After reading HDM’s recent story, “EHR Problems Affect Patient Relationships,” I could not agree more.

I make my living in the health information technology industry, and it works with a different sense of time and urgency than the clients that it serves. In the world of medicine, where a wrong test result or incorrect data can mean the difference between a treatment that restores health and one that destroys it, speed and accuracy are the twin supports from which good medicine hangs.

I.T. managers and developers are concerned about different issues. They are concerned about satisfactory operation of a software package or the uptime in a system. Those concerns are almost always held in isolation from the particulars of any one person's medical needs. It is only the macro behavior of the application that matters. So, when issues or bugs are encountered, they are accumulated to be dealt with in batch fashion. Six months to a year may pass before a known problem is addressed and released, often requiring that more money to be paid to receive the fix.

This is especially true when the number of customers that a software company has is large because in addition to the correctness of the software, there are also the practical concerns of rolling out the upgrade to a large user base. Just as you may have had a problem when installing an update to your personal computer, amplify that by several orders of magnitude, and you have what software companies dread when offering an upgrade or a fix to existing user-base installations.

The examples referenced in the HDM article point out what is the often overlooked dimension of any I.T. rendition of what would otherwise be manual practices: error remediation. In the case of the display window not accommodating a full display of the data, the REAL problem was not necessarily the window; rather it was the data itself. The focus on the cosmetics and not the substance is a dangerous and perilous road in medicine, one that is and should remain contrary to its mission.

Modifying one's EHR should not fall into the trap of becoming as difficult to correct as it now is to correct one's credit record because more hangs in the balance. Above all, the naive trust that seems to spill over from every corner of the room with respect to the benefits of digitizing medicine needs to be tempered with reality. IT employees do not walk on water. They make mistakes, exercise specious judgment in many instances, and make assumptions can work at cross purposes to those of the professionals who work with patients on a daily basis.

If money were not an object (which it is) and if hospital administrators, physicians, and nurses would be truly willing to collaborate with business process management experts and I.T. personnel to re-design how medical services are delivered (which they often are not), then what could be produced would be truly exciting and worth every penny spent on it. Medical services would be delivered rapidly, ongoing costs could be contained, insurance costs would decline, doctors would make money, and patients would be healthier. It can happen, however, only if all the parties are willing to check their egos at the door.

Robert DeFazio is president at Calabria Consulting. He can be reached at

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