Monday, May 18, 2009

Meaningful use: Don't pee on my leg and tell me its raining

Standardizing and automating processes within a complex system makes the system more reliable, that is, more likely to produce an expected outcome. This is a core principle of system design although one infrequently taught to front line healthcare professionals, most of whom came-of-age in an intention-based ethic.

If Mr. Rogers were explaining what it means to come from a culture of intention , he'd say, "Can you say, 'The Five Rights of Medication Administration?' or 'Hippocratic Oath,' boys and girls?" But I'm not channeling Mr. Rogers here. This is a Judge Judy day.

Judy Sheindlin, you may recall, is the TV judge and author known for her sharp-tongued assessment and analysis of problems, most of which arise from choices made by imperfect humans and result in less-than-desirable outcomes. Judge Judy pulls from a strong personal moral center, but her opinions are informed by years as a family court prosecutor in New York City.

So what advice might Judge Judy offer to stakeholders who are about to get $20 billion dollars from the American Recovery and Reinvestment Act of 2009 to develop IT solutions that have meaningful use? I'm thinking it should start with, "Don't blow it!" and include a lot of input from front line clinicians.

To date, efforts to automate healthcare processes in clinical settings have produced, on a good day, variable results, especially when compared to what others (like Walmart, Chili's, AirTran, and hell, even Thrifty Car Rental) have achieved. This doesn't mean that automation doesn't work. It means that automation, like every other human endeavor, will rarely produce a desirable outcome spontaneously. (Or as my dad would say: "Fail to plan, plan to fail.")

Few, if any, health IT solutions in the public domain today were built on a strong patient-centric scaffolding, one that saw creation of a static stream of data to and from front line clinicians as a key objective. IT vendors have produced many satisfactory products and solutions. But their wares evolved in response to a market demand for piece-meal solutions, many arising in a reactionary fashion to address narrowly defined needs or mandates. We're now trying to satisfy a champagne appetite for high-stakes patient information that's been built on a beer pocketbook.

Making the patient the center of IT endeavors has the potential to make patient data the default output. And patient information is what professionals closest to the secretions need most to produce reliable outcomes: current medication histories; real-time medication profiles; provider orders; lab results; alarms signaling that an at-risk-to-fall patient has left the bed; that pharmacy-review of medication orders has occured; that an off-service test has been scheduled; that a patient is allergic to this food but likes that one; that an infusion is complete; DNR status; the list goes on.

Today's healthcare IT solutions are like puzzle pieces, with inter-operability specifications (enabling pieces to interlock with one another) in their infancy. Absence of shared platforms & standards may confer a competitive advantage to vendors in an unregulated marketplace, but it's the practical reason why your lab computer system often doesn't "talk" to your pharmacy computer and why patients admitted for community acquired pneumonia may receive a double dose of antibiotics when the ER's system doesn't "talk" to the inpatient system (an outcome, by the way, that standard quality reporting doesn't capture or penalize, but one that's not good for patients, not good for pocketbooks, and one that wouldn't be endemic with more robust communication systems.)

Front line clinicians often aren't enthused by the net effects of healthcare IT, and it's not because they don't recognize and enjoy the benefits of technology while grocery shopping, booking a vacation, or downloading music. But when patchy automation increases complexity and decreases efficiency--outcomes opposite those that normally found with tech-mediated solutions--don't blame the victims for not loving what torments them. Or, as Judge Judy would say, "Don't pee on my leg and tell me it's raining."

With $20 billion and a mandate to create IT solutions that result in meaningful use, maybe success can be measured by the whether the front line wears dry pants.

1 comment:

man-nurse said...

Ah!! Yes! Our ER, pharmacy, lab, medical floor, and OB floor staff ALL USE DIFFERENT SOFTWARE SYSTEMS. And we just computerized our charting, so it's not like this was a piecemeal over-the-years problem. Also our radiology images and results are viewable to our physicians in two separate software environments, which is still different from the environment we see them in.


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