{"id":7742,"date":"2010-11-15T01:44:17","date_gmt":"2010-11-15T05:44:17","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=7742"},"modified":"2010-11-15T15:21:53","modified_gmt":"2010-11-15T19:21:53","slug":"amia-board-hold-harmless-clause-in-emr-contracts-is-unethical","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/11\/amia-board-hold-harmless-clause-in-emr-contracts-is-unethical.html","title":{"rendered":"AMIA board: &#8220;Hold harmless&#8221; clause in EMR contracts is unethical"},"content":{"rendered":"<p><i>Update the next afternoon: be sure to read the comments, with important updates as the conversation continues.<\/i><\/p>\n<p><a href=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/11\/JAMIA-banner.png\" data-rel=\"lightbox-image-0\" data-rl_title=\"\" data-rl_caption=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-7743\" title=\"\" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/11\/JAMIA-banner-300x57.png\" alt=\"\" width=\"300\" height=\"57\" srcset=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/11\/JAMIA-banner-300x57.png 300w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/11\/JAMIA-banner-600x114.png 600w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2010\/11\/JAMIA-banner.png 676w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>Bulletin &#8211; I just learned about this tonight:<\/p>\n<p>Last Friday the board of the American Medical Informatics Association (AMIA) published a position paper in its journal (<a href=\"http:\/\/jamia.bmj.com\/content\/early\/2010\/11\/10\/jamia.2010.008946.abstract\" target=\"_blank\">abstract here<\/a>) saying that the &#8220;hold harmless&#8221; clause is unethical. One of the paper&#8217;s authors is Dr. Danny Sands, currently President of our <a href=\"http:\/\/participatorymedicine.org\">Society<\/a>.<\/p>\n<p>I hope to write more about it this week, after attending the AMIA conference in DC, but here&#8217;s the basic issue:<\/p>\n<ul>\n<li>For ages, makers of electronic medical record systems (EMR) have insisted on a &#8220;hold harmless&#8221; clause in the contracts a system buyer must sign. It says, in essence, that if any harm comes to anyone because of a system problem, the buyer (the hospital) will hold the manufacturer harmless.<\/li>\n<li>In other words, if anything goes wrong with the system and someone gets hurt, <em>it&#8217;s not the manufacturer&#8217;s fault<\/em>. The reasoning has been &#8220;Hey, you doctors are smart &#8211; if our system displays a wrong value, you&#8217;re supposed to notice it.&#8221;<\/li>\n<\/ul>\n<p><!--more-->I&#8217;m told this policy has been one big impediment to adoption of EMR systems, because it removes all motivation for vendors to fix things that make their product hard to use: if there&#8217;s a bug or the system slows someone down, and a patient gets hurt, <em>the hospital gets sued, not the vendor<\/em>.<\/p>\n<p>If you were a hospital, wouldn&#8217;t that make you eager to buy? What would that do to your trust of the vendor?<\/p>\n<p>Patients, how do you feel about that?\u00a0 Providers?<\/p>\n<p>This came up repeatedly during the Meaningful Use meetings I attended last winter; I wrote about it in &#8220;<a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2010\/02\/what-to-do-about-the-cream-of-the-crap-oncs-adoptioncertification-workgroup-meeting.html#more-4815\">What to do about the cream of the crap?<\/a>&#8221; &#8230; those strong words were how an unhappy buyer described the system they&#8217;d just chosen.<\/p>\n<p>That post links to a video of a lecture last December by Ross Koppel of the U of Pennsylvania, another author of the AMIA paper. Trust me, if you aren&#8217;t yet familiar with how ghastly some EMR systems are, this 30 minute lecture (and 30 Min Q&amp;A) will take you to school quick.<\/p>\n<p>The hold harmless clause has also been an immense impediment to improving the quality of software.\u00a0 Imagine if no matter how badly <em>you <\/em>did <em>your <\/em>job, you were legally not responsible. Better, think about that schlumpf down the hall &#8211; imagine if s\/he was not responsible for errors in his\/her work.<\/p>\n<p>Last spring as the Meaningful Use rules were being written, there was talk of mandating that vendors have to make their systems usable for providers in a harried hospital environment. According to rumor, an industry executive said &#8220;Over my dead body.&#8221; Very funny, making my nurses and doctors use crappy, buggy software. So when I spoke in June at the Agency for Healthcare Research &amp; Quality (AHRQ), I titled my talk &#8220;<a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2010\/06\/over-my-dead-body-why-system-usability-matters.html\">Over My Dead Body: Why Reliable Systems Matter to Patients<\/a>.&#8221;<\/p>\n<p>Thanks to the AMIA board for standing up for quality, and thanks to Dr. Sands, Ross Koppel, and the others who wrote the paper. It doesn&#8217;t have the force of law, but let&#8217;s hope it moves things in the right direction &#8211; for the benefit of the patients &#8211; and yes, I mean your mother, your child, your best friend. Our providers need tools that serve them well in serving us.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Update the next afternoon: be sure to read the comments, with important updates as the conversation continues. 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