Deborah’s comments are right on target–although I will say that MD Anderson has made significant strides using SOA to facilitate intra-organizational data availability. Single vendor solutions try to solve this problem by expecting customers to purchase all their products from a single vendor–works well with some, less so with others, and of course makes inter-organizational interoperability even more challenging and our oxymoron claim a little more legitimate!

However, I believe that too many provider organizations suffer from an inability to exchange information within their own boundaries — i.e., intra-organizational interoperability, architectures, and workflow. No wonder it’s difficult to try to exchange information externally when organizations cannot even exchange the information internally. (Maybe MD Anderson is different!)

Yes, today’s discussions about HIEs are about inter-organizational interoperability, architectures, and workflow. And this might be HIT’s oxymoron.

But too many individual organizations suffer from duplicate collection of data in their different care settings, can’t facilitate quick search of relevant data from a variety of their intra-organizational sources, and cannot rank data in terms of relevance to a particular clinical question — all design specs of inter-organizational architecture, as proposed by Vogel.

your points are wll taken. As I hope most know, I have long written that health IT can achieve the benefits claimed for it, with the caveat that only when done well.

I can also add that absence of evidence in not evidence of absence regarding unintended consequences (UC’s) of health IT, events none of us ever want to see. UC’s need to be eliminated.

A relatively smaller number of UC studies and articles compared to the positive findings studies and articles could have many possible causes. We need to know which of those causes is/are operative, ranging from, on one extreme, the possibility that unintended consequences never occur, to the opposite possibility that they occur in hair raising numbers but are not reported on, due to what really are social reasons, or somewhere in between. I do not believe we know the true rates of UC’s with any certainty in 2009.

I think the HIT industry can learn from the pharma industry. Per observations of my blog colleague:

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… A new study in the Archives of Internal Medicine focused on how articles report adverse effects found by clinical trials. [Pitrou I, Boutron I, Ahmad N et al. Reporting of safety results in published reports of randomized controlled trials. Arch Intern Med 2009; 169: 1756-1761] The results were not encouraging.

The investigators assessed 133 articles reporting the results of randomized controlled trials published in 2006 in six English language journals with high impact factors, that is, the most prestigious journals, including the New England Journal of Medicine, Lancet, JAMA, British Medical Journal, and Annals of Internal Medicine. They excluded trials with less common designs, such as randomized cross-over trials. The majority of trials (54.9%) had private, or private mixed with public funding.

The major results were:
15/133 (11.3%) did not report anything about adverse events
36/133 (27.1%) did not report information about the severity of adverse events
63/133 (47.4%) did not report how many patients had to withdraw from the trial due to adverse events
43/133 (32.3%) had major limitations in how they reported adverse events, e.g., reporting only the most common events (even though most trials do not enroll enough patients to detect important but uncommon events).

The authors concluded, “the reporting of harm remains inadequate.”

An accompanying editorial [Ioannidis JP. Adverse events in randomized controlled trials: neglected, distorted, and silenced. Arch Intern Med 2009; 169: 1737-1739] raised concerns about why the reporting of adverse events is so shoddy:

…”Perhaps conflicts of interest and marketing rather than science have shaped even the often accepted standard that randomized trials study primarily effectiveness, whereas information on harms from medical interventions can wait for case reports and nonrandomized studies. Nonrandomized data are very helpful, but they have limitations, and many harms will remain long undetected if we just wait for spontaneous reporting and other nonrandomized research to reveal them. In an environment where effectiveness benefits are small and shrinking, the randomized trials agenda may need to reprogram its whole mission, including its reporting, toward better understanding of harms.”

I think there are lessons to be learned from this regarding IT.

– SS

And you don’t need to move XDS based documents to a central repository for accessing them. Leave the documents / clinical data where it is and access it using an adaptor or wrapper componet that takes the legacy data(hl7 2.x) and wraps it with XDS to enable XDS and SOA. And any strength of SOA can be directly transferred to XDS as well, as SOA is a building block that’s used by XDS.

SOA is a generic architectural framework and XDS is a manifestation of SOA for healthcare that also encompasses the existing healthcare standards like HL7 and DICOM.

Cheers,
Saravana Rajan,
http://essarr.wordpress.com

I posted the list as a challenge to the people deriding HIT to bring the none anecdotal evidence. However I think it also shows something else; that there is plenty of activity in academic studies covering HIT. Another charge, frequently made in the comments, there are few studies. I was suppressed how many studies have been carried out.