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."