EMRUpdate's thoughts on health IT

I had posted about my relative's travails at the EMRupdate.com site where I have written or cross-posted a number of essays over the years. The site's proprietor Nick Harrington of the U.K. replied. In his bio:

Managing Director of UK based document management software vendor Ambay Software providing hosting and support to emrupdate.com

I recognized a number of familiar themes in his reply.

In turn, I replied to his reply as follows:

Nick Harrington replied on Mon, Jun 20 2011 10:12 AM

Dr. Silverstein,

We're sorry for your loss. Genuinely.

However, I don't think this is the right place for you to start a campaign against EMR. The Healthcare industry is making big progress in the quality of patient care directly as a result of using Information Technology. The single act of providing computerized Electronic Health Record for a patient - whatever shape or form from many vendors - makes available important medical information to the whole team involved in patient care. It allows information to be readily available, to be carried with the patient as they move within the health system, it allows Doctors to be more aware of previous treatments, drug regimes and how best to care for this patient now in this consultation or emergency.

Unfortunately laying blame at the door of IT and Electronic Medical Records isn't at all reaslistic and is unlikely to win your anything more than genuine sympathy. Certinaly no support for your premise that EHR is a direct cause of death, however unfortunate its circumstances.

I do wish you peace and strength in your sad bereavement.

Nick

My reply:

Nick Harrington wrote:

Dr. Silverstein,

We're sorry for your loss. Genuinely.

However, I don't think this is the right place for you to start a campaign against EMR.

Thanks for the expression of sympathy. It is appreciated.

A few clarifications though:

I have never maintained a "campaign" against EMR. I merely hold views that experimentation on patients with problematic, poorly engineered, unregulated medical devices (that are deliberately given special accommodation with regard to the federal FD&C act per Jeff Shuren at CDRH, see FDA Decides Regulating Implantable Defibrillator Medical Devices a "Political Hot Potato"; Demurs), and without informed consent, is unethical. As per Hoffman & Podgurski at Case Western School of Law, what I am against is the lawlessness of the industry today.

Nick Harrington wrote:

the Healthcare industry is making big progress in the quality of patient care directly as a result of using Information Technology

Much current and emerging literature refutes that (such as the sampling at this link). In consideration of this literature, today's commercial health IT is not yet ready for large scale rollout from an ethical perspective. Doing so is experimentation by definition. Doing s, especially without patient awareness or consent, is in violation of decades of policy on human experimentation (e.g., see HHS "Human Research Protections Frequent Questions.")

These are first principles, not open to debate. Even modest NIH research grant proposals involving health IT undergo strict review for human subjects (and researcher) protections. I know first hand, as a sat on a Study Section on health of the population and provided Medical Informatics expertise to such proposals.

Nick Harrington wrote:

"The single act of providing computerized Electronic Health Record for a patient - whatever shape or form from many vendors - makes available important medical information to the whole team involved in patient care. It allows information to be readily available, to be carried with the patient as they move within the health system, it allows Doctors to be more aware of previous treatments, drug regimes and how best to care for this patient now in this consultation or emergency."

Ideally, yes. However, we're still quite far from the ideal. At present, what we have is an unknown level of "health IT roadkill" on the way to perfecting the technology. As predicted by the field of Social Informatics, there are also other unanticipated and likely adverse side effects (such as at link), outcome unknown.

Nick Harrington wrote:

Unfortunately laying blame at the door of IT and Electronic Medical Records isn't at all reaslistic

That depends in what setting, and to whom, the blame is laid.

In any case, regarding my relative: may she rest in peace, and may my efforts [i.e., at whistleblowing on health IT problems] result in others not having to suffer similar mistakes at the hands of IT.

Nick Harrington wrote:

I do wish you peace and strength in your sad bereavement.

Nick

Thanking you kindly.

-- SS