a perspective on usability and safety in health IT
description
Transcript of a perspective on usability and safety in health IT
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a perspective on usability and safety in health IT
dean calcagni, MD
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observations intended to provide a perspective and to stimulate conversation
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standards
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where we have been
proprietary standards
open systems
architecture
agreed upon
standards
DHHS / ONC
carrots
sticks
- if health IT products were more usable, incentives xxxx and penalties wouldn’t be needed
- financial sector for consumer• ATM machine• on line banking
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detour sign
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annual DOD spending on health IT
• $200M for R&D• $2B to operate and maintain
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AHLTA is at the heart of DOD health IT
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CLO-05-002-RevV9
“AHLTA is ‘Intolerable,’ Where Do We Go From Here?”
• Actual title of Congressional Hearing
• Joint Hearing
– House Armed Services Committee Military Personnel Subcommittee
– Terrorism, Unconventional Threats and Capabilities Subcommittee
• March 24, 2009
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CLO-05-002-RevV10
situation with DOD healthcare IT
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Gordian Knot in Phrygia [a section of Turkey] there
was an intricate knot
it was prophesized that the one to untie the knot would become the king of Asia
Alexander the Great came to Phrygia with great aspirations
initially frustrated in his attempts to untie the knot
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Alexander’s solution
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DOD/VA interoperability
• iEHR program for ~ 20 yrs– a succession of generals / admirals in charge– recently a civilian retired army officer
• iEHR office probably will get phased out• RFI on street• likely to move to open systems architecture
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where we have been
proprietary standards
open systems
architecture
agreed upon
standards
Dept of Commerce /
NIST
encourage
facilitate
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NIST
• the Nation's Measurement Laboratory• working with industry– medical software industry– healthcare delivery ‘industry’
• EMR products are B2B products
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usability
The Cost of Technology JAMA, June 20, 2012—Vol 307, No. 23 p2497
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limitations of EMRs
The Cost of Technology JAMA, June 20, 2012—Vol 307, No. 23 p2497
• usability- data entry
• interoperability
• disparate databases
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NIST• before / after
before after
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veterans affairs VISN regions
22 regions means more than 22 different versions of VistA
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in the land of the blind the one eyed man is king
• latin: in regione caecorum rex est luscus, credited to Desiderius Erasmus's Adagia (1500).
poster from the movie Minority Report [2002]
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today is about moving to the right• is it in your interest?• low hanging fruit• most obvious, easiest actions
where we have been
proprietary standards
open systems
architecture
agreed upon
standards
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tectonic plates
pressure is building
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18% of gdp and increasing