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Three 'Nevers' for 2007Here's my journalistic New Year's resolution: I pledge to banish all clichés, hyperbole and misconceptions about healthcare information technology. It's a tall order, as this is a field teeming with all three. Thus, in upholding my resolution, I promise to:

  • Never refer to Robert Kolodner, M.D., the interim national coordinator for health information technology, as the "healthcare IT czar." Endlessly applied to his predecessor, David Brailer, M.D., the czar moniker quickly became one of the most overworked clichés in industry trade magazines, which assigned the modest Brailer almost mythical powers. Several named Brailer as among the "most powerful" people in healthcare. It's unclear where all this power went after he resigned. It is clear that no one person has the authority to make a substantial federal commitment to healthcare IT happen. When writers in the field cannot distinguish between power and visibility, we only confuse the issues, not clarify them.

  • Never quote any politician who uses the ATM metaphor when discussing healthcare IT. It goes like this: "If I can get money out of the bank, anywhere in the world, why can't the hospitals and physicians do blah-blah-blah (insert vague, computer-related healthcare concept here)." Last November, I heard a Congressional aide trot out this lame-and unchallenged-comparison at the American Medical Informatics Association conference. The IT needed to enable deposits and withdrawals in a common currency pales in comparison to the technology (and standards) needed to enable exchange of healthcare data, which is far more complex, far more regulated, and far more encumbered with ownership issues.

  • Never refer to software as a "solution." It's a nearly universal vendor marketing buzzword. But I have yet to see a new technology adapted that did not adhere to the law of unintended consequences. If you barcode medications, for example, you take a step toward boosting patient safety. Invariably, you also raise difficult issues-such as how, when and where the barcodes are affixed. The only real solutions are those hammered out by hard-working, multidisciplinary teams dedicated to improving patient care. It's these groups that somehow manage to insert the round peg of technology into the square hole of workflow.
-Gary Baldwin




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