The good, the bad

Modern Healthcare - - INFORMATION TECHNOLOGY -

The ti­tle of Dr. Scot Sil­ver­stein’s teach­ing web­site at Drexel Univer­sity, “Con­tem­po­rary Is­sues in Med­i­cal In­for­mat­ics: Good Health IT, Bad Health IT, and Com­mon Ex­am­ples of Health­care IT Dif­fi­cul­ties,” sum­ma­rizes the veteran physi­cian in­for­mati­cist’s gen­eral out­look on the cur­rent state of af­fairs in health in­for­ma­tion tech­nol­ogy.

It tells you noth­ing, how­ever, of the pas­sion with which Sil­ver­stein speaks or writes about the sub­ject.

Also a fre­quent con­trib­u­tor to the pop­u­lar re­formist “Health­care Re­newal” blog, Sil­ver­stein writes with the fire you might ex­pect coming from a self-de­scribed com­puter geek who says he has wit­nessed a faulty elec­tronic health-record sys­tem mys­te­ri­ously drop a sin­gle med­i­ca­tion from a pa­tient’s med­i­ca­tion list. That miss­ing drug led to a med­i­cal er­ror that re­sulted in a year of suf­fer­ing and, even­tu­ally, that pa­tient’s death, he says. Sil­ver­stein’s pas­sion is even more un­der­stand­able when he tells you that pa­tient was the doc­tor’s own mother.

“The med, some­how, just dis­ap­peared,” Sil­ver­stein says. “It was con­firmed at triage, and then the sys­tem just lost it. She didn’t get her heart med­i­ca­tion, which led to car­diac ar­rhyth­mia. And that led to a cere­bral hem­or­rhage from the anti-co­ag­u­la­tion medicine to deal with her heart ar­rhyth­mia.”

The health IT world, Sil­ver­stein says, parts neatly be­tween “good IT” and “bad IT.” There are those who push hard for the good and com­plain about the bad, physi­cians and other clin­i­cians he calls “prag­matic,” and for whom he has sym­pa­thy and re­spect. And then there are those who stay silent, ig­nor­ing or ac­qui­esc­ing to the bad, the “hy­per-en­thu­si­asts” for whom he holds only un­mit­i­gated scorn.

“The doc­tors who don’t speak up about health IT, who work around it, which can cause its own bad re­sults, those are traitors to the oath they took to first do no harm,” he says.

“Physi­cians are still be­ing ac­cused of be­ing Lud­dites for not adopt­ing this stuff,” Sil­ver­stein says. “Physi­cians are not Lud­dites. When it’s good IT, it’s used. I see the ten­sion now be­tween hy­per-en­thu­si­asts, who turn a blind eye to the neg­a­tives, and prag­matic physi­cians and nurses who have work to do.”

From 2000 to the end of 2003, Sil­ver­stein ran a li­brary at a re­search fa­cil­ity of the phar­ma­ceu­ti­cal gi­ant Merck, learn­ing lessons there, he says, that could and should be ap­plied to clin­i­cal IT on the provider side of the health­care sys­tem.

“I look at health IT and see it need­ing the same rigor ap­plied to it as pharma IT and med­i­cal de­vices, which are reg­u­lated,” he says. He says health IT needs reg­u­la­tion and will have it, whether self-im­posed or fed­er­ally man­dated, as med­i­cal de­vices are.

Sil­ver­stein is an ad­junct pro­fes­sor in health­care in­for­mat­ics at Drexel who has built health IT sys­tems from scratch as well as used and helped im­ple­ment sys­tems oth­ers have built. For all his years of crit­i­cism–and he’s been at it long be­fore his mother’s death—he re­mains a fan of health­care IT.

“I got into this field 20 years ago to help im­prove care for pa­tients,” Sil­ver­stein says. “That’s still my goal.”

It’s a rot­ten sys­tem,” de­clares Dr. Lawrence Weed, who at age 89 is the dean of health­care in­for­ma­tion tech­nol­ogy icon­o­clasts. Weed isn’t dis­parag­ing any par­tic­u­lar brand of elec­tronic healthrecord sys­tem. A dis­mis­sive “they’re in­ad­e­quate” would fairly well cover a Weed-guided tour of to­day’s EHR sys­tems. “Peo­ple don’t get the gen­eral pic­ture,” he says. “It’s bro­ken. It’s ba­si­cally an un­sound sys­tem.”

By that he means the en­tire health­care sys­tem, but not be­cause its providers are us­ing faulty in­for­ma­tion tech­nol­ogy, but be­cause they’re us­ing IT the wrong way, at least in part. Weed says the med­i­cal ed­u­ca­tion sys­tem is at the root of the prob­lem. “I’ve taught in five dif­fer­ent med­i­cal schools,” Weed says. “And over and over again, they kept de­fend­ing the idea of clin­i­cal judg­ment,” even though, Weed says, the un­end­ing and ac­cel­er­at­ing ex­pan­sion of clin­i­cal knowl­edge makes it im­pos­si­ble for hu­man minds to keep up—even the high-pow­ered and best-trained minds of physi­cians.

Still, he says, “In medicine, it’s what does the doc­tor think? It’s pa­thetic.”

“In the 1950s,” he ex­plains, “when com­put­ers came along, the engi­neers and the physi­cists, they caught on right away. You use the com­puter to do what the hu­man mind can’t do. If you want to go to the moon, you can’t have hu­mans do­ing the cal­cu­la­tions.” Com­put­ers could do the math, though, al­low­ing us to put men on the moon.

“Whereas the doc­tors, they didn’t say, ‘Oh, my God, all th­ese vol­umes. We can keep track of it now,’ ” Weed says. “They didn’t do that in the ’50s, and I’ll tell you why. Clin­i­cal judg­ment had been made sa­cred.”

“Os­car Wilde said, ‘To be in­tel­li­gi­ble is to be found out,’ ” Weed says, hence physi­cians’ many guises. “They knew they couldn’t do it so that’s why they be­came spe­cial­ists. They di­vided it up.”

To this day, med­i­cal schools per­pet­u­ate a myth—that the physi­cian brain is up to the task, is able to keep up with the ever-in­creas­ing knowl­edge bur­den placed upon it—by med­i­cal schools and then by the pro­fes­sion, Weed says. “When are they go­ing to wake up and stop mov­ing knowl­edge through heads and start mov­ing knowl­edge through tools?”

That would be an­other Weed so­lu­tion. In the 1960s, he in­vented the SOAP (sub­jec­tive, ob­jec­tive, as­sess­ment, plan) for­mat to help physi­cians think as they kept or­ga­nized pa­tient records on pa­per.

In 1984, to help physi­cians cope, Weed devel­oped a com­puter-based, di­ag­nos­tic sup­port sys­tem he called the prob­lem-knowl­edge cou­pler. The soft­ware com­pany he founded, but is no longer with, PKC, now part of Share care, still sells the sys­tem. Weed still pros­e­ly­tizes with fer­vor, call­ing for the use of com­put­ers to store, re­trieve and ap­ply med­i­cal knowl­edge.

In 2011, Weed and his son, Lin­coln, a lawyer, pub­lished a book, “Medicine in De­nial,” ad­dress­ing the pro­fes­sion’s prob­lems but also pro­vid­ing so­lu­tions.

Weed says he started stand­ing up against the sys­tem decades ago, “once I saw the root of the prob­lem,” be­cause “we were de­stroy­ing a lot of very bright young peo­ple,” set­ting them up for frus­tra­tion as medicine de­manded of them things they sim­ply could not do.

Dr. Scot Sil­ver­stein

Dr. Lawrence Weed

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.