What Silverstein is cautioning against—in a very timely fashion in my opinion—is a generally held belief that any health IT, even poorly designed or implemented system, must be better than a paper-based system. "The physicians have a moral and ethical obligation," he says. "They've taken an oath. They have all the responsibility. They have the obligations. They have the liability. They're the ones who have to deal with the downsides of the technology. The hospital or clinic is not a software beta-testing shop," Silverstein says.
The current healthcare IT ecosystem, with its rush to implement meaningful use and grab the limited government incentive dollars being doled out by HHS, is arranged to suppress reporting of bad outcomes, Silverstein says, with the health IT industry given extraordinary regulatory accommodation compared to other healthcare and technology sectors. For example, he echos previous claims that hospitals have signed "gag clauses" so that defects in health IT cannot be reported to anyone but vendors. "Because of numerous impediments to information flow such as this, as reported by FDA, IOM, and others, we do not know the magnitude of harms, and we need to study it further," Silverstein says.
Silverstein says a likely reason some doctors, such as those at the Contra Costa Medical Center in Martinez, Calif., have been able to speak out is that they are unionized. Non-unionized doctors who raise concerns can face reprisal, for example in the form of sham peer reviews, where hospitals can "pickle them for minor problems and blow things out of proportion," he says. Fearing such retaliation, many of these doctors stay silent.
"In summary, physician resistance to health IT is not due to backwardness, and physicians' resistance to hyper-enthusiasts pushing bad health IT without concern for the potential and actual downsides needs to be considered," Silverstein says.
Undoubtedly, there is a lot of good health IT doing good things. But Silverstein believes, and I agree, that not enough attention is being paid to bad health IT. I'm eager to hear your comments.