Rais­ing ques­tions

Modern Healthcare - - INFORMATION TECHNOLOGY -

Re­searcher Ross Kop­pel started an up­roar in 2005 when he and a col­league coau­thored an ar­ti­cle in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion that found a first-gen­er­a­tion com­put­er­ized physi­cian or­der en­try sys­tem (CPOE) at the Hospi­tal of the Univer­sity of Penn­syl­va­nia was si­mul­ta­ne­ously cre­at­ing new er­rors even as it re­duced oth­ers.

Just three years ear­lier, the Leapfrog Group, a health­care ini­tia­tive of the Busi­ness Roundtable, had pro­vided a ma­jor boost for CPOE, launch­ing a pro­mo­tional cam­paign to en­cour­age its high-pow­ered cor­po­rate lead­ers to lean on lo­cal hos­pi­tals to adopt the then-rare CPOE sys­tems as a way of im­prov­ing their em­ploy­ees’ health­care qual­ity and con­trol­ling their com­pany’s health­care costs.

Kop­pel’s bomb­shell—he’s now an ad­junct pro­fes­sor of so­ci­ol­ogy at the Univer­sity of Penn­syl­va­nia—brought down the wrath of in­for­ma­tion tech­nol­ogy boost­ers. The Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety, a health IT trade group, chal­lenged the study’s “method­ol­ogy and its sub­se­quent out­comes,” and crit­i­cized its au­thors for their “lim­ited view” and not “look­ing at the big pic­ture.”

Un­de­terred, Kop­pel, who holds a doc­tor­ate in so­ci­ol­ogy from Tem­ple Univer­sity and serves as Penn’s prin­ci­pal in­ves­ti­ga­tor in the school of medicine on the study of hospi­tal work­place cul­ture and med­i­ca­tion er­ror, kept stir­ring the pot.

In 2009, he re­vealed in an­other JAMA ar­ti­cle that health IT ven­dors’ con­tracts in­cluded “hold harm­less” clauses that shielded soft­ware de­vel­op­ers from le­gal li­a­bil­ity for med­i­cal er­rors their sys­tems caused, even if the de­vel­op­ers had been warned about the de­fects.

“That got me ma­jor up­heaval,” the worst of his ca­reer, Kop­pel re­calls. “The ven­dors tried to say it was un­true. And they tried to show that by say­ing, ‘Show us ex­am­ples where we set­tle (law­suits) on a prob­lem.’ ”

There are no open tri­als, Kop­pel says, be­cause when there is a set­tle­ment on suits al­leg­ing wrong­ful death, the sur­viv­ing spouse or fam­ily mem­ber signs a re­lease, “the hospi­tal doesn’t want to talk about it (and) the ven­dor doesn’t want to talk about it. All of th­ese things are set­tled hush-hush. There are no pub­lic set­tle­ments avail­able.”

In 2011, Kop­pel tes­ti­fied be­fore a fed­eral IT pol­icy sub­com­mit­tee that “us­abil­ity” of EHRs had been “largely ig­nored” and that a pro­gram to test them for ease of use is needed—just as the Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy at HHS has EHRs tested for func­tion­al­ity.

Last fall, in a scathing co-au­thored cri­tique in the Wall Street Jour­nal, Kop­pel and a col­league de­scribed to­day’s clin­i­cal soft­ware as “gen­er­ally clunky, frus­trat­ing, user-un­friendly and in­ef­fi­cient.” They added, it is “al­ready com­mon knowl­edge in the health­care in­dus­try that a cen­tral com­po­nent of the pro­posed health IT sys­tem—the abil­ity to share pa­tients’ health records among doc­tors, hos­pi­tals and labs—has largely failed.”

Kop­pel says the en­tire fo­cus to date has been get­ting doc­tors and hos­pi­tals to buy the soft­ware. In­ter­op­er­abil­ity is added only “very slowly and very in­cre­men­tally,” he says. The main fed­eral push is to boost EHR adop­tion “like that big ther­mome­ter out­side the United Way. It’s a false mea­sure of success. The re­sult is we’ve cre­ated in­nu­mer­able Tow­ers of Ba­bel. We’ve in­vested hun­dreds of bil­lions of dol­lars in tech­nol­ogy that can’t com­mu­ni­cate across the hall­way.”

Had the IT sys­tems first been made in­ter­op­er­a­ble and easy to use, he says, physi­cians would have flocked to them with­out in­cen­tives.

Ross Kop­pel

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