Dr Lindberg’s 1969 statement that “computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice” is actually a restricted and narrow statement. In reality *most* non medical professionals of all kinds do not understand medicine (how could they?) and therefore his statement is obvious and self-evident.

Challenging the obvious is a pointless endeavor. Why even bother?

While I agree with your concerns about still trying to make systems fit the needs of clinicians, I disagree the issue is about technology or advancement thereof. Dr. Lindberg’s historical observation seems valid then and now.

Regarding “good computers”, the lessons learned from these “primitive” machines are unchanged today, the insights gained then about human computer issues as relevant now as then.

I speak from experience. I started programming on an on-site DEC PDP-8/S in 1970 in high school, along with an IBM1130 at an agricultural research station I worked at in the summer of ’72 trying to fortify milk with nutritional proteins, a CDC Cyber 6600 at Temple Univ. (through begging!) via timesharing, and an IBM 360/95 via timesharing in that same time frame, then an IBM370/165 in college. The availability of calculators is not really relevant to computing issues although I used a Olivetti Programma 101 calculator dating to 1965 in the summer research internship in ’72 to do calculations when the 1130 was occupied.

I should also point out that the evidence base is increasing that our current approaches to health IT are insufficient, again having nothing to do with the technology. Here is just the most recent:

==snip==

http://www.healthcareitnews.com/news/electronic-health-records-not-panacea-researchers-say

Electronic health records not a panacea, researchers say
December 14, 2009 | Diana Manos, Senior Editor

LONDON – Large-scale electronic health record projects promise much, but sometimes deliver little, according to a new study.

In a study published Monday in the U.S. journal Milbank Quarterly, researchers at the University College of London (UCL) said they identified fundamental and often overlooked tensions in the design and implementation of EHRs. The study was based on findings from hundreds of previous studies from all over the world.

Researchers said their findings have implications for President Barack Obama’s election promise to establish electronic health records for every American by 2014, and for other large-scale EHR initiatives around the world.

Professor Trish Greenhalgh, lead author of UCL’s Department of Open Learning, said EHRs are often depicted as the cornerstone of a modern healthcare, capable of making care better, safer and cheaper. Yet, clinicians and managers the world over struggle to implement EHRs.

” Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of electronic health record projects fail – and the larger the project, the more likely it is to fail,” Greenhalgh said.

“Our results provide no simple solutions to the problem of failed electronic patient records projects, nor do they support an anti-technology policy of returning to paper. Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world,” according to Greenhalgh.

==snip==

I suggest anyone with an interest in better healthcare recognize there is a problem with our approaches to HIT that have little to do with technology, and much to do with the issues of Medical Informatics vs. MIS, and then become part of the solution.

1969? Wow, you guys are really scraping the bottom of the barrel here. Quoting somebody, quoting a paper from the time when we didn’t have good calculators, let alone computers. Its embarrassing at this stage that we have opinion makers doing this. And its why we are still trying to make the systems fit the needs of clinicians.

Dr. Lindberg wrote:

“Computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems…in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information” (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21)

If those words and the writings they’ve spawned by myself and others have helped JB produce better HIT than others (I do not know if this is the case but by the way he writes about the issues, I find it a distinct possibility), then bravo to him, and shame on those who have ignored these issues.

One additional point: Unless you are in a very senior management spot in HIT, your career is subject to the seemingly capricious and often ill informed decisions of your leaders about how HIT should be designed, developed and implemented. On other words, at risk.

Been there myself – saw a major pharma’s discovery scientists denied access to the informatics tools they needed to discover new drugs and assure the safety of current ones, by a senior IT executive lacking expertise in biomedicine.

The company has in the past few years laid off tens of thousands, and has an empty wagon of new products.

Sooner or later, mismanagement catches up to the little guys.

– SS

Still, athenahealth demands a nice pound of flesh for their services compared to other traditional alternatives (e.g., outsourced RCM providers) and I would think long and hard if I were a small doc before I would let any EMR company host my data. The bread and butter of any small practice is their clinical data. It is something that I would try to maintain control of as much as possible.