{"id":4815,"date":"2010-02-18T04:00:38","date_gmt":"2010-02-18T09:00:38","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=4815"},"modified":"2010-03-07T08:13:13","modified_gmt":"2010-03-07T13:13:13","slug":"what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/02\/what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting.html","title":{"rendered":"What to do about &#8220;the cream of the crap&#8221;? ONC&#8217;s&nbsp;Adoption\/Certification Workgroup meeting"},"content":{"rendered":"<p><a href=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/02\/ONC-HIT-banner.png\" data-rel=\"lightbox-image-0\" data-rl_title=\"\" data-rl_caption=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-4816\" title=\"\" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/02\/ONC-HIT-banner-300x68.png\" alt=\"Health IT banner graphic\" width=\"300\" height=\"68\" srcset=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/02\/ONC-HIT-banner-300x68.png 300w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/02\/ONC-HIT-banner-600x136.png 600w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/02\/ONC-HIT-banner.png 625w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>I&#8217;d like your help preparing thoughts and testimony for a policy meeting I&#8217;ve been invited to attend in Washington next week.<\/p>\n<p>For these meetings, one needs to submit prepared remarks in advance, for the committee to digest in advance.\u00a0 And from what I&#8217;ve learned so far about this, there&#8217;s a lot to chew on, and people of all stripes (that&#8217;s you) can probably provide valuable input. At <em>very<\/em> least you can express yourself.<\/p>\n<p style=\"padding-left: 60px;\">[<em>Update 1 pm ET Thursday: <\/em>I haven&#8217;t been able to convert the recording mentioned below (which is in RealPlayer format) to display it here, but if you have RealPlayer installed you can play it yourself at <a href=\"http:\/\/real.welch.jhu.edu\/ramgen\/DHSI\/Dec182009.rm\" target=\"_blank\">http:\/\/real.welch.jhu.edu\/ramgen\/DHSI\/Dec182009.rm<\/a>. The slides are often out of sync with the audio but they catch up. Skip the first 9 minutes; the talk starts around 9:15 and goes 30 minutes, followed by 30 minutes of Q&amp;A. The meat of it is in Dr. Koppel&#8217;s talk, but the Q&amp;A has more juice.]<\/p>\n<p><!--more-->The meeting subject is <strong>Health IT Safety.<\/strong> This sounded like an odd topic &#8211; considering all the things that go wrong because data is NOT computerized, what are they talking about, re safety risks WITH the technology??<\/p>\n<p>I know I&#8217;m in over my head, being &#8220;just a patient.&#8221; But the more I learned tonight, the more I thought maybe that&#8217;s a good thing.<\/p>\n<p>Because tonight I learned there are truly massive problems with the workflow and flow of information in today&#8217;s systems.\u00a0 Later Thursday I hope to post a link to a 30 minute webcast with 30 minutes of Q&amp;A from December, documenting what some horrifying failures in today&#8217;s big EMR systems.\u00a0 You&#8217;ll judge for yourself, but imagine&#8230;<\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">&#8230;if a system you had to use every day would often display unreliable information, while insisting you do things that make no sense.<\/li>\n<li style=\"line-height: 1.4em;\">&#8230;that the maker of the system insists on a &#8220;hold harmless&#8221; clause, so when something goes wrong, it&#8217;s not their fault. Legally no consequence for failures.<\/li>\n<li style=\"line-height: 1.4em;\">&#8230;that nobody involved in the malfunctions talks about them, and many people are not <em>allowed <\/em>to talk about them, much less collect a bug list.<\/li>\n<\/ul>\n<p>Examples of software issues in these multi-million dollar systems, as documented in the webcast:<\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">The user interface (UI) <strong>may not highlight what needs the user&#8217;s attention. <\/strong>(Ever dealt with a web page where you can&#8217;t spot the info you need? That&#8217;s what these systems can be like.)<\/li>\n<li style=\"line-height: 1.4em;\">Sometimes, <strong>values <em>can&#8217;t be sorted in numerical order<\/em>.<\/strong> The computer system cannot be programmed to do this, so workers have to hunt through a list to find the number they want. (I&#8217;m not making this up.) (Imagine a website where a list of states was unsorted and couldn&#8217;t be fixed.)<\/li>\n<li style=\"line-height: 1.4em;\"><strong>Units of measure get intermingled: <\/strong>a patient&#8217;s weight that must be entered in kilograms on one screen might be displayed on another screen <em>without the units showing<\/em>, so sometimes it&#8217;s interpreted as pounds (because pounds are used elsewhere in the same system). Imagine the consequence on medication dosage.<\/li>\n<li style=\"line-height: 1.4em;\">Workflows are sometimes set up to <strong>insist on certain actions (even if they&#8217;re wrong),<\/strong> so users have to create torturous workarounds. (Remember, &#8220;users&#8221; is the doctors and nurses who are trying to take care of your mother. Part of their attention is consumed by coping with a system that doesn&#8217;t work.)<\/li>\n<li style=\"line-height: 1.4em;\">Attempts at quality control (for instance bar codes for prescriptions) can be thwarted by <strong>real-world circumstances that weren&#8217;t tested: <\/strong>babies who chew off their bar code bracelets, bar codes on prescription bottles that aren&#8217;t durable enough to withstand normal handling, etc. In this study, 4.2% of all bar code bracelets didn&#8217;t work! How&#8217;s <em>that <\/em>for a safety feature?<\/li>\n<\/ul>\n<p>I&#8217;m not making this up; you&#8217;ll judge for yourself when the video is up.\u00a0 <span style=\"text-decoration: underline;\">Pitfalls we wouldn&#8217;t tolerate in the simplest word processing program are commonplace in million dollar medical systems.<\/span> Ending up with erroneous data is <strong>not unusual.<\/strong><\/p>\n<p>And we want to transmit this data? Yikes.<\/p>\n<p>For the purpose of this post:<\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">Imagine that the system running your hospital might be full of crap. (Yes, that word appears in the webcast: a major hospital executive famously rejected a major EMR system and replaced it with another, which he described as &#8220;the cream of the crap.&#8221;) (He said about the system they&#8217;re <em>moving <strong>to<\/strong>.<\/em>)<\/li>\n<li style=\"line-height: 1.4em;\">Given this situation, <strong>what do we ask our government to do?<\/strong><\/li>\n<\/ul>\n<p>Our answers will go to the specific people who will recommend national policy on this. <strong>What advice can we give them <\/strong>on how certify a system so that it qualifies for Federal stimulus money?<\/p>\n<p>You software system people out there: what would <em>you <\/em>do?\u00a0 You don&#8217;t get to demand a different reality; we have to start where we&#8217;re at. What do we do?<\/p>\n<p>You clinicians &#8211; the people who have to use the systems: what would <em>you <\/em>want the government to do?<\/p>\n<p>_____________<\/p>\n<p>Here&#8217;s one radical idea:<\/p>\n<blockquote><p>What if a system could only get certified (and thus get the stimulus money) <strong>if\u00a0the people who use it say it basically works??<\/strong><\/p>\n<p>(Can a system be meaningful if the users say it doesn&#8217;t work?)<\/p><\/blockquote>\n<p>Guiding principle: ask the workers who are directly impacted if the system screws up.<\/p>\n<p>_____________<\/p>\n<p>Another idea: since we can&#8217;t wave a wand and fix everything instantly, <strong>prioritize collecting failure data<\/strong> so we\u00a0 can figure out what needs fixing, and we can prove that a fix has worked. (Software tools to do this are common in high tech.)<\/p>\n<p>Two guiding principles here:<\/p>\n<ol>\n<li style=\"line-height: 1.4em;\"><strong>Lives are at stake. <\/strong>I can imagine no valid excuse for interfering with this effort.<\/li>\n<li style=\"line-height: 1.4em;\"><strong>Let doctors and nurses do their jobs.<\/strong> If a system interferes with my nurse practitioner, to me that&#8217;s a problem. We must stop systems from getting in the way; good systems don&#8217;t.<\/li>\n<\/ol>\n<p>I imagine this has to be combined with amnesty for errors. If people get punished for reporting a mistake, it won&#8217;t happen. (I heard the FAA has such a policy, and it&#8217;s helped greatly in reducing causes of crashes.)<\/p>\n<p>_____________<\/p>\n<p>A third idea, which would need to be thought out: <strong>Allow a second set of eyes<\/strong> to check for obvious mistakes. An obvious resource here is the patient or family or advocate. But given that the systems can be awkward for professionals to use, I&#8217;m not sure how to approach this.<\/p>\n<p>I do know, though, that no stakeholder is more motivated. And as cancer widow and 73 cents artist <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2009\/12\/what-part-of-give-us-our-damn-data-do-you-not-understand.html\">Regina Holliday<\/a> made abundantly clear in December, you might be surprised what a motivated &#8220;just a high school graduate&#8221; can spot that&#8217;s a useful contribution. (And free.)<\/p>\n<p>_____________<\/p>\n<p>What else can we say about achieving safe, reliable data? What policies should they recommend, to cope with the cream of the crap?\u00a0 Comment please.<\/p>\n<p>Some background &#8220;footnotey&#8221; details follow.<\/p>\n<p>____________________________________________________<\/p>\n<p>This workgroup&#8217;s position in the hierarchy:<\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">The <strong><a href=\"http:\/\/healthit.hhs.gov\/portal\/server.pt?open=512&amp;objID=1269&amp;parentname=CommunityPage&amp;parentid=1&amp;mode=2&amp;in_hi_userid=10741&amp;cached=true\" target=\"_blank\">Health IT Policy Committee<\/a><\/strong> is chaired by Dr. David Blumenthal, the National Coordinator for health IT.\u00a0 The committee is tasked with\n<ul>\n<li style=\"line-height: 1.4em;\">recommending a &#8220;policy framework for &#8230; a nationwide health information infrastructure, including standards for the <strong>exchange of patient medical information.<\/strong>&#8221; (That&#8217;s <em>your <\/em>medical data, your mother&#8217;s, etc. etc.)<\/li>\n<li style=\"line-height: 1.4em;\">&#8220;recommendations on standards, implementation specifications, and certifications criteria in eight specific areas.&#8221;\u00a0 In other words, they get to say <strong>what&#8217;s acceptable and what&#8217;s not, <\/strong>when it comes to health IT.<\/li>\n<\/ul>\n<\/li>\n<li style=\"line-height: 1.4em;\">Inside that committee, this is a meeting of the <strong><a href=\"http:\/\/healthit.hhs.gov\/portal\/server.pt?open=512&amp;objID=1473&amp;parentname=CommunityPage&amp;parentid=2&amp;mode=2&amp;in_hi_userid=10741&amp;cached=true\" target=\"_blank\">Certification\/Adoption Workgoup<\/a><\/strong>, which will make recommendations about &#8220;certified electronic health records that support meaningful use, including issues related to certification, health information extension centers and workforce training.&#8221;\n<ul>\n<li style=\"line-height: 1.4em;\">Got that? That&#8217;s &#8220;How do we certify that a given health IT system is reliable, so it contains &#8211; <strong>and transmits<\/strong> &#8211; accurate data?&#8221;<\/li>\n<li style=\"line-height: 1.4em;\">They even get to recommend issues of workforce training. If you&#8217;ve ever implemented a new computer system in your workplace, you know how important that is.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>This meeting&#8217;s agenda:<\/p>\n<p><strong>Adoption\/Certification Workgroup Meeting<\/strong><br \/>\nOmni Shoreham Hotel, 2500 Calvert Street, NW, Washington, DC<br \/>\nThursday, February 25, 2010, 9 a.m. to 3:00 p.m.\/Eastern Time<\/p>\n<p><strong>9:00 a.m. Call to Order\/Roll Call <\/strong>\u2013 Judy Sparrow, Office of the National Coordinator<\/p>\n<p><strong>9:05 a.m. Meeting Objectives and Outcomes: Health IT Safety<\/strong><br \/>\n\u2013 Paul Egerman and Marc Probst, Co-Chairs<\/p>\n<p><strong>9:15 a.m. Identifying the Issues<br \/>\n<\/strong><\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">Ross Koppel, University of Pennsylvania<\/li>\n<li style=\"line-height: 1.4em;\">David Classen, CSC<\/li>\n<li style=\"line-height: 1.4em;\">Gil Kuperman, Columbia University<\/li>\n<li style=\"line-height: 1.4em;\">Alan Morris, Intermountain Healthcare<\/li>\n<\/ul>\n<p><strong>10:45 a.m. Stakeholders<br \/>\n<\/strong><\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">Dave deBronkart, ePatientDave<\/li>\n<li style=\"line-height: 1.4em;\">Justin Starren, Marshfield Clinic<\/li>\n<li style=\"line-height: 1.4em;\">Jeanie Scott, Veterans Health Administration<\/li>\n<li style=\"line-height: 1.4em;\">Susan Edgman-Levitin, National Patient Safety Foundation [invited]<\/li>\n<li style=\"line-height: 1.4em;\">Gay Johannes, Cerner<\/li>\n<li style=\"line-height: 1.4em;\">Carl Dvorak, Epic<\/li>\n<\/ul>\n<p>12:15 p.m. LUNCH BREAK<\/p>\n<p><strong>1:00 p.m. Possible Approaches<br \/>\n<\/strong><\/p>\n<ul>\n<li style=\"line-height: 1.4em;\">Jeff Shuren, FDA\/medical devices<\/li>\n<li style=\"line-height: 1.4em;\">William Munier, AHRQ<\/li>\n<li style=\"line-height: 1.4em;\">James Walker, Geisinger<\/li>\n<li style=\"line-height: 1.4em;\">Edward Shortliffe, AMIA<\/li>\n<\/ul>\n<p>2:30 p.m. Summary Comments from the Workgroup<br \/>\n2:45 p.m. Public Comments<br \/>\n3:00 p.m. Adjourn<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;d like your help preparing thoughts and testimony for a policy meeting I&#8217;ve been invited to attend in Washington next week. For these meetings, one needs to submit prepared remarks in advance, for the committee to digest in advance.\u00a0 And from what I&#8217;ve learned so far about this, there&#8217;s a lot to chew on, and [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[114,367,59],"tags":[3452,305,423,3485,3483,613,3474,3478,3479,3476,1616,3475,340,3477,1142,3482,3484,1210,3480,3481],"coauthors":[8260],"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>What to do about &quot;the cream of the crap&quot;? ONC&#039;s&nbsp;Adoption\/Certification Workgroup meeting - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2010\/02\/what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What to do about &quot;the cream of the crap&quot;? ONC&#039;s&nbsp;Adoption\/Certification Workgroup meeting - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"I&#8217;d like your help preparing thoughts and testimony for a policy meeting I&#8217;ve been invited to attend in Washington next week. For these meetings, one needs to submit prepared remarks in advance, for the committee to digest in advance.\u00a0 And from what I&#8217;ve learned so far about this, there&#8217;s a lot to chew on, and [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/participatorymedicine.org\/epatients\/2010\/02\/what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting.html\" \/>\n<meta property=\"og:site_name\" content=\"SPM Blog\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/participatorymedicine\" \/>\n<meta property=\"article:published_time\" content=\"2010-02-18T09:00:38+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2010-03-07T13:13:13+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/02\/ONC-HIT-banner-300x68.png\" \/>\n<meta name=\"author\" content=\"e-Patient Dave\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@s4pm\" \/>\n<meta name=\"twitter:site\" content=\"@s4pm\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"e-Patient Dave\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/participatorymedicine.org\/epatients\/2010\/02\/what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting.html#article\",\"isPartOf\":{\"@id\":\"https:\/\/participatorymedicine.org\/epatients\/2010\/02\/what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting.html\"},\"author\":{\"name\":\"e-Patient Dave\",\"@id\":\"https:\/\/participatorymedicine.org\/epatients\/#\/schema\/person\/964cf120da8ac17067b46802eb561e5d\"},\"headline\":\"What to do about &#8220;the cream of the crap&#8221;? 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