Wednesday, January 16, 2013

One Of Our Occasional International Blog Commenters Gets Good Coverage In A Key US Forum.

This appeared over our break.

Scot Silverstein's Good Health IT and Bad Health IT

Scott Mace, for HealthLeaders Media , January 8, 2013

Inevitably, when the subject turns to the pitfalls of bad health IT, you will find Scot Silverstein, MD, ready to comment. He has been writing about health IT difficulties since 1998.
Silverstein is an adjunct professor at Drexel University who I recently interviewed for an upcoming HealthLeaders magazine story on physician resistance to health IT.
A recent Silverstein blog post caught my eye for the following statement: "It is impossible for people, especially medical professionals, to be 'ready' for a system that 'is not ready for them.'"
I wanted to learn about the good doctor's thinking and so I gave him a call. We spoke for two hours and it felt like scratching the surface of issues that healthcare will be facing for a good while to come.
If health IT has a canary in the coal mine, it is Silverstein. His Drexel website and contributions to the Health Care Renewal blog are the places to go to examine the voluminous literature about health IT's many shortcomings, errors, and challenges.
Silverstein completed a postdoctoral fellowship in medical informatics at Yale School of Medicine 20 years ago, but his experience with IT goes back to the 1970s, when building a computer involved using a soldering iron. His technology interests are diverse; he is also a ham radio enthusiast licensed at the highest level ("extra" class) by the FCC. In the 1990s, after years of practicing medicine and the post-doc, he joined Yale's faculty and began building electronic health record systems, including for King Faisal Specialist Hospital in Saudi Arabia, "even though my name's Silverstein," he notes.
After helping implement clinical IT at Yale New Haven Hospital, Silverstein took a CMIO-type role at Christiana Care Health System in Wilmington, Del., at a time when the term "CMIO" hadn't yet been coined.
At Christiana Care, Silverstein architected clinical information systems for critical care areas such as invasive cardiology from the ground up, from data modeling all the way up to supervising the programming team. He also was the clinical leader of commercial health IT acquisition and implementation for other medical specialties.
During the dot-com boom, he worked for an IT vendor, and then got recruited by Big Pharma, to run Merck Research Labs' internal science research library and IT group supporting drug discovery.
Today, at Drexel, Silverstein teaches and also consults with both plaintiff and defendant attorneys on health IT-related issues. "I cannot work in the health IT industry anymore," he says. "If I could even get a job, I'd likely be fired in five minutes from pointing out the problems." In short, those problems are manifestations of what he calls "bad health IT," as opposed to "good health IT."
Unfortunately, critics such as Silverstein are branded as anti-technology Luddites, or worse. "That framing of the issue is misleading," Silverstein says. "It is propaganda generated by the industry. Here's the proper framing of the issue. In fact, physicians are largely pragmatists. They will adopt technology when it's clear to them that it's both safe and effective and might actually make their patient care better. They'll adopt that readily, so much so that often times, one has to be careful of it being over-adopted, say cardiac stents, for example."
More here:
We all need to be utterly clear here. Scot is no madman or Luddite and he is making some points similar - in some ways - to those I am making.
Both he and I agree that ‘Big Health IT’ (Govt. or Private) are not delivering what clinicians want and need. The NEHRS / PCEHR is a banner example of this fact.
We also agree clinicians are not getting anywhere near enough input and influence into what is being designed and inflicted on us in the name of efficiency and not patient care and outcomes.
I suggest you keep a close eye on his blog and his occasional comments here!
David.

1 comment:

InformaticsMD said...

Thanks for posting this David. Also suggest Australian readers review my presentation to HISA at HIC2012. A description's at http://hcrenewal.blogspot.com/2012/08/my-presentation-to-health-informatics.html and PPT available at http://www.ischool.drexel.edu/faculty/ssilverstein/HISA2012_Final.ppt .

Note that I'd used the terminology health IT "done well" (in terms of the often unrecognized underlying sociotechnical complexity), or "not done well, which creates risk, in my past writings and in my presentations. After HIC Jon Patrick suggested I use the simpler terms "good health IT" and "bad health IT" to make the concepts immediately understandable to a wider audience.

As to Luddites, my HIC presentation and the current media piece addresses that canard about physicians, nurses and other clinicians. It's a technology hyperenthusiast v. pragmatist tension, not a modernist v. Luddite one.

As to "madmen", one needs to ask the question about who might be mad - 1) those who believe medical rigor applies to health IT, or 2) those who believe that bad health IT in mission critical settings (such as ED's, ICU's, OR's etc.) or even the day clinic should deterministically accomplish miracles.

I leave it to the reader to discern.

-- SS