Irresponsible Optimism on Health IT? Pharma should demand the same treatment ...

Imagine a government report about pharma that glosses over the rough edges. Imagine a report where the most critical issues in pharma are reluctant doctors, difficulty measuring ROI of drugs, and the criteria for the quality of drugs being solely dependent on whether users take them correctly.

Well, no such pharma report exists (the opposite is true - pharma is put under a microscope and excoriated harshly by the government, media, activist groups, etc. for even the slightest "deviation"), but in Health IT, it is a different matter. Optimism and idealism prevail at a level that might be considered irresponsible considering the known risks of HIT difficulties and failure. Such costs represent capital and resources healthcare simply cannot afford to waste.

In the milquetoast May 2008 report "Evidence on the Costs and Benefits of Health Information Technology" (PDF), the Congressional Budget Office essentially whitewashes the downsides and difficulties of Health IT. Most of the potential benefits (largely as yet unrealized after 30+ years of continued, unabated efforts and optimism) are laid out, but none of the drawbacks - the expensive project difficulties and failures, the unexpected complications, the cost overruns, the de-installation of systems, etc. are covered in any substantive manner or even mentioned.

It is difficult to believe such material was unavailable or unknown to the analysts who produced this report. It is quite likely they simply ignored it.

Why might this occur?

A clue is in the preface:

Stuart Hagen of CBO’s Health and Human Resources Division and Peter Richmond, formerly of CBO, prepared the report under the supervision of Bruce Vavrichek and James Baumgardner. Keisuke Nakagawa provided able research assistance. The report benefited from comments by Tom Bradley, Robert Dennis, Keith Fontenot, Holly Harvey, David Moore,Robert Nguyen, Allison Percy, William Randolph, and Philip Webre, all of CBO.

In addition, several briefings organized by the Health Information Management Systems Society provided helpful data. A number of outside reviewers also provided comments: Laura Adams of the Rhode Island Quality Institute, Mark Leavitt of the Certification Commission for Health Information Technology, David Cutler of Harvard University, Richard Hillestad of the RAND Corporation, and Douglas Johnston and Eric Pan of the Center for Information Technology Leadership.

It seems many of the outside consultants to the report may have a vested interest in the unfettered diffusion of clinical information technology.

That is, unfettered by any concerns about the immaturity of the technology, unexpected adverse consequences, false assumptions, underestimations of difficulty, lack of understanding of sociotechnical issues that impair acceptance, out of control technology costs ($100 million for an EMR?), unclear benefit and irrational exuberance over HIT, demands that clinicians use tools designed by business IT personnel, designed and implemented via processes and methodologies best known for failure, produced by an industry rife with conflicts, whose leaders often lack substantive credentials, produce ill-conceived and/or shoddy products whose use is mandated by non-clinician hospital managers and that several Harvard physicians note in the NEJM here can impair medical practice and education.

Not to mention a rather short supply of greenbacks laying around in the halls of healthcare for IT misadventure.

In other words, just minor concerns.

Not even the pharmaceutical industry with the powerful Pharmaceutical Research and Manufacturing Association PhRMA (perhaps one of the largest and most influential lobbying organizations) receives such deference.

Maybe the pharma industry should demand the same almost-scandalously and willfully blind, superficial treatment that is accorded to the health IT industry.

-- SS