In response to Joseph Conn's "Paper records more secure: survey":
What are we to think when a supposedly not-for-profit healthcare organization such as Kaiser Permanente uses a "survey" to manipulate its patients? As Louise Liang (a Kaiser senior vice president) expressed it, Kaiser conducted the survey to increase patient awareness of healthcare information technology, and create "more of a pull" for IT than a push. In other words, Kaiser was not conducting a genuine survey so much as using the survey form as a public relations tool to create favorable impressions of EHRs in its patients (even though, as she admitted, "electronic medical record" means different things to different people).
After spending nearly $4 billion on Kaiser's current EHR system with little quantified benefitnot to mention the resources spent on the EHR system Kaiser tried to build itself throughout most of the '90sit's not too surprising that Kaiser would try to manipulate its patients into an ex post facto acceptance of its managerial malfeasance. After all, Kaiser management needs countervailing PR for the increased premiums that must be charged to cover the money it squandered on EHR systems, money that could have been spent on better clinical systems and procedures known to improve outcomes or money to attract higher-quality staff.
In The Wealth of Nations, Adam Smith identified the principal/agent problem in business. As businesses get largermore complex and dispersed than they ever were in the 18th centuryit becomes much more difficult to prevent managers from placing their interests above those of the people they are supposed to be serving. It also becomes more difficult to expose malfeasance and incompetence, and once exposed, to see justice done because of the way the legal system operates.
Tom ShillockPresidentM2 ConsultingPortland, Ore.To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.