I agree with Dr. Mark Coan that information technology is not the cure-all for healthcare, but I take issue with a few of his views. He suggests that using IT to improve delivery and quality of services will lead to "consistency and mediocrity" and "away from innovative, sometimes inelegant, inventive and entrepreneurial" approaches to care. He further notes that IT will guarantee a "smoothing of the curves and a decrease in the general rise representing improvements."
Since when does consistency necessarily lead to mediocrity? This is the time-worn argument against "cookbook medicine," whether the blame is placed on guidelines or IT. After more than 20 years of private practice, I'm involved daily in reviewing inpatient quality and potential (or actual) errors.
Frankly, I look forward to a "smoothing of the curves," i.e. decreased variation. We badly need this, and owe it to our patients. While Dr. Coan may feel that variation reflects conscious innovation or personalized care, too often it results from oversights, or lack of physician awareness of the effectiveness (or danger) of their "entrepreneurial" care. Patient-safety data show clearly that improvements in consistency of treatment are needed to avoid harm. Despite the "general rise representing improvements," we still see far too many low points on the curve. For example, these "inventive" approaches include omitting deep-vein thrombosis preventive measures, or feeding stroke patients before a swallowing evaluation is done, because "he's hungry and I checked his gag reflex"resulting in aspiration pneumonitis.
I agree that we need to develop and monitor IT systems to avoid unintended consequences. However, relying on our past approach of "each physician knows best" is not the answer.
Paul F. McKenney, M.D.Acting vice president, medical affairs/medical directorKent HospitalWarwick, R.I. To submit a letter to the Modern Physician Reader Blog, click here. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.