First, do no harm...

Here's a copy (without graphics--to see the version with graphics, please send me an E-mail) of First Do No Harm, the first edition of a publication put out by the Health Professionals Liberation Army (HPLA), both founded by Duane Caylor, M.D. Caylor summarizes HPLA's goals for First Do No Harm:

This is the inaugural issue in a series devoted to the resurrection of prudence and common sense in the utilization of computerized medical delivery systems. First Do No Harm will address philosophical, ethical, economic, sociological, and medical issues as they relate to health information technology (HIT). Today's number offers an annotated list of recommended readings for HPLA partisans. We hope you find it both stimulating and entertaining.

For readers not experienced in large-scale software implementations across educational institutions, corporations, and nonprofit organizations, here's an explanation of the conflict that has led to the founding of HPLA and its publication of First Do No Harm.

We've all known (or known of) physicians impaired by their addiction to alcohol or drugs, but who's heard of physicians impaired by the health information technology their clinic or hospital forces them to use?

Patients beware! The latest threat to life and limb is the move from hospital charts to computers running a class of computer programs called "computerized medical delivery systems." After listening to my friend, Duane Caylor, last night, I'm a believer in old fashioned paper charts--at least if the implementation of industry-leader Cerner's computerized physician order entry system in the Dubuque hospital is typical of this category of software.

Dr. Caylor is a Christian physician in Dubuque, Iowa, who works primarily as a family practice doctor. About 23% of his billing, though, comes from hospital care.

Duane tells me that Dubuque's implementation of Cerner's computerized physician order entery system, Genesis, has proved to be quite unhelpful in the provision of patient care. He's argued with his administrators that their patients ought to be asked to give their informed consent to serving as guinea pigs in the latest wave of technological utopianism in the medical world as this system is implemented, for instance, in Dubuque.

The essential fact is that, until now, doctors could write with a pen on paper medical charts they held in their hands...

In a matter of seconds, they could insert a thumb here, a forefinger there, and find the information they needed to make a clinical decision. But now, pens and paper are out the window; computer screens, servers, and databases have taken over. And the entry and accessing of information has become a hugely inefficient process that, in many cases, has led to a decline in the care and safety of his patients.

Consider, for instance, a recent article by Yong Y. Han that ran in Pediatrics (2005: 116: 1506-1512) titled, "Unexpected Increased Mortality After Implementation of a Commercially sold Computerized Physician Order Entry System," in which the author and his colleagues documented a three-fold increase in mortality in children admitted to a special care unit after that unit introduced a computerized order entry system similar to the Cerner system being implemented in Dubuque.

Han and his colleagues' conclusions were called into question. They responded with with their own letter to the editor.

But make no mistake about it: any time sophisticated software programs (often called enterprise software) are implemented, the mental health and contentment of those doing the implementing will be helped immensely if they understand they've had their ticket punched for a journey from the world of objectivity and reason to the world of religious faith.

The cost of the purchase and implementation of Cerner's Genesis System in Dubuque is in the hundreds--yup, HUNDREDS of millions of dollars. How exactly do top executives admit they spent three hundred million dollars on a paperless hospital room that their doctors hate, and that puts their patients at risk?

A few years back, the Baylys learned firsthand the kind of mess enterprise software creates when our daughter, Michal, wasn't accepted at Indiana University until just after 99% of available scholarship funds had already been awarded. And so, despite her grades and test scores, she was left out in the cold--all due to one of a nearly-infinite number of failures caused by IU's implementation of PeopleSoft. But IU had paid $52,000,000 for that software so everyone in authority maintained a stiff upper lip and continued to preach the PeopleSoft gospel.

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"But IU had paid $52,000,000 for that software so everyone in authority maintained a stiff upper lip and continued to preach the PeopleSoft gospel."

This is the key. During the internet bubble years I was employed by a company which sold supply chain software of the same size and complexity of the systems sold by SAP, PeopleSoft, etc. It wasn't hard to make a case that our software NEVER WORKED, at least as advertised.

Why no lawsuits? Because the people who had approved the purchase of the software had paid such huge amounts for it that it was impossible for them to admit that they had squandered the money. So instead they squandered more money, as they paid us to continue trying to get the stuff to work.

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