You've probably heard this phrase used by surgeons in the evaluation of patients with a fatal disease which were simply with a complicated medical procedure and look like they will survive - but doctors do not want to exaggerate their enthusiasm. This is how I think the value of it in the resolution of problems of America's health care. It is not allowed to hear that I think it's at the door of the death of health care. In fact, I am convinced that electronic health records (EHRs), telemedicine, automated computerized entry of orders medical, and similar systems have a huge potential to improve patient care and reduce costs. But I maintain a healthy skepticism. I'm not quite sure how much of this potential has actually been achieved.
In that spirit, here is my collection of preconceived ideas about healthcare IT from outsider informed ready to dive in the pool in head first.
Talk about software. Having worked closely with doctors and nurses in the trenches and academic over the years, I have heard the complaint that software developers do not always include their needs because developers do not have "walked a mile in their shoes." They are simply too remote bedside to offer the kind of functionality needed for care effective patient. Similarly, I heard that the workflow integrated in many applications is not user friendly or intuitive enough, and that it people speak a language that clinicians have a difficult time understanding.
Systems not reliable. And then there are seeds of unexpected software to deal with. Earlier this year, medical electronic centralized Swedish Medical Center records (EMR) system quit unexpectedly during four painful hours. One report said that the glitch affected about 600 suppliers, 2,500 members of staff and possibly up to 2,000 patients." Fortunately, no safety problems were reported. Which is nothing compared to a software glitch that affected Veterans Administration health centres 2009. This electronic hiccup has led to several patients receiving the incorrect dosage of medications and delays in processing.
Pressure Government too? Billions of dollars that the Federal Government has put on the table for the EHR cause it professionals and vendors to exaggerate the value of all these electronic tools or to too quickly? I can't point to all of the data difficult to sustain this harassment concerns, but human nature being what it is, I suspect that greed will prevail, as long as it did when they are related to the diagnosis groups and other "innovations" have been put in place a few decades ago. With so much money at stake, I am sure that will attempt some hospitals and group practices to game the system - with patients and taxpayers pick up the Bill.
Education: the good and bad. On a more positive note, I was impressed by what he brought to the field of vocational training. There is PubMed, for example, the huge bibliographic database, sponsored by the Government that contains more than 20 million citations of medical journals and the life sciences. More impressive still include database owners which offer practical advice on the diagnosis and treatment. An example is UptoDate, a clinical decision support system available on the Web and through mobile devices covering some 17 specialties and approximately 8 500 subjects. Essentially, it's like having a library of manuals available, updated each month.
Unfortunately, a healthcare IT domain that is not enough attention is the education of patients. After reading by lots of blogs and Web sites considered for many of the movers and shakers in it, I find that most of the focus is on the side of the provider, that is what he can do to improve data entrydiagnosis and treatment, evaluation and management coding and so forth. But not much emphasis was placed on the end user, the person.
Granted, in many scenarios of acute care, patient education is not a priority. When someone comes into emergency room to have a fracture of the tibia repaired, he or she did not need a lot of complex, detailed instructions on how to take care of the fractured arm. But a large part of the patient care focuses on treatment of chronic degenerative diseases such as diabetes and coronary artery disease. In situations like these, the education of patients is essential, because a large part of the treatment is not something for patients, but the interventions that we expect patients to themselves, including changing their way of life. Involving serious dollars in technology that improves this kind of patient education has a meaning, and I plan to spend more digital ink, reports on innovations in this area.
Is where the hard data? My greatest concern, however, is the relative lack of convincing research to show that health care improves clinical outcomes. Over the years, academic medicine took a critical look at the research methodology used in support of various treatment protocols, and it is a subspecialty sometimes referred to as evidence-based medicine. Health care, should be subject to the same scrutiny. We need more randomized controlled trials (RCTs) to replace the anecdotal reports that only reference to the effectiveness of the EHR, similar and clinical decision-making tools.
Recently, the team of David Blumenthal in the Office of the National Coordinator for Health Information Technology published a review in Health Affairs that concluded that "92% of recent articles on health information technologies reached conclusions that have been generally positive." Sounds impressive. I'm not sure. How many of these articles were RCTs? How many have made considered statistically significant results which, in practical terms, were too small to be clinically significant? How many studies that have questioned the benefits of health it never published because of the tendency of the research journals to promote positive studies?
Therefore my original comment: I remain cautiously optimistic. From here a year, I can look back at and say: "what happens in the world I thought." In the meantime, I hope you, our readers, will offer this newbie some of your wisdom and set me straight when you think that I am off the coast of the base. I do not always agree with you, but the editors at InformationWeek Healthcare are still open to debate and informed discussion.
Paul Cerrato is editor of InformationWeek health services.
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