Jon has just alerted to e-Health Community to a Magnum Opus on Emergency Department (ED) computing based on a range on NSW Experiences and a lot of research.
I will let him introduce the work:
“For those of you interested in the problems in EDs and don't want to read my 190 page report at
http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146
which covers:
This is a study into the roll-out of Cerner FirstNet into EDs in NSW.
- The original study was issued in Dec 2009 (Part 3.1).
- This has been added to with a new study in 2010 consisting of discussions with 7 ED Directors (Part 3.2),
- Discussions with software experts who do performance evaluations on Cerner sites (Part 3.3),
- Reviews of Entity-Relationship Diagrams (Part 3.4),
- Schema descriptions and data tables from customer installations (Part 3.5 & 3.6).
- All this information is coalesced to establish a much more detailed picture of a Cerner installation (Part 3.7).
- A number of weaknesses are identified in the design and implementation and risk assessments are recommended for organisations using this software or intending to use it. Regulations that might minimise the risks to users of health software are recommended (Part 3.8).
- An alternative architecture and method for constructing clinical information systems is presented (Part 3.9). “
Already there has been some commentary and as Jon mentions there is a blog, by Scot Silverstein that has drawn out some of the more important points. This is found here:
http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html
I am sure there will be many who are interested to have a look at both the blog and the work. Comments are welcome and I am sure he will respond to the useful and interesting ones.
The ED Director's comments are just damning of NSW Health and their approach to their clinicians (Part 3.2). Read and weep!
David.
10 comments:
one "t" in Scot!
Cheers,
Scot Silverstein, MD
Fuss pot!
David.
Sorry Dr Moore
Behave yourselves - It was a direct cut from Jon's email!
David.
My mother objected to "Scott" when I was born. Not my fault! :-)
Can we now move on to discussing Jon's work please?
David.
I believe Prof Patrick has made a health IT 'cultural breakthrough' in getting past the IT marketing messages, to a point when officials realize this technology needs to be treated as experimental and requiring rigorous evaluation.
He led the way in making a compelling case as to why, and in showing how this can be done.
I think documents such as from the UK NHS (that I linked to in my posts) on HIT quality and safety lay out processes and procedures that could benefit from the specifics of the analytical inspections he performed.
I believe every EHR system inclusive of CPOE, CDSS, etc. needs to undergo the type of 'forensic inspection' as he has done before being deployed, especially to a wide number of organizations.
It needs quality validation, from low levels starting at the conceptual and logical models, right up to the user experience in real world settings.
A technology the purveyors claim will "transform" healthcare (as this company does) or "revolutionize" it (as others have said), needs to be of revolutionary high quality.
Scot
Scott, who do you propose pays for the forensic inspection? If hospitals don't see the value in funding an "inspection", are you proposing no one implements clinical information systems? If you ask vendors to do this, they probably won't object, but they'll also need to pass the costs back to the hospitals. Wouldn't more value be delivered to healthcare from these dollars being spent on innovation?
Anonymous wrote:
"Scott, who do you propose pays for the forensic inspection?"
Those who coerced purchasers to buy HIT should pay. It should have been a due diligence anyway.
I can say who should NOT pay: the patients, in blood, as did my mother (see banner atop http://www.ischool.drexel.edu/faculty/ssilverstein/cases/).
"Wouldn't more value be delivered to healthcare from these dollars being spent on innovation?"
No.
cf. 'slot machines' in my HC Renewal posts.
Innovative electronic slot machines with whiz-bang lights and sounds, whose jackpots are morbidity and mortality, are no better than old fashioned mechanical ones with the same properties.
Primum non nocerum.
Then innovate.
-- SS
Did somebody say "innovation"?
"Innovation" = "Change Agent".
Despite the fact local solutions to health care exist, the pit bull's (read bureaucrats) on the gate have no interest in change other than to maintain their own status quo.
Politicians are often replaced, bureaucrats, less so.
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