Wednesday, November 02, 2011

The Evidence For Health IT - Some Still Doubt and We Really Lack Proper Trials. Time To Do Them I Believe!

The following very interesting article appeared last week.

Love of Health Tech Doesn't Have to be (Double) Blind

Gienna Shaw, for HealthLeaders Media , October 25, 2011

One of my favorite quotes from last week's Center for Connected Health Symposium in Boston came from Peter Tipett, MD: "Information technology can reduce cost, increase quality, and advance science," said the vice president of industry solutions and security practices at Verizon's business unit. "But other than that it's not worth it."
In so many ways, so many kinds of Health IT make perfect logical sense. Making patient medical records easily accessible in electronic format? A no-brainer. Giving patients access to their own records which, after all, belong to them? Makes sense.  Tools that help clinicians make quick and accurate evidence-based diagnoses at the point of care? Well, of course that's a good idea.
But try proving it.
There is some research suggesting that electronic health records can have a positive impact on quality. But for medicine, so enamored with empirical evidence, double-blind studies, and peer review, it isn't always enough. Telemedicine, remote health, and m-health are particularly vulnerable to that phrase that concludes so many academic papers: "more research must be done."
Another of my favorite nuggets from the symposium was when Joseph Kvedar, MD, founder and director of the Center for Connected Health, said researchers add that line to the end of their papers because it's in their best interest—they are, after all, in the business of conducting said research.
Tippet noted that it's not just a healthcare thing—there's very little science about the efficacy of technology in any field. Did Watt need empirical evidence before patenting the steam engine? Did Sony do double blind studies to see if consumers would rather listen to music on a Walkman instead of lugging a boombox around on their shoulders? Did the healthcare industry need peer reviewed studies of imaging technology such as CT-scanners when they were new?
Oh, wait. Scratch that last example.
OK, so there are some healthcare technologies that demand rigorous study. But do text messages reminding patients to take their medication at the correct time each day fall into the same category? What about wireless scales that send a patients' weight to their doctor's office? An app that helps overweight patients make healthy food choices or gives tips to folks trying to quit smoking?
Again, back to the symposium. In a debate-style session, Kvedar and Sahid Shah, CEO of the health IT consultancy Netspective who blogs under the handle The Healthcare IT Guy, debated whether current approaches to patient self-management improve quality or lower healthcare costs.
More here:
This is a real ripper of a debate and we need to have it globally. There are applications that we know work, those we imagine will work and those where the jury is well and truly out!
We know in good quality trials that if you present helpful information to a clinician at the point of decision making care you can see a positive improvement in what people do as they treat patients. On the broader question of just how these trials translate into the clinic and how much they improve patient outcome - to say nothing of the overall cost of care - I think - except for a few isolated examples - we are still struggling.
Bringing it closer to home the PCEHR is simply an ideological fantasy. There is no evidence anyone has shown me that it will make a whit if difference to the quality and safety of scare.
Just what is Government scared of? Actually conduct a proper trial with a real PCEHR system and show it actually makes a difference to patient outcomes - or admit to the public you are a money wasting rabble who just ignores the concept of seeking evidence when you have a pre-conceived idea something will work!
You say the science of climate change is in - and I agree - so we should act - but on the PCEHR it is just not true. You can’t have it both ways! Without any evidence the PCEHR is an astonishing fraud on the Australian public.

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