It's All CHIT To Me

There is enormous enthusiasm for Clinical Health Information Technology both from within health care and from the outside as well. There is enormous enthusiasm for provide rapid access to information about patients, with widespread belief that such systems will improve the quality of care and the satisfaction of both patients and providers.  There is no question that, on a small scale, such systems can work, and work extremely well. For instance, my own direct experience with my own department's pre-op clinic software, designed and developed by a clinician, was simply phenomenal. Satisfaction with locally developed systems is generally quite high.  More broadly, the larger the scale, the lower the performance and satisfaction. 

Our new administration is calling for increased utilization of CHIT at the national scale, and seems poised to spend a substantial amount of money for this purpose.  Once again, it makes sense to evaluate the English experience. The results are not encouraging. Worse, the bad news does not seem to have traveled well across the Atlantic.  My colleague Richard Cook has been following this story for some time, and you can read his bog posting about it here:

U.K. NHS computer system on verge of collapse & implications for the U.S investment in CHIT

There is also an interesting article, forwarded to me by  him, here:

http://business.timesonline.co.uk/tol/business/industry_sectors/technology/article5636437.ece

His other posts on the subject in the RIsks forums are also very much worth reading:

http://catless.ncl.ac.uk/Risks/25.44.html

This one is both erudite and humorous:

http://catless.ncl.ac.uk/Risks/23.81.html#subj6.1

Like so many things in health care, it is far easier to get this woefully wrong than most outsiders appreciate. As importantly, the financial costs of these failures are staggering.  The vast majority of CHIT systems in use or under development today have cost far, far more than projected, and taken far longer to go-live than their proponents represented.  Put differently, I am not aware of any system that was completed on time and under budget. 

In 2002, Cedars-Sinai in LA tried to bring up an electronic medical record. A caregiver revolt forced them off-line, back into the functional world of paper and pen.

Here is follow-up from the Cedars-Sinai implosion from years ago:

http://www.washingtonpost.com/wp-dyn/articles/A52384-2005Mar20.html

And finally, even when you go live with such systems, you confront potentially insuperable security and privacy problems:

http://www.latimes.com/news/local/la-me-cedars-sinai23-2008dec23,0,6381180.story

http://www.consumeraffairs.com/news04/2006/05/va_laptop.html

Be certain: in this, the electronic world mirrors the real world: security and easy access/ease--of-use struggle to co-exist.  Secure systems will be painful to their users, and easy to use systems will be riddled with security vulnerabilities.