The good, the bad

The title of Dr. Scot Silverstein's teaching website at Drexel University, “Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties,” summarizes the veteran physician informaticist's general outlook on the current state of affairs in health information technology.

It tells you nothing, however, of the passion with which Silverstein speaks or writes about the subject.

Also a frequent contributor to the popular reformist “Healthcare Renewal” blog, Silverstein writes with the fire you might expect coming from a self-described computer geek who says he has witnessed a faulty electronic health-record system mysteriously drop a single medication from a patient's medication list. That missing drug led to a medical error that resulted in a year of suffering and, eventually, that patient's death, he says. Silverstein's passion is even more understandable when he tells you that patient was the doctor's own mother.

“The med, somehow, just disappeared,” Silverstein says. “It was confirmed at triage, and then the system just lost it. She didn't get her heart medication, which led to cardiac arrhythmia. And that led to a cerebral hemorrhage from the anti-coagulation medicine to deal with her heart arrhythmia.”

The health IT world, Silverstein says, parts neatly between “good IT” and “bad IT.” There are those who push hard for the good and complain about the bad, physicians and other clinicians he calls “pragmatic,” and for whom he has sympathy and respect. And then there are those who stay silent, ignoring or acquiescing to the bad, the “hyper-enthusiasts” for whom he holds only unmitigated scorn.

“The doctors who don't speak up about health IT, who work around it, which can cause its own bad results, those are traitors to the oath they took to first do no harm,” he says.

“Physicians are still being accused of being Luddites for not adopting this stuff,” Silverstein says. “Physicians are not Luddites. When it's good IT, it's used. I see the tension now between hyper-enthusiasts, who turn a blind eye to the negatives, and pragmatic physicians and nurses who have work to do.”

From 2000 to the end of 2003, Silverstein ran a library at a research facility of the pharmaceutical giant Merck, learning lessons there, he says, that could and should be applied to clinical IT on the provider side of the healthcare system.

“I look at health IT and see it needing the same rigor applied to it as pharma IT and medical devices, which are regulated,” he says. He says health IT needs regulation and will have it, whether self-imposed or federally mandated, as medical devices are.

Silverstein is an adjunct professor in healthcare informatics at Drexel who has built health IT systems from scratch as well as used and helped implement systems others have built. For all his years of criticism–and he's been at it long before his mother's death—he remains a fan of healthcare IT.

“I got into this field 20 years ago to help improve care for patients,” Silverstein says. “That's still my goal.”