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Podcast: Scot Silverstein talks health IT safety risks

In a sidebar to the September cover story I did for Healthcare IT News, I reviewed some of the work of Scot Silverstein, M.D., who has long been chronicling problems with EHRs and other health IT systems. Unfortunately, he wasn’t available for an interview in time for that report, but he was last week, so I got him for a new podcast.

Silverstein, a professor of health informatics at Drexel University in Philadelphia, considers EHRs to be experimental and, sometimes, less safe than paper records and would like to see health IT subjected to the same kind of quality controls as aerospace software or medical devices. “Suboptimal system design could lead even careful users to make mistakes,” Silverstein said in this interview.

During this podcast, we refer to a couple of pages that I promise links to, so here they are. Silverstein writes regularly for the Health Care Renewal blog, a site founded by Roy Poses, M.D., a Brown University internist who runs the Foundation for Integrity and Responsibility in Medicine. His definitions of good health IT and bad health IT appear on his Drexel Web page.

Podcast details: Scot Silverstein, M.D., on health IT safety risks. MP3, mono, 128 kbps, 33.8 MB. running time 36:59.

1:10 How this interest came about
3:05 His blogging
3:45 His 11 points demonstrating why he believes the FDA should be concerned about health IT risks
5:00 IOM, FDA and ECRI Institute statements on health IT safety
5:50 Comparing EHRs to medical devices and pharmaceuticals
8:35 Lack of safety testing in health IT
9:25 Issues with EHR certification
10:00 Safety validation of software
10:35 EHR’s role in Texas Health Presbyterian Hospital’s initial discharge of Ebola patient
11:50 EHR failure causing medical harm to a close relative
13:10 Poor design vs. poor implementation
14:35 Who should regulate?
15:55 Billions already spent on EHRs
16:45 Threat of litigation
17:40 “Postmarket surveillance” of “medical meta-devices”
18:50 EHRs now more like “command and control” systems
19:30 Movement to slow down Meaningful Use
20:17 Safety issues with interoperability
21:40 Importance of usability
22:30 His role at Drexel
24:18 “Critical thinking always, or your patient’s dead”
25:05 Lack of health/medical experience among “disruptors”
29:30 Training informatics professionals and leaders
31:15 Concept vs. reality of “experimental” technology
32:50 Advice for evaluating health IT
33:55 Guardians of the status quo
35:10 Health IT “bubble”
36:10 Good health IT vs. bad health IT

 

October 20, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Faxing should be malpractice

As you undoubtedly know by now, I am now officially all about patient safety. (Thanks, by the way, for all the support in the wake of my father’s untimely death.) That’s why I was so upset to read a friend’s recent Facebook status update: “So I discovered the real reason why I was in the hospital last week (and not generally feeling well for the past 4.5 months). My doctor’s office faxed a prescription to my mail order pharmacy that was 2x the dose I was expecting.”

In case anyone has forgotten, fax is technology from the late 1980s and early ’90s. It is now 2012. I cannot remember the last time someone asked me if I had a fax number. Yet, inexplicably, this obsolete means of transmitting low-res images—images, not computable data—remains perfectly acceptable in healthcare.

Here’s a radical proposal: medical societies and state medical pharmacy boards should prohibit the use of faxes. Medical errors related to faxed documents should be considered malpractice. Period.

May 20, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Liability from Wikipedia?

On Monday afternoon, word got around on Facebook and, I’m told, on Chicago sports radio, that someone had altered the Wikipedia page of Atlanta Falcons wide receiver Julio Jones to include the obviously false line, “His dad raped him every night after school.” (Click here for a screen grab.)

Within minutes of the publicity, someone had fixed the page. But before that happened, I mentioned in a Facebook discussion that this is additional evidence that Wikipedia should never be the primary source for any kind of research. But people rely on Wikipedia all the time when they look up information online.

Another participant in that discussion said that I should have corrected the information as soon as I had seen it. “I suspect there will be a case before long when a health professional spots an error on wikipedia and doesn’t correct it. A patient then takes notes of or acts on the information & the health professional could then be liable for not correcting the error – a part of professional practice?” this person said.

(Dramatic pause as a chill runs down your spine.)

Yeah, what happens when a patient gets wrong information from Wikipedia that his or her physician/nurse/family member saw but didn’t bother to fix? Medical error? Malpractice liability?

Has anyone ever thought this through? Am I reading too much into this or is this a real concern?

December 13, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Health Wonk Review, summer research edition

I haven’t blogged a lot lately because the real work tends to get in the way. There’s only so long I can spend in front of the computer each day before I start to get a little antsy. OK, a lot antsy.

Fortunately, others are more focused on their blogs than I am, and that brings me to the latest iteration of Health Wonk Review, hosted by Brad Wright at the Health Policy Analysis blog. With summer here, this is the last edition of HWR until July 22, because, let’s face it, everybody needs a break from time to time.

Wright focuses quite a bit on research, but does link to one IT post and another about the patient-centered medical home. He also includes some editorial cartoons culled from around the Web, notably this one from Orlando Sentinel cartoonist Dana Summers. The elephant in the room re: health reform is tort reform, Summers suggests. Yeah, we haven’t addressed the liability problem yet, but the fee-for-service payment system is, in my humble opinion, the greatest culprit. There’s that little matter of poor quality, too.

June 28, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.