Forget Sicko; Here Comes “Clicko”

If Michael Moore has reignited the national debate on healthcare reform with his film “Sicko,” the people on the front lines of health-IT planning and implementation are faced with what one leading medical informatics professional calls “Clicko.”

“We are getting our own version of an exposé starting to shape up,” according to William Bria, chief medical information officer (CMIO) of Tampa, Fla.-based Shriners Hospitals for Children and chairman of the Association of Medical Directors of Information Systems (AMDIS), an organization of CMIOs.

In “Clicko,” the threat is not the alleged greed of corporate profit-mongers, but rather something Bria calls “e-latrogenesis,” the fear that health-IT can cause harm, brought to the fore by several recent peer-reviewed journal articles questioning the clinical benefits of electronic medical records (EMRs), computerized physician order entry (CPOE), and clinical decision support.

For example, a study of computerized drug-drug interactions at the Veterans Health Administration, published in the January/February 2007 issue of the Journal of the American Medical Informatics Association, found that only 30 percent of clinicians who prescribed medications thought the electronic alerts provided useful information most of the time.

“Is technology really the problem?” Bria asked at the 16th annual Physician-Computer Connection Symposium, a high-level AMDIS meeting last month in Ojai, Calif. “There isn’t real tight integration between systems and clinical decision support,” he said, suggesting the true issue is application, not the technology itself.

And CMIOs have a responsibility to provide the integration -- and to communicate their needs to their superiors and system users alike.

“This is a lot of hard, on-the-ground work. This is work that does not stop,” Bria said. “People here need to communicate realistic expectations,” he told the gathering of about 150 CMIOs and other experts in applied medical informatics.

Yet, unlike at early editions of the Physician-Computer Connection, the tech-savvy attendees at the 2007 meeting no longer are lone wolves in a paper-filled wilderness. Sure, they still have to fight to be heard, but for different reasons than in past years.

“The maturation of the national discussion on healthcare has highlighted informatics both for what it promises and what it hasn’t delivered,” Bria said.

The looming threat of disruption from outside the healthcare system -- perhaps from the likes of large employers or tech heavyweights like Google -- represents a “sleeping giant” that could rock healthcare, according to Bria, and CMIOs need to understand what’s coming.

“Our world is set to be shaken,” Bria told his fellow CMIOs. “We have to get ahead of this curve for the benefit of patient care … and for our survival.”

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