I personally like to call it blog sparring. Basically, you take someone else’s post and provide the opposing perspective or at least you add to the conversation that they started. I love these types of interactions with other bloggers. Plus, I love the deep dive into a specific topic that happens when you do this type of blogging. As a reader, I think it’s fun to read the various blogger’s perspective on the topic. So, on that note, I’m going to make the next week, Blog Sparring Week.
Let the parallels between the EHR and the ATM, and between patients safely visiting the hospital and flying in a plane stop here. I find it interesting that humans natural gravitate towards drawing comparisons on past experience. It’s a lot like how the federal government based the model for Regional Extensions Centers (RECs) on the model for US agriculture, which was intended to disperse new info to the family farm. Alike agriculture, the goal is to ensure that HIT is reaching the family physician and providing advice in terms of selection and implementation. Yes, it’s true that there are lessons to be learned from other industries, but as Keith Boone of at the Healthcare Standards blog recently pointed out, it must be done thoughtfully.
The patient in the National Journal article, after being sold a flight departing months past his desired travel date, after he is required to fax in a consent form, and after he must call a separate company to handle his baggage, informs the customer service representative that in a modern system, he would be sold “a safe round-trip journey, instead a series of separate procedures. It would have back-office personnel using modern IT systems to coordinate my journey behind the scenes. The systems and personnel would talk to each other automatically. At the press of a button, once I entered a password, they would be able to look up my travel history. We’d do most of this stuff online.” He’s describing the way most industries operate today, from air travel to banking to freight transportation, all of which are able to successfully communicate between systems, companies and types of data.
While it’s true we often wish that the healthcare industry was as efficient and safe as the aviation industry, the fact of the matter is, patient safety is harder and will require more effort as Jeff Terry, Managing Principal, Clinical Operations, asserted on the GE Healthcare Quality & Safety blog.
Why is patient safety harder? You be the judge:
- On any given day in the United States, there are about 800,000 inpatients and many more outpatients. By contrast there are about 30,000 flights per day.
- The major US airlines fly about 25 different types of planes. By contrast, the ICD-10 lists 12,420 diseases. Each plane, like each disease, requires different protocols to manage.
- There are 2.5M nurses compared to 200,000 pilots
It’s very similar to Godwin’s law, but related specifically to Health IT. In any sufficiently long discussion of Healthcare IT, the probability of a comparison being made to the financial sector approaches unity. Keith’s corollary is that that in any sufficiently long discussion of patient safety, the probability of a comparison being made to the aviation industry also approaches unity.
- Transaction payload – Single pieces of data are not being transmitted in the payload with healthcare. Conversely, financial transactions however are very small (include account holder identity info, merchant identity info, and a transaction amount.
- Business model – in financial transactions, there’s a payment model already built in, who would pay for it in healthcare transactions and why?
- Regulation, Trust and Security – The financial industry deals with audit trails, logging and security, but again, back to point #1, single pieces of data aren’t in the payload, there are instead hundreds or thousands – especially with imaging studies.
Aviation experts quoted in a Wall Street Journal article predict the accident will result in a shake-up of pilot training over concerns pilots have abdicated too much responsibility to computer aids and, when those aids malfunction, can’t handle emergencies because of rusty piloting skills.
Not sure anyone would argue the health care industry is in any immediate danger of being over-automated, but the question of whether automation serves the user, or vice versa, is an important one. Industry gurus typically point to aviation as a model for medical reform, and there is absolutely no question that automation has increased aviation safety. But automation shouldn’t lead us to a point where a pilot stops being a “real” pilot, or a clinician a “real” clinician.
Well put Greg. As much as computers aid our decisions, we should never completely remove or undervalue the human element.