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Monday Morning Update 10/19/09

October 17, 2009 News 41 Comments

From eHealthDC: “Re: the Senate’s plan for making EHR incentives permanent. I had staff follow up on the story. According to a source, there was some misquoting – while there are a few areas of interest in Senate Finance, it does nothing aggressive on HIT. The key areas it touches on are the following: (a) the Secretary will conduct a study on methods to encourage meaningful use by entities offering insurance plans through a state-based exchange; (b) organizations participating in the CO-OP program will be permitted to enter collective purchasing arrangements for HIT-related materials; (c) the bill requires CMS to develop a plan to integrate the PQRI program with the standards for meaningful use; (d) no less than triennially, the Secretary will identify quality measure gaps and may appropriate grants to entities with expertise in developing such measures. These measures specifically include, among others, meaningful use of HIT. To this end, HHS will appropriate $75 million for fiscal years 2010 – 2014; (e) free clinics will be eligible for meaningful use Medicare and Medicaid HIT incentives; (f) the Secretary will incorporate reporting requirements and incentive payments and penalties related to electronic prescribing and EHRs into accountable care organization requirements; (f) the bill creates a bonus payment structure for care coordination and management activities conducted by Medicare Advantage plans. HIT programs are included as eligible activities. Nothing earth-shattering.” Thanks.

stromberg

From MEDITECH Customer: “Re: Kronos. I guess it isn’t really a rumor since I heard it first from my Kronos sales guy, then verified it in about half a dozen places. Kronos bought Stromberg from Paychex Inc. Stromberg had been beating out Kronos in some of the small hospitals in my area lately.” Paychex sells its time and attendance business to Kronos for an undisclosed sum. Kronos gains 1,400 customers that it describes as primarily mid-market (250 to 1,500 employees). Stromberg was an independent vendor in Lake Mary, FL that Paychex acquired in 2004 after first buying its Time in a Box product for small businesses the year before. It continued to operate under the Stromberg name as a Paychex subsidiary, offering free version upgrades, fixed price implementation, and a 99.7% customer retention rate.

From HITgeek: “Re: Siemens reorg. You can assume that Siemens reorg rumors around this time of year — right at the start of its fiscal year — are based on reality. Siemens’ most dependable product release timing is new org charts every year.”

From Simon Kirke: “Re: Meditech 6.0. I hear Meditech is forcing customers to buy a scanning and archive product with Meditech 6.0, even if they have a current document imaging solution. Can you verify this?” The floor is open.

From VA HIMSS: “Re: HIMSS. Friday night at the VA HIMSS Fall Conference, John Hoyt, VP HIMSS Analytics, said that HIMSS sees itself as matchmakers between providers and vendors. Huh? I thought HIMSS was a professional organization!” I’ve said all along that HIMSS is a highly profitable bar with a business model in which ladies (providers) drink free provided they don’t mind being groped by men (vendors) who pay dearly for the privilege. As evidence, I usually link to the HIMSS Exhibitor Priority Point Opportunities list (warning: XLS) that enumerates what vendors have to buy to earn the right to spend massive dollars on their annual conference exhibit (the cover charge?) 

emrpollI’m fascinated by the unintentional insight provided by responses to the poll I did on whether your primary care doctor uses an EMR. The PCPs of 63% of respondents use an EMR, which is astoundingly high and, frankly, hard to believe as representative. However, only 23% feel so strongly about EMR use that they would choose only EMR-using doctors, so those of us in the HIT industry aren’t eating our own dog food.

My doctor uses an EMR and I’m finally buying the concept after longstanding skepticism. I can confirm my appointment online and pay my co-pay online with a credit card (which lets me skip the check-in at the office), I can see my labs online from anywhere with his notes about what they mean, he can pull up my records from anywhere I’ve been seen within the health system, he uses e-prescribing, and he has done a great job in integrating the EMR as part of his patient teaching right in the exam room. Nobody has asked me even once for repetitive information. And most importantly, he says he finds it useful and clinically beneficial. Like most of the respondents, I’d stick with him even without the EMR, but it makes my encounters more convenient, adds clinical value, and gives me the peace of mind that if I show up at another health system facility I won’t be just an empty clipboard to them. I get it, I like it, and I’m looking forward to having more electronic and online services. I figure it’s no different than when I get my $13 haircut from the local cheap chain place since they look up my records by telephone number, their version of an EHR (electronic haircut record).

New poll to your right: are you and/or your employer planning to upgrade to Windows 7? It ships Thursday. I’m riding the fence myself. Microsoft panicked that it would lose impressionable students for good when Apple priced its Snow Leopard upgrade low, so I’ve got a $29.99 upgrade coupon for Windows 7 Home Premium since I have an EDU e-mail address for reasons too complicated to explain. Even then, I’m finding it hard to get excited about displacing XP since the Vista wounds are still fresh and I’d have to install from scratch this time since there’s no XP upgrade. Everything I do is on the Web, so I don’t know that a prettier and allegedly better Windows would change my life since Firefox would still look the same.

I see some folks have added their Webinars and conferences to my events calendar. Just a suggestion: put them up well in advance so those interested folks can lock in. You won’t get many new registrants for an onsite conference if the posting is made the week before.

A reader forwarded an e-mail from Kaiser CEO George Halvorson touting the Archimedes healthcare modeling system. Interesting: it’s an artificial intelligence system that uses computer models of the human body to analyze treatment approaches, rather like a virtual clinical trial. Kaiser did a stroke and heart attack prevention study with it to determine optimal combinations of drugs in a large population. It predicted that a combination of aspirin, lisinopril, and lipid-lowering agents would reduce risk by 71%, darned close to how it turned out in Kaiser’s real-world result of 60%. It has rolled out the protocol to 250,000 patients. Kaiser is the ideal environment for that kind of project since it fully manages its HMO patients and is incented to improve their health.

This isn’t news to us industry types, but an investigative report says EMR stimulus could cost twice the $19.5 billion figure that everybody remembers. Now we all know the real numbers – the incentives are pegged at $46 billion but will supposedly be offset by non-specific savings, giving a net cost of $19.5 billion as a best case. The report quotes a taxpayer group that compares HITECH to irresponsible overeating with a plan of going to the gym later to work off the calories. There’s not much point in debating whether the numbers are right or wrong, however. Once you’ve hitched your wagon to idealistic taxpayer bailouts as a national program despite crushing national debt, you shouldn’t expect the SWAG numbers to be anything more than irrationally exuberant.

UMass Memorial chooses Accenx Exchange for interoperability.

Iowa Health System and Allscripts launch ePrescribe Iowa, in which physicians will be offered a free Web-based e-prescribing tool.

Eclipsys Sunrise Pharmacy customers are on the rise, although exact numbers aren’t given in the press release. It says 80% of them do CPOE on Sunrise (a more interesting stat would be the number of its CPOE customers using their pharmacy system, of course, since Sunrise Pharmacy probably isn’t bought as a standalone system very often). It has some big-name users like El Camino, RWJ, SUNY Downstate, University of Kentucky, and HUP.

dvd

University of Iowa Health Care creates a half-time CMIO position and hires otolaryngologist Douglas Van Daele, MD for it. He’ll oversee its new $61 million implementation of — you guessed it — Epic. Their state representative gripes that UI gave the doc a $46K salary boost to $291K, saying, “I can’t think of any justification for adding any position while these cuts are being made that can’t draw down more (grant) dollars or doesn’t save lives. I can’t believe they’ve gone this long and they are adding it into a half-time position — and that couldn’t wait?" Apparently there’s friction over the university’s recent layoffs and some other recently added executive positions.

If you’re a fan of Dr. Gregg Alexander on HIStalk Practice and are attending the American Academy of Pediatrics conference this week, Gregg invites you to stop by the Pediatric Office of the Future exhibit and then join him at the Official Unofficial HIStalk Practice Happy Hour Reception at the President’s Sports Bar in the Renaissance Washington from 5:00 to 7:00 p.m. on Monday, 10/19. It’s a block and a half from the conference center.

Indiana cancels its 10-year, $1.34 billion welfare services contract with IBM and ACS, saying “the system wasn’t working, and it wasn’t getting better, despite best efforts.” The failed effort to privatize the systems was the largest contract in state history. It was supposed to save the state $500 million. ACS call center workers said they were told to lie to welfare recipients whose benefits were delayed, always telling them they’d get them within 48 hours just to get them off the phone. House Speaker Pat Bauer wants IBM to “go away and pay us something.”

Speaking of Indiana, its HIEs band together under a new governance organization called Indiana Health Information Technology to apply for stimulus money.

GE announces ugly Q2 numbers: revenue down 17%, EPS $0.26 vs. $0.54. GE Healthcare’s earnings were down 20%.

Just who you want advocating for EMRs: South Carolina Governor Mark Sanford, who is best known for disappearing for a week to cavort with his Argentine mistress and then lying about it with a lack of skill that is surprising for a politician.

vanderbiltdna

Vanderbilt University Medical Center gets $6.4 million in stimulus money to look for a link between drug performance and genetic factors, matching 67,000 DNA samples in its database to de-identified patient medical records.

E-mail me.

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Currently there are "41 comments" on this Article:

  1. “I’ve said all along that HIMSS is a highly profitable bar with a business model in which ladies (providers) drink free provided they don’t mind being groped by men (vendors) who pay dearly for the privilege.”

    Mr. HIStalk, you made my Sunday morning laughter meter reach 10. This reminds me of another business model, though this business involves another “s” word, that being sick patients. This is the saddest commentary I have read on the entire HIT industry.

  2. Re: U Iowa CMIO:

    “Their state representative gripes that UI gave the doc a $46K salary boost to $291K, saying, “I can’t think of any justification for adding any position while these cuts are being made that can’t draw down more (grant) dollars or doesn’t save lives.”

    I agree with the state representative, but for another reason. A CMIO role, especially in a large organization, is a full time position (and more) and is best served by someone with a formal background in healthcare informatics. I would also fear the position lacks true control of resources, hiring & firing, and other accoutrements of executive presence. If that is the case then it is a “Chief of Nothing” role.

    Further physicians who lack certain clinical skills and knowledge are referred to by the licensing boards as “dyscompetent.” I don’t know why HIT gets a pass – both for dyscompetent IT personnel who know nothing of healthcare or healthcare informatics, yet are placed in charge of multi millions dollar HIT projects, and for physicians appointed to serve them (which is what these Chief of Nothing roles really are).

    The position is structurally defective on first principles.

  3. Some here have asked for some real examples of HIT defects. Here is such a list from the FDA MAUDE (Manufacturer and User Facility Device Experience) database:

    http://tinyurl.com/hit-defects

    These reports were voluntary, many apparently submitted after reports by users. How many problems are not reported via this voluntary system?

  4. Some here have asked for some real examples of HIT defects

    Actually, that isn’t what some have asked for. What some have asked for is evidence that computer records result in more errors than paper records.

  5. ” What some have asked for is evidence that computer records result in more errors than paper records.”

    Such studies have not been accomplished. “Results” arise from the hype and opinions that were purchased by the HIT trade groups. This capriciousness has deceived the Congress to persuade the purchase of unproven devices. Interested readers and users of theses devices should add to the FDA data base of adverse events and device defects, which should include user interface issues.

  6. Re: The PCPs of 63% of respondents use an EMR, which is astoundingly high and, frankly, hard to believe as representative.

    When you asked about using EMR, were you intending to ask if EMR is used at point of care? That might ellicit different responses.
    Plus, I’m assuming your typical reader / survey respondent is not the average American.

  7. Such studies have not been accomplished.

    Until such studies are accomplished, your claims don’t appear to be supported by any evidence.

  8. Programmer moves the goalpostrs once again.

    I did nothing of the kind. If you think computer records are more dangerous than paper records, it’s up to you to prove it.

  9. I can confirm that Meditech has also advised our hospital we need to buy a scanning and archive product with Meditech 6.0, even though we have a current document imaging solution.

  10. RE: MEDITECH’s request for the purchase of their scanning and archiving solution; our client’s are also being told that to migrate to 6.0 the MEDITECH solution is required.

  11. We’d heard that, too. But our current scanning\archiving vendor said they will support 6.0. The vendor, Valco Data (since bought out by Hyland Software), sent out a notice to that affect quite sometime ago.

  12. The prerequisite of Scanning & Archive (SCA) and Data Repository (DR) for Focus (C/S 6.0) is true. Since it is a rewrite and the Focus platform, they store and reference items in both, making both required for movement to Focus. In addition, there is also a hardware requirement of a SAN.

    From Simon Kirke: “Re: Meditech 6.0. I hear Meditech is forcing customers to buy a scanning and archive product with Meditech 6.0, even if they have a current document imaging solution. Can you verify this?” The floor is open.

  13. I’d like to see you do an article on what EHR vendors are charging for interfacing to state HIEs. I have heard reports of $10,000+ per practice. The same ARRA that provided the EHR incentives (that will help vendors) is paying for the HIE’s start-up. As a vendor and knowing what it really costs to do interfaces (and that they are reusble) this just seems plain wrong.

  14. “If you think computer records are more dangerous than paper records, it’s up to you to prove it.”

    Non-inferiority (to a comparable product) is the minimum proof needed to be acceptable for use in clinical medicine. It is the onus of the manufacturer of the new product to accomplish this. The HIT vendors have violated cardinal precepts of scientific study with the aid of the purchased opinion from its trade groups.

  15. Suzie, I wish this lady was drinking for free. I’m just a lowly independent integration consultant who has been faithful to HIMSS for over a decade… and I have to pay $295 for an exhibit pass… and it’s restricted to 1 day! Ever go to HIMSS and try to talk to all the vendors you work with/ recommend in 1 day?

  16. What’s more wrong, paying for an interface with a vendor or not being able to have an interface from your vendor? Obviously not all interfaces are reusable, but I agree that charging for each interface is a little much…but at least you are one of the fortunate ones that uses a vendor that interfaces or “plays well with others”. I have a hard time buying the excuses from some vendors out there that say that you have to buy alllllll of their software & tools if you want to have a properly functioning infrastructure. While interfacing is not ideal, I think it’s rather asinine that you are pigeonholed (or penalized) if you choose to get a far superior product for your hospital. This obviously won’t fly for much longer with the requirements for interoperability.

  17. “HIMSS-what? Says: I have to pay $295 for an exhibit pass… and it’s restricted to 1 day!”

    WOW, HIMSS won’t give you a free pass?? That’s an insult… HIMSS spends that amount per minute at annual conference on beverages alone! I know of other “independent” consultants at CCHIT who received free exhibit passes. To be blunt, loyalty gets you nothing at HIMSS. You have to be part of the “In” crowd to get the independent consultant perks and invited to the HIMSS after parties.

  18. Programmer wrote:

    “What some have asked for is evidence that computer records result in more errors than paper records.”

    Such information would be useful as well. However, considering the lack of transparency in the health IT industry about defects and failures, close calls and patient injury, such a calculation is not currently possible. The voluntarily reported information I posted is a small fraction of some larger total.

    Those who work for HIT vendors, would you care to share your company’s HIT defects and adverse outcomes/close calls events list? Or is that forbidden?

  19. The HIT vendors have violated cardinal precepts of scientific study with the aid of the purchased opinion from its trade groups.

    In other words, there is no evidence to support your claims, right?

  20. However, considering the lack of transparency in the health IT industry about defects and failures, close calls and patient injury, such a calculation is not currently possible

    Why do you need health IT industry participation? That isn’t going to give you any info about the pre-IT error rates. It shouldn’t be very difficult to compare pre-IT error rates with IT error rates.

  21. Programmer writes:

    “It shouldn’t be very difficult to compare pre-IT error rates with IT error rates.”

    It is not possible to calculate the value of n/(unknown), where n=error rates due to paper, and (unknown)=error rates due to IT.

  22. It is not possible to calculate the value of n/(unknown), where n=error rates due to paper, and (unknown)=error rates due to IT.

    You don’t need to know the error rates due to IT or paper. You just need to know the overall pre-IT error rates and the post-IT error rates.

    Of course, the fact that you need an IT person to tell you this is a pretty good indicator of why you need IT.

  23. RE: Errors in paper vs. in IT.

    My issue with this entire discussion is that even a layperson knows that there were FAR more errors and points of failure in a paper-based world then there is or has been in a paperless world. Sure you will always have mistakes because right now all some of the hospitals are allowing is for the paperless environment to just replace the paper in the same broken workflow process…wrought with the ability to create a lot of mistakes. In some of the early adopters and fully automated hospitals that have been using IT for years, you can clearly see the efficiencies, adaptations of their workflows, and greater reductions in errors (patient safety, financial, bed throughput, medication distribution, wellness, etc.). All-in-all, to sit back and make unsubstantiated claims that IT is “bad” for healthcare and it somehow is a death sentence is absolutely pointless and incorrect.

  24. Pezman writes:

    “Even a layperson knows that there were FAR more errors and points of failure in a paper-based world then there is or has been in a paperless world.”

    No, those who study these issues objectively don’t know that, at all; we cannot know it since information on HIT-caused clinical mishaps is shielded by the industry.

    Even the Joint Commission in their Sentinel Events Alert on HIT stated “There is a dearth of data on the incidence of adverse events directly caused by HIT overall” ( http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm ) They are not saying that idly, or because such events don’t happen.

    This type of statement about layperson wisdom reflects a lack of scientific understanding and/or of logical reasoning. The fallacy is called Argumentem Ad Populum (http://en.wikipedia.org/wiki/Argumentum_ad_populum). An argumentum ad populum (Latin: “appeal to the people”), in logic, is a fallacious argument that concludes a proposition to be true because many or all people believe it; it alleges, “If many believe so, it is so.”

    This lack of scientific understanding and logical reasoning, alien to medical science and culture, is a form of professional dyscompetence. It is why many IT personnel are dangerous in clinical environments unless overseen by domain experts.

    By way of anecdotal experience, (with the caveat that anecdotal experience does not make data), in my own clinical experience and that of many of my colleagues, we in fact cannot recall a medical error being committed due to problems in the paper record, including unavailability or illegibility. I, in fact, did my pulmonary and neurology fellowships at a hospital that in that time period did not staff the records room and kept it locked on weekend evenings, Hahnemann in Philadelphia. No medical errors occurred as a result; we took out own histories and physicals and that was quite adequate to assure decent care. I don’t recommend that system, but it reflects a very possible irrational underconfidence in paper and equally irrational overconfidence in computing as HIT exists in 2009.

    On the other hand, many of the events described in the MAUDE reports are already at the level of affecting patient care adversely. MAUDE represents the one-gram tip of the iceberg.

  25. Programmer writes:

    “You don’t need to know the error rates due to IT or paper. You just need to know the overall pre-IT error rates and the post-IT error rates.”

    It’s that simple? In a complex environment, just pop in IT, perform a simple A/B test that fails to consider myriad other variables and issues, and you have proof the IT is effective.

    I am currently teaching a graduate course on “Evaluation in Healthcare Informatics” using the text “Evaluation Methods in Medical Informatics” by Friedman et al. I suggest you buy it and read it.

    “Of course, the fact that you need an IT person to tell you this is a pretty good indicator of why you need IT.”

    It’s statements like this that make me say “thank god for international IT outsourcing.”

  26. we cannot know it since information on HIT-caused clinical mishaps is shielded by the industry.

    I already pointed out how this can be determined without HIT industry help. Do you really need the Stats for Dummies explanation?

  27. It’s that simple? In a complex environment, just pop in IT, perform a simple A/B test that fails to consider myriad other variables and issues, and you have proof the IT is effective.

    Yes, it’s that simple. If you select for pre-IT and post-IT data and use a large enough sample size the other factors with equal out. If the sample size is large enough you should have a relatively small margin of error.

  28. Should have added this to the above comment as an example of the troubling populist belief that “doctor + computer = Marcus Welby.”

    “High Rates of Adverse Drug Events in a Highly Computerized Hospital” ( http://archinte.ama-assn.org/cgi/reprint/165/10/1111.pdf ) that show that irrational exuberance and sticking one’s head in the sand is inappropriate for medicine. Evaluation studies in HIT are anything but simple A/B comparisons.

    The best data in any study, of course, is primary data, not surrogate. The primary data on HIT-caused clinical close calls and mishaps is sorely lacking. This is why I have written that HIT needs regulation akin to that of pharma IT.

  29. We know about 3% to 5% of medication errors. The discussion of pre-IT and post-IT errors is cute but largely meaningless.

    Most of the time, if we knew we were committing an error, we’d not do it. Almost be definition, you are asking us to measure that which we don’t see. (And, Yes, I know the literature on ascertaining medication errors.) Also, even finding the error if we suspect one is very hard: people in hospitals tend to be sick and old. Bad things happy to sick and old people in hospitals. We are not responsible for all of those bad things.

    Charles Babbage

  30. From the report posted above.

    “It appears from
    the shift in distributions of error-associated ADEs that
    the VA computerized interventions worked to reduce error-
    related ADEs almost exactly as designed.”

    “Because the VA’s computerized patient
    record system likely makes ADEs more visible than
    would a paper-based system, this study does not support
    the interpretation that the VA computerized patient
    record system induces ADEs.”

    They go on to recommend decision support, which really is the point. It’s possible with a well implemented HIT system, no so much on paper. Its also worth noting some of the reasons VA hospitals don’t have decision support, its mainly political.

    It is a complex issue, it depends on the individual implementation, but I have still to see a valid study that shows HIT increases error rates.

    By the way, the individual implementation issue is also a problem for the vendors. A patient safety issue in one hospital with a certain vendor, may not be in another hospital with the same vendor.

  31. blah wrote:

    “They go on to recommend decision support, which really is the point.”

    Yes, that was also the point of the National Research Council who wrote that current approaches to HIT are inadequate, one major issue being lack of cognitive support. Why are we about to spend $20 – $50 billion dollars on this technology?

    “It is a complex issue, it depends on the individual implementation, but I have still to see a valid study that shows HIT increases error rates.”

    These are my opinions on the matter:

    1) The MAUDE database cases, the literal tip of the iceberg, as well as much longer malfunction lists existing in hospitals today, strongly suggest such studies are needed. They must be performed if we are to move to national HIT.

    2) The literature on HIT benefits is equivocal. To go on faith that HIT is worth a $20 to $50 billion investment is symptomatic of why our economy failed. Too many heads in the sand, too much wishful thinking.

    3) HIT postmarketing surveillance is made much more difficult if information about HIT malfunctions and adverse events is kept secret. We already know they occur. What is the extent? This is one reason why the drug industry is highly regulated by FDA and is required to perform rigorous postmarketing (i.e. Phase 4) studies of drugs in use.

    4) Studies to show exactly what HIT does with regard to clinical adverse events need to consider many variables. For instance, process change, personnel changes, education, awareness etc. can all contribute to lowering of medical error rates even in the face of an IT device that is error-neutral, or errorogenic (i.e., creates new errors of its own). Simple studies of pre/post error rates are inadequate.

    5) An industry that produces medical devices but resists transparency, even if to improve its own products, is an industry that is irresponsible.

  32. I have a hard time believing that if in truth that ADEs are increased because of implementing an HIT given the “facts” you presented. I presented an equally compelling counterargument before you even responded within my original post. If you look at some of the most automated healthcare establishments like the Cleveland Clinic or Mayo Clinic, you can clearly see that their workflow processes have greatly changed since they went from paper to paperless. Of course when initially starting out they worked around their paper workflows that they were used to and were only met with strife and benefit realization. Only through decision support, efficiency studies, and using the system they purchased were they able to realize what it is like to truly be in a paperless environment. Typically what you and most of the clinical community sees is a national healthcare landscape that is no more than 8% fully automated. There are tons of paper workflow processes still in effect mixed in with paperless “bolt on” applications.

    I also like your definition of argumentum ad populum. I know and understand this…but do you not find that statement entirely ironic since it was posted on a blog for HIT.

    Also, there is transparency in the US HIT vendors out there…just as much as there is across the pond. So, I fail to see your point that the grass is greener “internationally.”

  33. PezMan>>> My issue with this entire discussion is that even a layperson knows that there were FAR more errors and points of failure in a paper-based world then there is or has been in a paperless world.

    Oh really? Have you ever read the U.s. Pharmacopeia’s 5th annual study of medication errors, published in 2005? It found that illegible or unclear handwriting accounted for only 2.9% (6,134) of reported mediation errors, and ranked as the 15th leading cause of these errors. It also found that computer entry errors, accounted for 13% (27,711) of the medication errors reported in 2003, and ranked as the 4th leading cause of errors, so overall data input errors far exceed handwriting errors. They found that there were 22 ways which EHR software systems can increase medication errors.

    URL: http://www.ama-assn.org/amednews/2005/01/24/prsa0124.htm

    We need more studies for such enlightening data… to counter the politically correct stance that the EHR increases quality, decreases errors, and decreases cost. I find that what few studies we do have show the opposite is true on all 3 counts.

    Al

  34. “I have a hard time believing that if in truth that ADEs are increased because of implementing an HIT given the “facts” you presented.”

    In fact it does not matter what you or I or others “believe” about HIT and adverse events; more data in the form of studies are needed considering the risks evidenced, for example, in MAUDE.

    Merck’s leaders, for example, believed VIOXX quite safe until more postmarketing surveillance data came in.

    My approach is one of medical caution: it can be summarized by this: “I see many red flags, and conflicting evidence as well on the benefits of HIT and these need to be investigated rigorously before we spend $20 – $50 billion on it nationally.”

    This is in line with my medical training, where we were taught a simple rule that has served me well: “critical thinking always, or your patient’s dead.” (Victor P. Satinsky, MD, Hahnemann Medical College, 1972).

    If people take issue with that, that’s their right, but it seems some who take issue with it have inherent conflicts of interest. I do not work for or have any investments in any HIT, IT, or technology company or affiliate.

    My fear is the cyber equivalent of the “Libby Zion” incident (google it) that will result in forceful governmental intervention. I’d rather see regulation of HIT occur (which it most certainly will, as is occurring in the EU) under less catastrophic circumstances. Also, if litigation occurs over a known HIT defect that causes injury, the plaintiff lawyers will be asking the vendors why the defect was not publicly revealed. It is in the industry’s own best interests to be forthcoming. Pharma learned that to the tune of tens of billions of dollars.

    “I also like your definition of argumentum ad populum. I know and understand this…but do you not find that statement entirely ironic since it was posted on a blog for HIT.”

    Not sure I understand what you mean, but it’s not my definition. A whole page of logical fallacies is at this link: http://en.wikipedia.org/wiki/Category:Logical_fallacies . Learned most of them in high school debating. Required reading for my students.

    “Also, there is transparency in the US HIT vendors out there…just as much as there is across the pond. So, I fail to see your point that the grass is greener “internationally.”

    Not sure what you’re referring to here, either. However, if there were transparency, we’d see far more entries in MAUDE – as a simple example of what transparency means.

    With that, I end my participation in this thread.

  35. Just exasperating.

    Scott S. – what do you want to do? Stick with paper – fine, just do it.

    HITGal and Suzie – get over yourselves, you’re just slowing down my web browser at this point without adding value.

    This is the fundamental problem in healthcare –

    If you can’t prove it, don’t do it.

    Somehow rhymes with –

    First do no harm.

    Which ultimately reinforces status quo.

    Obviously, health care people aren’t idiots.

    You could spend another 10 years trying to figure out if it makes sense to add more automation to healthcare. If that’s what you and your organization think is best, then do it. Be a role model. Show us all. Lead by example. Don’t rush in.

    Obviously with your level of knowledge on this you have significant impact in your organization. Show us how you excel with paper and have conquered the problems of the past with 12.3 % more nurses, or yet another paper on evils of an EMR. Teach us.

    Enough.

  36. Mr HISTalk, can you maybe start a PaperRecordsTalk site where some of these folks can spend their time so we can focus here on the main issues for the future?

  37. Al hits the nail on the head. Some people are still living in 2003.

    What is it with people who post studies to back up their case, but fail to read them? Sadly Pharmacopeia’s report is pay only, I assume Al just read the article and not the full report, if he has he would know it does not back up his case. It shows reductions in errors when using prescribing, it shows the drop off of handwriting errors are due to people using prescribing and HIT more. And that was 2003. I am sure since 2003 HIT has reduced handwriting medication errors even further.

    [From Mr. HIStalk] Be careful about intermingling “reducing medication errors” with “reducing patient harm”. The Lucian Leape systems theory study found what most clinicians known intuitively — transcription and interpretation errors are nearly always caught downstream of the doctor by a pharmacist or nurse and therefore rarely reach the patient, so while bad handwriting does cause patient harm, it’s not a major cause overall. Most of the really harmful errors involve incorrect dispensing or administration, not doctor ordering, which is why bedside barcoding of medications and smart IV pumps almost certainly save more patients than CPOE systems. Nurses and pharmacists don’t have the safety net that doctors do for someone else to catch their mistake. Reducing errors that were already being caught is a good, but not necessarily great thing. Better still would be to attack those that weren’t being caught, the best hope for which is still technology, just not the usual CPOE systems that hospitals are often buying and sometimes using.

  38. That’s a good point Mr HISTalk. I was just reporting back on the finding of a report posted to show CPOE is a bad thing, and to make sure there was no confusion over its conclusions.

    However there are still 1.5 Million injuries caused by prescribing errors, 7000 deaths, every year that are not caught down the line. Resulting in 3.5 Billion in costs per year, and $887 million to Medicare alone.

    Many are caused by “sounds like” errors, many by interaction problems, many by allergic reactions. These are human errors, that can be easily reduced using IT. Can anybody come up with a paper based system to reduce these errors, or should we just live with them?

    Of course a Physician who is sloppy in the paper world is likely to be sloppy in an electronic world as well. So HIT is no magic bullet. But when we have accurate data, we can protect the Physician and the patient from mistakes. There are no valid and credible studies that show otherwise.

    http://docs.google.com/gview?a=v&q=cache:d1RqItJzBuAJ:www.iom.edu/File.aspx%3FID%3D35943+National+Academies+of+Science's+Institute+of+Medicine+(IOM),+preventable+medication+mistakes+also+injure+more+than+1.5+million+Americans+annually&hl=en&gl=us&pid=bl&srcid=ADGEESigSrFxzh2QkKmcdNvVbVMVBENnxmFaCPA6f5htqpKZ1JMCSeEVZoCOI_4kra5_xgbs8xJYUUtGoOfBMY96-MU3yIdlRHo9dP-J-kAMFymcVNe3BXVjJxsf1ui7l6ePKmfvfEMa&sig=AFQjCNHC7wPOpHeTNsNEtppbjQ4lmuytPw

  39. >>> However there are still 1.5 Million injuries caused by prescribing errors, 7000 deaths, every year that are not caught down the line. Resulting in 3.5 Billion in costs per year, and $887 million to Medicare alone.

    Can you post a URL so that I can look at the study where those numbers came from, or is this some Obamanian set of “facts” that are supposed to prop up an agenda?

    Heck, if we’re going to use funny numbers, then lets take the real data, ie the Pharmacopedia data that shows that the EMR gives us 3.5 (to make this exercise easier, we’ll round down to 3) times more errors, then multiply it to your numbers, then voila, you end up with the following for EMR use:

    — 45 Million injuries caused by prescribing errors,
    — 21000 deaths
    — Resulting in ~ 10.5 Billion in costs per year, and
    — almost $3 billion to Medicare alone.

    I feel that these numbers are more realistic… although without a study, they don’t mean much, and likewise are pure garbage.

    Al

  40. Mr Histalk and Inga,

    Thank you for this resource.

    I write to state that the data is not there to support using current HIT iterations on patients with complex illness and whose lives depend on pinpoint accuracy. MAUDE data cause distrust for these systems. You never know when the unexpected will rear its ugly head. Once you know where to look for patient care errors in this technology, they are abundant and do reach the patient.

    Certainly, there will not be billions in savings as concocted by the US Government who based opinion on HIT industry sponsored “study”.

    If the vendors wish to experiment to improve their devices to make them user friendly, safe and effective, then declare all current deployments and “go lives” (or deads) as experiments. Then get IRB approval and determine and record the dangers and injuries to patients, explore each unexpected death; and report the data to the FDA.

    It has been suggested by other commenters on this dynamic blog for users to report problems of these computerized ordering machines to the FDA.

    While you are at it, write to your Congressmen (and women) to educate them that CCHIT Certification is not a stamp of safety and efficacy.







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