Scot Silverstein's Good Health IT and Bad Health IT

Scott Mace, for HealthLeaders Media , January 8, 2013

After helping implement clinical IT at Yale New Haven Hospital, Silverstein took a CMIO-type role at Christiana Care Health System in Wilmington, Del., at a time when the term "CMIO" hadn't yet been coined.

At Christiana Care, Silverstein architected clinical information systems for critical care areas such as invasive cardiology from the ground up, from data modeling all the way up to supervising the programming team. He also was the clinical leader of commercial health IT acquisition and implementation for other medical specialties.

During the dot-com boom, he worked for an IT vendor, and then got recruited by Big Pharma, to run Merck Research Labs' internal science research library and IT group supporting drug discovery.

Today, at Drexel, Silverstein teaches and also consults with both plaintiff and defendant attorneys on health IT-related issues. "I cannot work in the health IT industry anymore," he says. "If I could even get a job, I'd likely be fired in five minutes from pointing out the problems." In short, those problems are manifestations of what he calls "bad health IT," as opposed to "good health IT." (Editor's note: After publication, Scot Silverstein noted that the good health IT / bad health IT dichotomy was introduced to him by Professor Jon Patrick at the University of Sydney in Australia.)

Unfortunately, critics such as Silverstein are branded as anti-technology Luddites, or worse. "That framing of the issue is misleading," Silverstein says. "It is propaganda generated by the industry. Here's the proper framing of the issue. In fact, physicians are largely pragmatists. They will adopt technology when it's clear to them that it's both safe and effective and might actually make their patient care better. They'll adopt that readily, so much so that often times, one has to be careful of it being over-adopted, say cardiac stents, for example."

Silverstein says it is wrong to think of the tension in healthcare as being IT modernists versus Luddites. "It's actually IT hyper-enthusiasts, or what I call 'Ddulites,' Luddites with the first four letters reversed," he says. "I didn't invent that term. I found it on the Web somewhere in a different context, but I believe the proper framing of this tension between technologists and physicians is that of technology hyper-enthusiasts, who either are unaware of or deliberately ignore the downsides and ethical issues of healthcare information technology in its present state, versus pragmatist physicians who just want to get a job done."

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6 comments on "Scot Silverstein's Good Health IT and Bad Health IT"

Tim Cook (1/10/2013 at 5:34 AM)
You can find my comments in the Healthcare IT community on Google Plus at

Bob Coli, MD (1/9/2013 at 3:04 PM)
Dr. Donald Berwick's famous observation that in healthcare, "The excellence of the status quo is a sentimental illusion", accurately describes the chronic, dangerous and costly problem of poorly designed and implemented health IT systems. One of the most glaring examples of defective health IT design is the antiquated formats still being used to report the results of patients' diagnostic tests to physicians and patients. This is a user interface problem which has been overlooked or ignored since medical computing began in the 1960s with Homer Warner (1) and Octo Barnett. (2) The tsunami of test results data is important because it constitutes more than 80 percent of the objective data in an individual's medical record and it directly impacts at least 65 percent of all critical patient care decisions. (3) The basic "job" that American physicians and patients need to get done is efficiently viewing and sharing the billions of annual diagnostic test results. The basic problem confronting them is the user interfaces of EHR, PHR and HIE platforms are still using variable reporting formats to display results as incomplete and fragmented data. The adverse patient safety, workflow and redundant testing effects produced by this poor user interface design and unclear data display are very familiar to clinicians and nurses, but until recently, they have not yet been recognized by researchers, journalists, policy makers or the vendors of bad health IT systems. Fortunately, there is a relatively simple solution, which will require the development and adoption of an intuitive, easy-to-use, standard reporting format that can display the results of all 7,500 available tests as clinically integrated, actionable information. Accomplishing this may be finally becoming feasible because of unsustainable healthcare costs, disruption of "HIE 1.0" by ONC's emerging portfolio of open source interoperability standards, national expansion of consumer-centered, value-driven financing and delivery reforms and a recently more crowded and more competitive health IT system vendor marketplace. In addition to improving patient safety, by collaborating to overcome this major barrier to information visualization and full interoperability, government and the private sector can also support MU Stages 2 and 3 by helping physicians engage patients and their families, minimize unnecessary testing and improve physician workflow, practice efficiency and care coordination. (4) (1) (2) (3) (4)

canary keeper (1/8/2013 at 8:42 PM)
This comment system here is worse than the HIT computers managing the patients. Kudos to Dr. Silverstein for expposing the sham of HIT.




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