Executive Watercooler Bonus Question: Contrarian Beliefs

The HIStalk Executive Watercooler is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. You are welcome to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful for the help of members 

This question this time: What’s a commonly accepted belief in health IT that you think will turn out to be wrong?

The idea that having an EHR will improve care, enhance safety, and facilitate a “learning health system” has been widely promulgated. Although some improvements have occurred (primarily in legibility of notes and ability to access historical notes and notes from offsite), other results of this magical belief in EHRs include increased documentation requirements, bloated notes, deterioration of clinical decision making, and electronic data that is often inaccurate.

Burnout and clinical inefficiency is common because of the EHR and the bureaucratic requirements that it has facilitated. Staff don’t read much of what is documented. And “learning” from inaccurate data does not create valid conclusions. Requirements for different quality metrics are often conflicting. For example, our institution now has three different delirium screening tools in use because different certification programs require use of different tools.

In sum, we can’t go back, but the benefits of EHRs have been oversold. 

The  hope that AI chatbots will improve patient satisfaction and save the health system money. The “support” chatbots at airlines, e-commerce sites, etc. are uniformly dreadful and annoying. On many sites it’s almost impossible to get through to a live human to resolve a problem now.

• Phishing drills are an effective way to educate the workforce to be diligent and cautious in opening/responding to emails.
• Planned system outages are positive in the sense they force users to remember how to practice without support of technology.
• Longer/more complex passwords result in greater system security.
• Cloud-based solutions will be big wins for health care enterprises.

That IT serves the business. While that’s partially true, IT really should be actively involved in transforming the business with the use of technology. We all know that IT should have a seat at the table for overall strategy and capital projects, but IT needs to be integrated/embedded across the organization and should be active/proactive, not passive/responsive for ongoing business operations.

In my years in the business (just celebrated 20 years as a CMIO) I have come across many IT leaders that see their role is to meet the customer needs. They see IT as a support department meeting operations and business needs. Its about how we achieve that is where I disagree. One way to do it is deliver whatever the customer is asking for. If they ask for a bicycle, get them one. If they ask for a motorcycle, get them one without thinking through what the true problem that they are trying to solve and whether a car might be the better solution.

Early on in my career before we created out Informatics team, the same problem might have been solved in a few different ways depending on who the customer spoke to. If they ask a documentation analyst, they got a new form. If they asked the order set analyst, they got a new order set. The rules analyst, they got a rule or a report, etc. We still do this today in rev cycle and other operational areas that haven’t invested in an informatics-like infrastructure.

I’m generally skeptical of any AI claims. I do think we are reaching a tipping point with AI where applications of it will really jump start improvements, but there are so many AI experts on LinkedIn that they can’t all be right.