We would have thought that there was one expression in the IT lexicon that wouldn’t be applied to ehealth, but nope, telecommunications research chief Paul Budde couldn’t help himself: “E-health is rapidly shaping up as one of the key killer apps on the truly high-speed broadband networks,” he declared yesterday, possibly proving that people who spend their working lives dealing with the machinations of big telcos have a diminished sense of the macabre.
As it happened, Budde’s remark couldn’t have been more timely, juxtaposed, as it was, against a keynote address last week by Professor Enrico Coiera, director of the Centre for Health Informatics at the University of NSW, at the 2010 World of Health IT Conference in Barcelona (Slides here) which warned that national scale Health IT developments would inevitably produce an unforeseen disaster involving fatalities … which would make it literally a “killer app”.
“We’ve yet to experience our first health IT plane crash – a health IT failure that claims many lives,” Professor Coiera said. “But I think that will happen… I think it’s unavoidable given what we’re doing. We need to do our best to mitigate that.”
Professor Coiera’s remarks (there are some background papers here, here and here) reflect his and his colleague’s research which indicated that in many cases Patient Care Information Systems (PCISs) – “lauded as one of the key building blocks for a safer health system” – seemed to foster errors rather than reduce their likelihood.
As his joint paper with Joan S. Ash and Marc Berg “Unintended Consequences of Information Technology” points out:
In health care practices in the United States, Europe, and Australia alike, we have seen situations in which the system of people, technologies, organisational routines, and regulations that constitutes any health care practice seemed to be weakened rather than strengthened by the introduction of the PCIS application. In other words, we frequently observed instances in which the intended strengthening of one link in the chain of care actually leads unwittingly to a deletion or weakening of others.
Warning that “some PCISs are designed or implemented in such a way that error can arguably be expected to result”, that paper goes on to identify several potential steps towards calamity that remind me unpleasantly of several years which I spent, as The Australian’s Aviation Correspondent, ploughing through aviation accident reports.
One can only hope that these papers are compulsory reading for medical informatics professionals.
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