At “Background On The ‘Ecosystem’ of Commercial Healthcare IT” I wrote:

… In reading about HIT difficulties it is important to understand the “ecosystem” of commercial health IT, that is, the identity and nature of the principal constituents and stakeholders, and their interrelationships. Familiarity with this environment is useful in order to place the social and organizational issues affecting HIT diffusion in the proper context.

By implication, I made the case that the commercial HIT ecosystem was far from healthy.

Recently at Health Care Renewal and at another blog I visit, HISTalk, frequented largely by IT industry workers and officials, I’ve noted an uptick in comments from anonymous commenters that resort to ad hominem, strawman arguments, or other forms of logical fallacy in a fairly clear cut attempt not to seriously debate the issues but to de-legitimize serious arguments. I generally respond to such comments, but a few have been so debased here that I have simply deleted them.

Here is an example of a duplicitous strawman argument recently posted at the aforementioned other site with regard to my HCR post “21st century EMR experiments: screwing around with people’s lives in a broke city, while not having a clue what you’re doing“:

… Jumping to conspiracy theories about cover-ups whenever there is an IT problem acknowledged by an organization does not really help improve the state of health IT.

I find the sickness of the commercial health IT ecosystem very disappointing and, in fact, revolting due to the implications for patients.

Perhaps a little background as to why I feel that way is in order.

I believe my background is not too dissimilar from the background of many physicians, who have had similar experiences. The following is therefore not so much about me, but about the challenges of medical training and practice in general and the life experiences imparted.

Pre-informatics, while a resident at Abington Memorial Hospital in Pennsylvania and then as a Manager in a regional transit authority’s medical department, I handled situations such as these:

• Being admitting officer in the ED in the busiest night, ever, in the hospital’s history to that time, New Years Eve 1985-6, having to see perhaps a hundred patients and admit ~ 30. The ED staff needed to — and did — perform flawlessly after participating in the highly upsetting and depressing, unsuccessful resuscitation effort of a medical colleague shot in the chest in his home around midnight. It was I who performed heart massage on him — open-chest style — with my gloved hands after the surgeons on the trauma team cracked his chest;

• Running three near-simultaneous cardiac arrests in the ICU’s during family visiting hours, while being trailed by a Mennonite minister-in-training as an observer. Dealing with the patients’ crises and their families was not easy and in fact was extremely stressful. The minister-in-training at the end of it all after several hours stated he was amazed at how I and the intern I was overseeing kept our cool during the affair;

• Not telling an intern colleague on the telephone whose mother I’d just declared deceased in the MICU that she had died, because his call was coming from his father’s funeral. His father had died a few days before in the CCU right next door, previously healthy but having had an MI from the stress of his wife’s condition. (The intern later thanked me for not telling him about his mother’s death until after dad’s funeral).

• Repairing a malfunctioning GE CT scanner’s computer to get it up and running late one Sunday might ca. 1986, which permitted a life-saving CT scan of the head of an unidentified young man brought in in a delirious state. A repairman left near midnight and said it was fixed, but it was not, and service, I was told, was unavailable between midnight and 7 AM Sun-Mon. so he could not be called back. I’m not sure if this was a vendor policy or a contractual issue (either of which would reflect Titanic lifeboat-like stupidity, since people need CT scans 24×7), but due to radiology training and computer expertise I knew what the problem was and fixed it, going above and beyond the call of duty of an internal medicine resident.

• Dealing strongly and firmly with militant labor union leaders and drug-troubled vehicle and train operators as Manager of Medical Programs and drug testing in a large regional transit authority. I was very firm in my stance about keeping these operators off the street, and getting them help, to protect the public from possible catastrophe. I was threatened more than once, including being threatened with my life, by operators I had to put out of service.

• Standing up to a police officer and a FOP union official regarding what I believed was gross exaggeration of a minor injury, with no objective findings to substantiate the reported symptoms, multiple inconsistent findings on exam (indicative of ‘acting’), and ongoing injury-clinic (a.k.a. fraud-factory) hot pack and massage “treatments” for more than a year, to take advantage of the injury compensation system. This type of activity was unfair to truly injured personnel, to the city that had to pay for these activities at the expense of other needed services, and to the taxpayer.

Experiences such as this impart a sense of the fragility of life, of responsibility, obligation, and an understanding of the need for critical thinking and serious and uncompromising attitudes where patients are concerned into physicians of good character.

Most serious, critical thinking physicians thus would find irrational arguments coming from the HIT industry, marketing spin, petty character attacks on those who report on HIT difficulties, and other unpleasantries quite unserious and disappointing. I certainly do.

After all, IT industry personnel in large part went through educations far simpler than that of a physician. They generally have bachelor’s or masters’ degrees, have had no medical school experience, internships, residencies, postdocs, etc. They have what are essentially comfortable desk jobs, no liability for patient harm, and compared to most physicians, a cakewalk in their professional lives.

On the other hand, as a physician who had such experiences, I’m a serious professional concerned about serious issues that affect people’s lives in their time of need.

I expect nothing less from others involved in aspects of healthcare that can be life or death (as my own mother recently experienced via EHR-initiated iatrogenic catastrophe).

From that perspective, I find the commercial HIT ecosystem quite disappointing indeed.

Scot Silverstein is a physician and medical informatics professional who blogs at Health Care Renewal.

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