a few hours though. Thinking of a typical practice that I've encountered, there are three general feeds: 1. General Labs - This interface would send over your microbiologies,blood tests etc. 2. Transcriptions - This interface would send over, well, transcriptions anything dictated. 3. Radiology - This interface would send over all your radiology transcriptions with the added feature of being able to handle images. Not that I've actually seen one in action, these are all just claims right now. The sheer size of radiology images dissuades labs from sending them over the system because of bandwidth issues, also because not many interfaces currently support DICOM, or one system in the flow doesn't support DICOM. So, if we take one of the larger EMR's, your eCW's, GE's, Misys's, Allscripts et cetera, the cost for one of these systems range from $12,000 to $15,000 that I've seen for a small practice. Then if you take the $4000 (lets be nice and give EMR's the lower number) at three interfaces for a total of $12,000 we have a system that costs $24,000 to $27,000. That's ridiculously insane for a broken system that somewhat works. Another thing that has always got me wound up with looking at these costs are that the EMR's know their application best, they know how the HL7 data should look, but they have no way of mapping the HL7 to be compliant with their systems. So I'm forced to map it for them, I'm lucky if they have specs, and if they do they're likely out dated (I have yet to receive a spec that was not out of date by the way). Reverse engineering an application's interpretation of HL7 is insane. To be fair, some vendors do offer though to do the mapping, then again they also charged $40,000+. I've tinkered with EMR systems when I can, some were nice, some were trash, most were trash. These applications work and look great for me, but lets face it, I'm no clinician I don't understand most of what is on the screen, I can fumble around though and figure things out. These applications are designed and developed by engineers, these applicationsonly make sense to engineers. These systems are pure trash. Here's to taking down the shroud and smoke screen HIT has put up the past couple decades. Feel free to post this in its entirety if it will help take down the smoke screen. </blockquote> Having been a CMIO, I can vouch for these expense levels charged for interfaces that I knew, also being a computer professional, were quite simple to code. -- SS

Outrageous extremely overpriced ridiculously simple EMR interfaces

This in from a 2005 college graduate working in healthcare IT for almost 3 years, with a technical background only, who has found my site on...

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The Malpractices of the Multitudes: the HIT Mission Hostile User Experience, Part 8

More on the origin of this post's title, penned in 1836, below. (Note: Part 1 of this series is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">here</a>, part 2 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and.html">here</a>, part 3 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_24.html">here</a>, part 4 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_26.html">here</a>, part 5 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_27.html">here</a>, part 6 is <a href="http://hcrenewal.blogspot.com/2009/02/it-makes-healthcare-easier-is-this.html">here</a>, part 7 is <a href="http://hcrenewal.blogspot.com/2009/03/information-technology-makes-healthcare.html">here</a>, and part 8 is <a href="http://hcrenewal.blogspot.com/2009/03/malpractices-of-multitudes-mission.html">here</a>. 2011 addendums: a post that can be considered part 9 is <a href="http://hcrenewal.blogspot.com/2011/04/special-k-red-berries-mission-hostile.html">here</a>, part 10 is <a href="http://hcrenewal.blogspot.com/2011/12/ehr-mission-hostile-user-experience.html">here</a>.) This post is part 8 of a series on the stunningly poor human engineering of production healthcare IT from major vendors, in use today at major medical centers. These devices provide a decidedly mission hostile user experience, yet with an almost religious fervor are being touted as cybernetic miracles to cure healthcare's ills. <blockquote>April 2011 addendum: see what might be considered part 9 <a href="http://hcrenewal.blogspot.com/2011/04/special-k-red-berries-mission-hostile.html">at this link</a>.</blockquote> My college is a member of the <a href="http://www.ischools.org/">iSchool</a> consortium, consisting of schools of information science and technology (notably, not "information technology and science"). <blockquote>The iSchools are interested in the relationship between information, people and technology. This is characterized by a commitment to learning and understanding the role of information in human endeavors. The iSchools take it as given that expertise in all forms of information is required for progress in science, business, education, and culture. This expertise must include understanding of the uses and users of information, as well as information technologies and their applications.</blockquote> Note the "as well as." Note the primary focus, and that which is secondary. This philosophy parallels that of Medical Informatics well. This probably sounds like Martian to many in the healthcare and perhaps the broader business IT sector. One of my colleagues on reviewing this HIT series had this to say: <blockquote style="font-family: arial;"> It's really nice to hear that for once IT professionals have been able to successfully repeat the development lifecycle for healthcare information systems: <ul><li>Fail to understand the problem -></li></ul><ul><li>create a fragmentary and inaccurate requirements definition -></li></ul><ul><li>design an ambiguous, ignorant and risk-laden user interface -></li></ul><ul><li>pull all the misguided notions together with baling wire and call it a design-></li></ul><ul><li>translate the "design" into an executable form, adding and subtracting design elements at random -></li></ul><ul><li>observe the first output from the system and declare it ready for the healthcare professionals. fini</li></ul> Did I miss anything?</blockquote> I believe he captured the essense of today's HIT vendor market well. Here are examples of screen displays of vital patient information, displays that force clinicians to go on wild goose chases and seem designed by true neophytes to the field of information presentation and user interaction design. This is not to single out any one vendor. Many vendor products have deficiencies. See this display of something as simple (one would think) as blood pressures: <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmvltC6XKg9_afHVtZV2WZ0TvHAEIQpEvXBBWRHkdj_uuUXFofKZ2vd0m7pZL6Y4fvgSG6IAvDZi-01x6FXwiJkE_qXeJklZRtWJlnhM31qXTn9IAN3SoBIXy4f96AVCypr5rGSyeAt_N9/s1600-h/bp1.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309109363406374482" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmvltC6XKg9_afHVtZV2WZ0TvHAEIQpEvXBBWRHkdj_uuUXFofKZ2vd0m7pZL6Y4fvgSG6IAvDZi-01x6FXwiJkE_qXeJklZRtWJlnhM31qXTn9IAN3SoBIXy4f96AVCypr5rGSyeAt_N9/s320/bp1.jpg" style="cursor: pointer; display: block; height: 269px; margin: 0px auto 10px; text-align: center; width: 429px;" /></a>(click to enlarge) <div style="text-align: left;"> Note the following: <ul><li>Diastolic blood pressures in the left column;</li><li>Systolic blood pressures in the roight column;</li><li>An adventure to match them by date;</li><li>No column headers at top.</li></ul> Which value goes with which? How much energy does it use up to scroll around and connect the two? This display is so poorly conceived, one wonders why it was included at all in a production system. There's more. Let's troll for data, shall we? See the blood oxygen saturation level, circled? <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu905SrE7UWqih06dfekAG55ypw5xED6AUaRoRY0-Wjr3odjrpQwAA0mFgxu_zx5a8LbhNks40uBeNXXNv2_yvqiAWSrOj2hUKa0wQfBvya9VrIq6Me0IhzX8dvcpx_eos6H6JZaND5VxJ/s1600-h/pulseox1.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309111713343813090" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu905SrE7UWqih06dfekAG55ypw5xED6AUaRoRY0-Wjr3odjrpQwAA0mFgxu_zx5a8LbhNks40uBeNXXNv2_yvqiAWSrOj2hUKa0wQfBvya9VrIq6Me0IhzX8dvcpx_eos6H6JZaND5VxJ/s320/pulseox1.jpg" style="cursor: pointer; display: block; height: 317px; margin: 0px auto 10px; text-align: center; width: 433px;" /></a>(click to enlarge)</div> What percentage oxygen was this patient receiving? It's not there! Where is it? Scroll down ... <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3mRxHdhg82E8YHmARGw4DK8MJSWJAmfPNBNaoZgRgTjdTu5E39LXvMM9uzmnJcBMEIzZAcEHf_OSMzFghi2teoOZoTIIRKiWgkSMon2E6SjcYik8-YLh70lTnjAAL6RTh5Yoyw1aI5E6M/s1600-h/pulseox2.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309112826374552962" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3mRxHdhg82E8YHmARGw4DK8MJSWJAmfPNBNaoZgRgTjdTu5E39LXvMM9uzmnJcBMEIzZAcEHf_OSMzFghi2teoOZoTIIRKiWgkSMon2E6SjcYik8-YLh70lTnjAAL6RTh5Yoyw1aI5E6M/s320/pulseox2.jpg" style="cursor: pointer; display: block; height: 342px; margin: 0px auto 10px; text-align: center; width: 412px;" /></a>(click to enlarge)</div> ... and down ... <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifM6KQKapHXEeScoAmiSvodQhpSkZ5RwkVCT_sWpAGAeD9yi47aTcHPd-ZyA69UxpnnG-8cZx0d-7Pe5iKgUBtkV0rqsckNYHiOZNhyphenhyphenEwiVTVxezg5MLgUJCSD1DiMSgelxAPUVUER64wD/s1600-h/pulseox3.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309114210505780354" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifM6KQKapHXEeScoAmiSvodQhpSkZ5RwkVCT_sWpAGAeD9yi47aTcHPd-ZyA69UxpnnG-8cZx0d-7Pe5iKgUBtkV0rqsckNYHiOZNhyphenhyphenEwiVTVxezg5MLgUJCSD1DiMSgelxAPUVUER64wD/s320/pulseox3.jpg" style="cursor: pointer; display: block; height: 336px; margin: 0px auto 10px; text-align: center; width: 403px;" /></a>(click to enlarge) <div style="text-align: left;"> Our answer, at last! Circled. Of course, the corresponding pulse oximetry is now off the screen. How much attention would it have taken to present the two together? How much coding would it have taken with today's computers, that execute billions of instructions per second, to dynamically condense the presentation of information, eliminating the absolutely empty cells between the two values? Similar isses are noted for other biomedically coupled values, such as coumadin dose and blood thinning value (INR). Screw matching those up, and as my mentor Victor P. Satinsky, MD might have said, your patient's dead. Speaking about information sparsity, how's this display? <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2u2XuKF_6ev1jaMi8nrl9NHK2pZueIvVWxEmRvdR9YewzNfU43HZ3A9hvThFc08qRN9cwz1moU_AVZVg3f52lM9m2SWdIZxbdfDrPLopxlzU10V7AF_u1QD4LpqbT3aiLRk0A3vX16Piv/s1600-h/sparse.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309115566446043474" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2u2XuKF_6ev1jaMi8nrl9NHK2pZueIvVWxEmRvdR9YewzNfU43HZ3A9hvThFc08qRN9cwz1moU_AVZVg3f52lM9m2SWdIZxbdfDrPLopxlzU10V7AF_u1QD4LpqbT3aiLRk0A3vX16Piv/s320/sparse.jpg" style="cursor: pointer; display: block; height: 311px; margin: 0px auto 10px; text-align: center; width: 428px;" /></a>(click to enlarge) <div style="text-align: left;">There's one value in the entire screen. What a waste. How much difficulty would it have been to simply present the one row, automatically? The EHR disperses and fragments vital patient information. How, exactly, is this is supposed to make clinicians more efficient and less error prone? I am only presenting the easiest to present problems, easiest that is in a static medium such as a blog. If presented dynamically, we find with some EHR's, for example, that it takes 50 or so mouse clicks across various screens and drop down lists and drop boxes to enter 5 common diagnoses. It takes selecting from multiple hierarchical lists and buttons across four different screens, multiple times repetitively, to find out how well a patient is eating. Here is simple advice from J Gen Intern Med 2009; 24(1):21-26. <blockquote> It is imperative that usability principles are embedded in CPOE design to avoid • overly complex screens • poor grouping of like terms • an inflexible human-computer interface • mis-use of clinician time</blockquote> Do the HIT vendors actually read such advice? I wonder. Medical Informatics reminds me of dentistry in its early days. B.T. Longbothom, author of the second dentistry book published in the U.S. ("A Treatise on Dentistry", 1802), gave an excellent description in his preface of problems at the time. His observations apply to Medical Informatics in our present age: <blockquote face="arial">The word "dentist" has been so infamously abused by ignorant pretenders, and is in general so indifferently understood, that I cannot forbear giving what I conceive to be its original meaning: viz, the profession of one who undertakes and is capable not only of cleaning, extracting, replacing by transplantation and making artificial teeth, but can also from his knowledge of dentistry, preserve those that remain in good condition, prevent in a very great degree, those that are loose, or those that are in a decayed state, from being further injured, and can guard against the several diseases, to which the teeth, gums and mouth are liable, a knowledge none but those regularly instructed, and who have had a long, and extensive practice, can possibly attain, but which is absolutely necessary, to complete the character of a Surgeon Dentist.</blockquote> Hardly anyone spoke out. More than thirty years later, untrained practitioners were as prevalent as ever. One of the leading dentists of the time, Shearjashub Spooner, in his "Guide to Sound Teeth, or, A Popular Treatise on the Teeth" (1836) warned the public of a phenomenon I believe now applies to Medical Informatics and healthcare IT: <blockquote style="font-family: arial;"> One thing is certain, this profession must either rise or sink. If means are not taken to suppress and discountenance the malpractices of the multitude of incompetent persons, who are pressing into it, merely for the sake of its emoluments, it must sink, - for the few competent and well educated men, who are now upholding it, will abandon a disreputable profession, in a country of enterprise like ours, and turn their attention to some other calling more congenial to the feelings of honorable and enlightened men.</blockquote> I understand that point of view. And with that, I end this series. -- SS </div></div></div></div></div></div>

The Malpractices of the Multitudes: the HIT Mission Hostile User Experience, Part 8

More on the origin of this post's title, penned in 1836, below. ( Note: Part 1 of this series is here , part 2 is here , part 3 is h...

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Lilly: "I were referred to me as person who specializes in pharmaceutical based informatics and wanted to reach out to me."

At "<a href="http://hcrenewal.blogspot.com/2009/01/what-me-worry-lilly-fined-over-zyprexa.html">What, Me Worry? Lilly Fined Over Zyprexa, Should Be Fined For eRecruitment Inanity As Well?</a>", I wrote about a very bizarre eRecruiting message I received from Eli Lilly: <blockquote face="arial"> In just about the most bizarre and inane recruiting email I think I've ever received, this unsolicited gem came in to my professional email account. This is at least the second time I received this identical message in the past few weeks.</blockquote> It began with "Dear MD." Click on the above link to see that solicitation. I didn't think it could get much worse than that. I was wrong. This just in, exactly as received (emphases mine): <blockquote style="font-family: arial;"> From: Hank Gehron <hank.gehron@rightthinginc.com> Sent: Tue, 3 Mar 2009 7:45 am Subject: Your Help Is Requested for a Eli Lilly Career Opportunity! (Discovery Informatics Director at Indianapolis) </hank.gehron@rightthinginc.com> <div align="left">I am a member of the Staffing Team at Eli Lilly. I were referred to me as person who specializes in pharmaceutical based informatics. I wanted to reach out to me, to see if you maybe able to recommend anyone that could qualify for the below position. [Perhaps I should recommend my grade school English teacher to go over this solicitation with a big red marking pencil? - ed.] </div> <div align="left">For more than 130 years, Eli Lilly and Company has been dedicated to meeting the health care needs of people in the United States and around the world. We address these needs primarily by developing innovative medicines-investing a higher percentage of our sales in research and development than any other major pharmaceutical company. If you are interested in being considered for employment with a "Best in Class" Pharmaceutical company, please review the following opportunity. </div> <div align="left">Please feel free to call me with any questions; or perhaps you may know of someone that could qualify. </div> <div align="left">Your consideration is most appreciated. </div> <div align="left">Hank Gehron, MBA, SPHR Lilly Talent Acquisition Team / RightThing Recruiting Process Outsourcing work. 610-263-3030 Ext. 4450, Country Code 001 blackberry. 610-836-1856 <a href="mailto:hank.gehron@rightthinginc.com">hank.gehron@rightthinginc.com </a> </div></blockquote><div align="left"> </div> Then there are the "requirements": <blockquote>MINIMUM REQUIREMENTS: M.S. or Ph.D. in Biology, Chemistry, or related Computational sciences Minimum of 8-10 years experience in biotech or pharma industry Minimum of 3-5 years managing/leading Informatics teams Strong understanding of genomic, proteomic, expression, and imaging platforms. Experience in the specifications, design, development, and deployment of bioinformatics, chemo-informatics, and translational informatics tools and analysis to support research portfolio. </blockquote> Note no call for formal medical or medical informatics training, as this position is not really "Discovery Informatics" (which would encompass medical informatics), it is primarily bioinformatics or "gene stuff." I commented on that field at "Has Bioinformatics Hit a Hard Wall of Stagnation?" <a href="http://hcrenewal.blogspot.com/2009/01/has-bioinformatics-hit-hard-wall-of.html">here</a>. I will not comment further, only asking a simple question: Is this a company you would want to work for or that inspires confidence in its ability to produce safe medicines? <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeS0Pj1l05PAku7KWlbhjKs48DG1jASdsevfMGhNGjW78zANl7Ehe1GfBSqbGggcqm0MOmu3-D-xr3o3ExkXl0nl1yQtd3CANbRQm8szR_4r3ju985uje9z5XsTVk7Ek-Pa5MSQRWiJrHA/s1600-h/alfred_e_neuman.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5309060942816173682" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeS0Pj1l05PAku7KWlbhjKs48DG1jASdsevfMGhNGjW78zANl7Ehe1GfBSqbGggcqm0MOmu3-D-xr3o3ExkXl0nl1yQtd3CANbRQm8szR_4r3ju985uje9z5XsTVk7Ek-Pa5MSQRWiJrHA/s320/alfred_e_neuman.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 125px; height: 163px;" /></a>What? Me worry about talking good with grammar? </div> -- SS

Lilly: "I were referred to me as person who specializes in pharmaceutical based informatics and wanted to reach out to me."

At " What, Me Worry? Lilly Fined Over Zyprexa, Should Be Fined For eRecruitment Inanity As Well? ", I wrote about a very bizarre...

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Meet the New Boss, Same as the Old Boss? - Health Care Reform to be Lead by a Director of Boston Scientific, Cerner, and Medco

Today we learned that President Obama has announced his new picks for Secretary of Health and Human Services and for Director of the White House Office for Health Reform. The choice of Nancy-Ann DeParle for the latter position raises some issues. The NY Times <a href="http://www.nytimes.com/2009/03/03/us/politics/03health.html">provides some background</a>: <blockquote> He also named Nancy-Ann DeParle to coordinate health policy for the administration. Her position, counselor to the president and director of the White House Office for Health Reform, is not subject to Senate confirmation. Ms. DeParle was commissioner of the Tennessee Department of Human Services from 1987 to 1989. Under President Bill Clinton, from 1997 to 2000, she was administrator of the Health Care Financing Administration, now known as the Centers for Medicare and Medicaid Services. Since then, she has gained extensive experience in the business world. That experience, though seen as an asset by many, prompted questions from some of the people vetting personnel for Mr. Obama, supporters of Ms. DeParle said. Ms. DeParle has been a director of large health care companies including Medco Health Solutions, a pharmacy benefit manager; Cerner, a supplier of health information technology, including electronic medical records; Boston Scientific, a medical device company; DaVita, which runs kidney dialysis centers; and Triad Hospitals. </blockquote> In addition, <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/03/02/AR2009030200371.html">according to the Washington Post</a>, <blockquote> DeParle, 52, was previously commissioner of the Department of Human Services in Tennessee. During the Clinton administration, she worked in the Office of Management and Budget and later oversaw Medicare and Medicaid as the administrator of the Health Care Financing Administration. DeParle currently is managing director of CCMP Capital, a private equity firm. She also serves on the boards of several firms related to health care. A White House spokesman said she is in the process of resigning all those positions. </blockquote> Administration spokespeople apparently brushed aside any questions about Ms DeParle's conflicts of interest. A <a href="http://www.nytimes.com/2009/03/03/us/politics/03czar.html">separate article in the NY Times </a>noted: <blockquote> In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, President Obama selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from Harvard Law School and Oxford University. But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate. In announcing her appointment Monday as the director of the White House Office of Health Reform, Mr. Obama expressed 'absolute confidence' in Ms. DeParle, who ran the agency that oversaw Medicare and Medicaid during the Clinton administration. But the White House instantly faced questions about whether her appointment was skirting the spirit, if not the letter, of the president’s tough conflict-of-interest policy. Since leaving the Clinton administration, Ms. DeParle has been managing director of a private equity firm, CCMP Capital, and a board member of companies like Boston Scientific, Cerner and Medco Health Solutions. White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was 'directly or substantially' related to former clients or employers. 'It is our view, and the view of counsel here, that the incidence of that will be very low,' an administration official said of the need for Ms. DeParle to recuse herself from decisions. The official, who was not authorized to speak publicly, said Ms. DeParle would be working mostly with federal agencies and lawmakers, and not directly with companies. </blockquote> MedInformaticsMD just <a href="http://hcrenewal.blogspot.com/2009/03/cerner-board-member-as-healthcare-czar.html">posted</a> about his concerns specifically vis a vis Ms DeParle's current position as a leader of Cerner. My main concern here is that Ms DeParle's ties to multiple health care corporations are so strong as to jeopardize her ability to be the new leader of health care reform for the whole country. To review, Ms DeParle is currently a member of the boards of three health care corporations, Boston Scientific, Cerner, and Medco. As we have <a href="http://hcrenewal.blogspot.com/2006/03/new-species-of-conflict-of-interest-in.html">discussed</a> many times previously, a corporate director has a legal obligation to advance the profits and financial fortunes of the corporation he or she serves. As Robert AG Monks put it, corporate directors are supposed to "demonstrate unyielding loyalty to the company's shareholders" [Per Monks RAG, Minow N. <a href="http://www.amazon.com/Corporate-Governance-Robert-G-Monks/dp/1405116986">Corporate Governance</a>, 3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.] As compensation for that loyalty, corporate directors are usually exceedingly well-paid for the nominal hours they spend in their meetings. In particular, per <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=5545615&format=PDF">the company's 2008 proxy statement</a>, in 2007, Ms DeParle received $160,338 in total compensation from Boston Scientific, and held 62,020 of its shares. Further, per <a href="http://library.corporate-ir.net/library/11/118/118401/items/287619/CERN_2008proxy.pdf">the Cerner 2008 proxy statement</a>, in 2007 she received $195,051 from that company, and held 27,000 of its shares. Ms DeParle was just elected to the Medco board in 2008, so her compensation and stock holdings were not listed in <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=5588519&format=PDF">that year's proxy statement</a>, but presumably her total compensation would mirror what other directors received in 2007: a retainer of $50,000, and an annual grant of shares and options worth $175,000 at the time it would be granted. Given her previous obligation of "unyielding loyalty"to and generous compensation from major health care corporations, it might be hard to suddenly be indifferent to their interests. Of course, a White House spokesperson pledged that Ms DeParle would "recuse herself from any matter that was 'directly or substantially' related to former clients or employers." The problem is that most of the issues that might come up in discussions of health care reform might be directly and substantially related to the interests of the companies Ms DeParle now leads. For example, one obvious way to control costs in a reformed health care system would be to reduce the current reimbursement system's bias in favor of procedures over cognition. Boston Scientific makes much of its money selling devices that are used during such procedures. Any general shifting of reimbursement more in favor of cognition rather than procedures could reduce Boston Scientific's profits, profits which Ms DeParle is currently sworn to protect. So would Ms DeParle recuse herself from all discussions of reimbursement? I submit that if Ms DeParle recused herself from discussion of all issues that might affect the interests of Boston Scientific, Cerner, and Medco, let alone the private corporations she directs whose interests might be less easy to define, and let alone the corporations which she used to direct, she would have very little to do in her new position. On the other hand, were Ms DeParle to be an active Director of the White House Office of Health Care Reform, would the reform be in the interests of all the US people, or in the interests from the large and powerful corporations whose interests she was so recently pledged to protect? Does this new appointment truly reflect President Obama's statement that he did not come to Washington "to work for the powerful and well-connected interests who have run this city for too long?"

Meet the New Boss, Same as the Old Boss? - Health Care Reform to be Lead by a Director of Boston Scientific, Cerner, and Medco

Today we learned that President Obama has announced his new picks for Secretary of Health and Human Services and for Director of the White H...

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Cerner board member as Healthcare Czar

President Obama has declared that National Electronic Health Records are essential to curing healthcare's ills. From <a href="http://www.msnbc.msn.com/id/29466833/" style="font-family: arial;">MSNBC</a>: <blockquote style="font-family:arial;">WASHINGTON - President Barack Obama will name former Clinton administration health official Nancy-Ann DeParle on Monday to lead the newly created White House Office on Health Reform, a U.S. official said.DeParle, a former administrator of what is now the Centers for Medicare and Medicaid Services, will lead the White House office charged with coordinating Obama's ambitious healthcare reform efforts with Congress. </blockquote>From the <a href="http://www.nytimes.com/2009/03/03/us/politics/03czar.html?ref=us" style="font-family: arial;">NY Times:</a> <blockquote style="font-family:arial;">WASHINGTON — In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, <a href="http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per" title="More articles about Barack Obama.">President Obama</a> selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/h/harvard_university/index.html?inline=nyt-org" title="More articles about Harvard University.">Harvard</a> Law School and <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/o/oxford_university/index.html?inline=nyt-org" title="More articles about Oxford University">Oxford University</a>. But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate.</blockquote> From <a href="http://www.cerner.com/public/Cerner_2.asp?id=27436" style="font-family: arial;">Cerner Corp</a>, one of the largest vendors of Health IT: <blockquote style="font-family:arial;"> Nancy-Ann DeParle was appointed to Cerner Corporation's Board of Directors in May 2001.</blockquote> From the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=granger_speaks_out" style="font-family: arial;">former head of the UK's Connecting For Health</a> National HIT program: "Sometimes we put in stuff that I'm just ashamed of ... Some of the stuff that Cerner has put in recently is appalling ... Cerner and prime contractor Fujitsu had not listened to end users ... Failed marriages and co-dependency with subcontractors ... A string of problems ranging from missing appointment records, to inability to report on wait times ... Almost a dozen cancelled go-live dates ... Stupid or evil people ... Stockholm syndrome -identifying with suppliers' interests rather than your own ... A little coterie of people out there who are "alleged experts" who were dismissed for reasons of non-performance."<o:p></o:p> From <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm" style="font-family: arial;"> The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee, Jan 2009:</a> <blockquote style="font-family:arial;">... 5 The termination of Fujitsu's contract has caused uncertainty among Trusts in the South and new deployments have stopped. One option being considered for new deployments is for Trusts to have a choice of either Lorenzo provided through CSC or the [Cerner] Millennium system provided through BT. There are, however, considerable problems with existing deployments of [Cerner] Millennium and serious concerns about the prospects for future deployments of Lorenzo. Before the new arrangements for the South are finalised, the Department should assess whether it would be wise for Trusts in the South to adopt these systems. Should either of the Local Service Providers take on additional commitments relating to the South, the Department should take particular care to assess the implications of the extra workload for the quality of services to Trusts in the Local Service Providers' existing areas of responsibility. 6 The Programme is not providing value for money at present because there have been few successful deployments of the [Cerner] Millennium system and none of Lorenzo in any Acute Trust. Trusts cannot be expected to take on the burden of deploying care records systems that do not work effectively. Unless the position on care records system deployments improves appreciably in the very near future (i.e. within the next six months), the Department should assess the financial case for allowing Trusts to put forward applications for central funding for alternative systems compatible with the objectives of the Programme.</blockquote> This appointment appears to my untrained eye, on the surface, to be a problem, even with typical promises that these conflicts of interest will not affect decisions. From the NY Times article: <blockquote style="font-family: arial;">White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was “directly or substantially” related to former clients or employers.</blockquote> That is a relief - somewhat. This HIT company is likely to make huge profits in coming years. Will Ms. DePerle give up all financial stakes in this company and industry she and/or her family may hold such as stock, options and other tangibles? In a more general sense, can we as a country really trust such statements from business and government leaders any more? Should we? The <a href="http://www.dcexaminer.com/opinion/Obamas-HIT-will-likely-be-a-miss-40512247.html" style="font-family: arial;">Washington and San Francisco Examiners</a> have it about right in this common sense-filled editorial in which I am cited (I played no part in its appearance): <div id="article_inner" style="font-family:arial;"> <blockquote><h1>America’s foray into HIT will likely be a miss</h1> Examiner editorial 3/2/09 There is a provision of the $878 billion stimulus package rushed through Congress for $20 billion to develop a centralized national health information technology system. Proponents claim HIT will save $77 billion during the next 15 years and greatly reduce medical errors. Who could possibly object to that? Well, for starters, ask health care providers in Britain’s National Health Service, who have been trying to get their HIT system to work properly for the past five years. The cost of NHS’ HIT has escalated to six times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the United States. In January, Public Accounts Chairman Edward Leigh reported to fellow members of Parliament that essential systems are late or, when deployed, do not meet expectations of clinical staff. HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next six months. But even if HIT is eventually junked, British taxpayers will still have to pay for it. The National Academies of Science noted that much of the electronic medical data collected in the U.S. is used mainly to comply with regulations or to defend against lawsuits, rather than to improve patient care. A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one. And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors. After spending billions of dollars during the past three decades, only 4 percent of U.S. physicians have a fully functional HIT system, according to Drexel University biomedical informatics professor Scot Silverstein — and its not because doctors don’t want to use technology. These expensive systems are just not designed for their extremely complex and highly specialized needs. In an open letter to President Barack Obama, Silverstein said HIT is an experiment that’s unproven on a large scale. Computers in hospitals have also been linked to the spread of MRSA, a deadly antibiotic-resistant staph infection. Yet, the same federal government that can’t keep its own military veterans’ medical records secure is bound and determined to spend $20 billion in a top-down, centralized effort that has a very good chance of messing up yours.</blockquote> </div> This raises several questions: <ul><li>Was Ms. DeParle as a board member at Cerner acting definitively when complaints such as those from the UK came in? And perhaps do a google search on terms such as <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&q=healthcare+IT+failure&btnG=Google+Search">healthcare IT failure</a>? </li></ul><ul><li>Will Ms. DeParle support or oppose <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/regulation_and_oversight_hoffman.pdf">needed federal regulation</a> of an industry in which she holds (held) a Board Membership? </li></ul><ul><li>With (former) board members of HIT companies whose products apparently caused the UK's CfH program to cry "uncle" now in positions of ultimate power over U.S. healthcare, and with an administration locked into irrational exuberance over HIT, should physicians in the U.S. also look forward to a forced cybernetic dystopia as at my series <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>?</li></ul> Finally, this is not a piece against our President. He is not, nor expected to be, an expert in information technology and healthcare informatics. I actually feel sorry for him. I feel sorry for him in letting reactionary and opportunistic corporate elements of the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=ecosystem">healthcare IT ecosystem</a> lead him to make calls for full national HIT, along with penalties for nonadoption of this experimental and often defective technology, on the hyperaggressive, absurd and in fact damaging timeframe of five years, by 2014. See "<a href="http://www.jamia.org/cgi/content/short/13/1/106" style="font-family: arial;">Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?</a>" by Ford et al. And parroting the industry line, declaring with full confidence that Health IT will improve quality and decrease healthcare costs. The evidence on both issues is, let's just say, far more contradictory and questionable than the evidence that VIOXX kills people. -- SS

Cerner board member as Healthcare Czar

President Obama has declared that National Electronic Health Records are essential to curing healthcare's ills. From MSNBC : WASHINGTON ...

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