Sunday, October 25, 2009

Apparent Australian Censorship of Adverse Academic Commentary on EHR Provider and NSW Health.

The following appeared a little while ago in the US.

Academic Freedom Curtailed: Censorship Down Under On EHR's for the Emergency Department?

In a stunning development:

The essay on Emergency Department electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney, that I referenced in my posts "The Story of the Deployment of an ED Clinical Information System Systemic Failure or Bad Luck" and "NSW Nightmare and Overuse of Computers" has been censored. This apparently occurred at the level of the Ministry of Health.

The essay was available as item 6 at http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 . Attempts to download now provide a message "This document is not currently available." I do not know if the vendor was involved.

(A copy of vers. 3 of Professor Patrick's report is still available here in PDF; it was a work in progress when it was pulled.)

Complete blog here:

http://hcrenewal.blogspot.com/2009/10/academic-freedom-curtailed-down-under.html

I can’t say I disagree with the poster (Thanks Scot for letting me know about the post)!

It would be nice to have honest academic criticism to be able to be freely discussed and reviewed. Indeed such a freedom is vital in any decent democracy – but this is happening in NSW! Enough said.

David.

Postscript:

As of 10am Sunday 25 Oct Professor Patrick has said he is happy with the way Sydney University is handling a complaint they have received. He also says 'time will tell' if that continues to be the case.

D.

Postscript 2:

File is no longer available from the US - as Prof Patrick has asked it be taken off-line for now.

D.

15 comments:

Anonymous said...

As someone that's worked on this project (NSW Firstnet), albeit for only a short period, I'm a little despondent that we seem to be failing to heed any of the lessons in this document and others.

Victoria is down a similar path with all-round rejection of the HealthSmart Cerner implementation, and Queensland are getting ready to embark on exactly the same approach.

Cerner, just like so many other systems in acute care were designed to be deployed in a single or small number of hospitals, tailored to those subset of needs. Deployment of an identical build on a state-wide basis to 200 or so hospitals is just ludicrous.

The health IT bureacrats in each of the states who are either ignorant or deliberately blind to this reality, along with the major health system vendors who pretend their systems are fit-for-purpose have a huge amount to answer for.

Incidentally, a presentation by researchers at the University of Sydney at the recent HIC conference came to the very similar conclusions:

http://www.hisa.org.au/system/files/u2233/hic09-1_JulieLi.pdf


Time for the health bureaurcrats to learn and the IT vendors who only see $$$ to admit that one-size-does-not-fit-all

Jim Cocks said...

Spot on Anonymous! One size simply doesn't fit all, for reasons which are pretty obvious even to the non-technically minded.

It's not as if this is a new problem either. This debate has been going on in NSW Health since it first developed Health IT systems back in the 1980s, as some of us know from bitter experience. Similar tales can be told of Queensland Health.

MedInformaticsMD said...

Note: Prof Patrick asked me to pull the copy of his paper from my server pending resolution of the issues, so the link above will not work.

Dr. S. Silverstein
Drexel University
Philadelphia, PA USA

Anonymous said...

If true, then these circumstances are unfortunate, but also unsurprising. More subtle forms of what is effectively censorship occur regularly, with the 'powers that be' requesting that independent consultants "polish" their final reports and recommendations (ie: sanitise them, make them more politically palatable), "re-consider the issues in a broader framework" (ie: make sure what you are recommending covers my ar*e) or else submissions, reports and recommendations are re-interpreted, selectively (mis)quoted or quietly filed safely away, never to be seen again. What this means in practice that we are operating under a 'don't ask, don't tell' policy, which gives decision makers and governance mechanisms plausible deniability, which in turn protects anyone from ever being held accountable. Gone are the days where we can tell it like it is and let the devil take the hind-most, whether in academia or not.

Anonymous said...

I would like some more details. The paper was reportedly 'pulled' from a website run *by the university*. For that to happen, the university IT folks would have had to been asked by someone high up in the university to do so, and the 'high ups' in the university presumably were asked by 'the government'. That's quite a long chain of compliance with external authority, for a university that would value its academic independence. One can perhaps think that what really happened was that the company in question has threatened legal action because it was explicitly named in the document, and that this was the driver for the university legal folks to ask for it to be pulled, pending resolution of the university's legal exposure? Pardon my scepticism, but if there are going to be claims of censorship then, rather than leaving things vague, we actually need to know what really happened. Being threatened with legal action by a company for writing a paper that they consider libellous because it explicitly criticises its product is not censorship by the state, as unpalatable as it may be to us who value freedom of expression, and want to see health IT systems perform safely and the industry behave transparently.

Anonymous said...

Yes, I actually read this paper and I have to say I am not sure "academic freedom" extends quite as far as mounting what really was an acerbic attack on a vendor the author clearly doesn't like whilst including no real corroborative evidence to back up his assertions. Fine to do that using your own blog or whatever but surely not using the University site. Especially when you then announce that your Department is busy developing an alternative system – see the bottom of this link: http://histalk2.com/2009/10/20/news-102109/

Anonymous said...

Anonymous 9:48 AM "Yes, I actually read this paper and I have to say I am not sure "academic freedom" extends quite as far as mounting what really was an acerbic attack on a vendor"

Anonymous 6:31 PM "Being threatened with legal action by a company for writing a paper that they consider libellous because it explicitly criticises its product is not censorship by the state,"

You two anonymous posters clearly have no bloody idea about what academic freedom is, or are shills for those behind this attack on academic freedom.

Why not "man up" and read an essay from someone who actually knows what they are talking about, and who are not talking out of their distal intestinal orifice:

http://president.uchicago.edu/speeches/columbia_address.shtml

Anonymous said...

Whenever the debate becomes personal, as in the last post, its usually a sign that they have no response to the points being made, and so call the other side names instead.

If an academic makes claims about a company's products, that could affect its profitability, do not be surprised if the company uses what powers it has to bite back.

There are laws in place to both protect decent companies from being tarnished by unfair criticism, as there are laws in place to support fair commentary when companies are not doing the right thing. Newspapers runs stories all the time that are critical of commercial entities.

I make no judgement about where this paper lies in that spectrum, nor whether it was right or not for the paper to be taken down by the university, but that is all that was being said by the previous two posts that attracted such personal abuse.

They were not defending any company, but asking reasonable and fair questions about the case, before invoking the lynch mob, using the freedom of speech so generously provided by this discussion space.

Sorry to not agree with the last post,but I will do you the courtesy of not calling you a name.

Anonymous said...

Anonymous poster above,

You write "I make no judgment where this paper lies in that spectrum, nor whether it was right or not for the paper to be taken down by the university."

The point the poster who flamed the other 2 anonymous posts made was that those 2 anonymous posters do not appear to understand the idea of academic freedom.

A company or person claiming defamation is no grounds for a university to force it faculty to withdraw papers - (unless those papers are advocating truly heinous acts for example). Why even bother having universities if it could be silenced by anone or any company threatening defamation. The answer is for said company or person to refute the ideas presented by professors.

So, the person who flamed is correct in the point they made that "you two anonymous posters have no [redacted colorful epithet] idea on what academic freedom is."

The flamer also posted a link to a fantastic essay to prove his or her point.

You should never dismiss an argument because the writer seems angry. Angry does not always imply "wrong."

Anonymous said...

"A company or person claiming defamation is no grounds for a university to force it faculty to withdraw papers"

Well, it might be, sometimes. Newspapers make the same call every day, running stories by legal before publishing, and often taking on and defeating corrupt industry, corrupt government etc.

So it is a choice for the university, based upon the advice of their legal counsel, as the university will have an exposure to defamation, and resulting costs, and not (I'm assuming) its employee. It would be great if universities supported their staff rather than fold at the first sight of legal challenge, but it is their call. We do hope that they find in favour of their staff when the evidence is on their side.

"The answer is for said company or person to refute the ideas presented by professors."

Does that really seem fair? It gives academics an asymmetrical right to say anything they want, with the onus on the one being criticised to defend themselves. I would doubt that there is any such protection in law that would allow such a situation, with the exception of parliamentary privilege.

And what if that criticism, rather than being of a big company that possibly deserves it, is of a blameless small company that goes bust, and 'mum and dad' investors lose their shirt?

We are definitely moving away from discussing the case at hand, but to explore the principle of academic freedom, and that's fine. In that vein I make some general observations:

- Academics have a crucial role in society, to examine things from a perspective not possible from vested interests, but it is not a license to say whatever they want, with no acknowledgement of the costs of that behaviour to others.
- It should also not be a camouflage for peddling their own interests - which is why so many academic journal go out of their way to ask academics to declare if they will benefit from publication of their research.
- Academics that criticise others in public (and long may they do so) should not be surprised when the people they challenge naturally defend themselves, using whatever means they have.

As I said, these general points are not directed at the case at hand. We still have no been provided clear information on the reasons for the removal of the paper, whether it was because of government or corporate intervention, and whether it was an appropriate request or not. Which was all that was being asked, before the flaming started.

You may not like 'my idea of academic freedom' but I hope you grant me the right to hold it, without further being vilified.

Anonymous said...

Just a thought, but isn't this easily solveable? Why doesn't the author simply submit a polished version of the paper in question to an academic informatics journal, where it will be peer reviewed, and if found by other academics to be worth publishing, it will out there for all to see for ever more? That is the ultimate academic freedom, and I dont think it is being denied in this case, is it?

Anonymous said...

RE: "We still have no been provided clear information on the reasons for the removal of the paper, whether it was because of government or corporate intervention, and whether it was an appropriate request or not."

Question:

Being that the paper was suppressed, how can anyone determine whether the request to remove it was 'appropriate' (such as, it defamed the vendor with untrue material) or merely capricious?

This is one of the problems with censorship...

Anonymous said...

"peer review ... is the ultimate academic freedom"

Quite simply, no.

The ability to publish one's thoughts unfettered (absent agitation for criminal actions or fictitious material represented as fact), is the ultimate academic freedom.

Anonymous said...

Unfettered is fine, unsubstantiated surely is not.

Anonymous said...

RE: unsubstantiated surely is not

Agree, but just to clarify, opinions of EHR's collected from end users and then reported (such as Prof Patrick did) are not "unsubstantiated." Qualitative research uses the narrative of those studied all the time.

So it might be better to say "unfettered is fine, made-up is not."