Friday, 1 March 2013

Dr. Richard Cook on the Health IT Sector's Ills

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This explanation of the health IT sector's ills comes from Dr. Richard Cook, a physician, educator, researcher, and patient safety expert formerly at the University of Chicago and now Professor of Healthcare System Safety at the Royal Institute of Technology, Stockholm, Sweden.

Dr. Cook was also a member of the U.S. Institute of Medicine panel that studied health IT safety, leading to the 2012 IOM report ("Health IT and Patient Safety: Building Safer Systems for Better Care").

He was also co-author of an article I consider a must-read for anyone in the health IT sector, Hiding in plain sight: What Koppel et al. Tell Us About Healthcare IT, Journal of Biomedical Informatics. 38 (4): 262-3.

Reproduced with his permission:

My views are already on record. [This links to his IOM report dissent where he made the case that health IT is a Class 3 medical device and should be regulated - ed.]

Politically important activities (cynically, things that cost >10B$) are never neutral. HIT techno-fantasies are common and easily commandeered. Claims about the present and future efficacy of HIT have been altered in bewildering patterns to fit the circumstances of the moment.  This is not uncommon for expensive technologies with a few dominant producers and strong government ties (cf. Mackenzie's Inventing Accuracy, MIT Press, 1993). 

The recent history of HIT is dominated by the social construction of several myths.  Although there are technical threads in the history, they are exceptionally frail. There have been myths of safety, of productivity, of economic efficiency, of clarity, of precision, of reliability.  

The truth is that the Obama administration depended, in part, on savings to be obtained from HIT for claims it made prior to the election of 2008 about the savings to be derived from the plan to "reform" healthcare. These interests aligned with those of the industry and a faction from academic medicine and the result was the usual sausage.

A central problem with techno-fantasies is that they are impossible to disprove. They are claims about the future. HIT's cornucopia has been promised repeatedly since the 1960's. Nothing like the promises has materialized.  Indeed, the IOM committee that was commissioned to evaluate the best evidence on this subject found no persuasive evidence that HIT improved patient safety. I know because I was there.

But this is not the point and never has been. Privileged entities marshall arguments in favor of their purposes. The devil can cite scripture to his purpose. The result is what matters to them and the goal here was to get the government to fund private HIT installation in private healthcare facilities by offering first a carrot and then a stick. They steamrollered the opposition -- which was much more nuanced and thoughtful than the attacks on you [Scot Silverstein] make it appear -- and made it happen.

To be clear, there was no conspiracy here. This is not deal done in back rooms by a few executives and cigar smoking pols. Instead it is the entirely predictable result of a confluence of interest among powerful stakeholders to advance their agendas. There is nothing shocking about an inferior, ill-conceived product getting government support, viz. Solyndra. Ultimately, the technical issues serve to the socio-political ones.

It's no better over here.  [That is, in Sweden - ed.] We face the same problems in Sweden that you do in the U.S. We have the advantage of paying about 1/3 of what you do for healthcare and getting, objectively, better medical care and a better life than you do in the U.S.  But we have the same fractionated approach that you do and the same age bulge looming in the next 2 decades and there are plenty of problems with safety and humaneness, just like in your country. 

I present this without any changes that might have occurred when unpleasant truths or opinions undergo peer review in a specialized, non-transparent and highly profitable sector.

-- SS



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