IT iconoclasts

Each month, more hospitals and office-based physicians buy and use electronic medical records and other health information technologies as the U.S. presses on toward achieving the goal first articulated by President George W. Bush in 2004: providing most Americans with access to an electronic medical record within a decade.

According to the latest data from the CMS, more than 190,000 providers have been paid a total of $10.7 billion to purchase and meaningfully use electronic health-record systems under the federal incentive payment program created by President Barack Obama's 2009 stimulus package.

But health IT has long had its critics, even among its pioneers and proponents, as these four prominent health IT iconoclasts will attest.

All four consider themselves to be proponents of health IT, but they rail against a tide of health IT boosterism. Their targets: misplaced priorities, failing to promote EHR usability and interoperability, inadequate concern for patient safety and privacy, overemphasizing EHR adoption, understating IT costs and overestimating the return on public IT investments.

When it comes to the criticism, “the one thing we can't do with this information is to ignore it,” says physician informaticist Dr. William Bria, longtime president of the Association of Medical Directors of Information Systems and a three-time selection as one of Modern Healthcare's Top 25 Clinical Informaticists.

“Obviously, the maelstrom of change within healthcare, including meaningful use, results in a weariness that could cause physicians and other clinicians to become exhausted and no longer vigilant,” Bria says. “Many, many technologies have come and gone in the history of medicine over the centuries, and it often has been a maverick physician that has called a timeout on ineffective medications or treatments.

“There is little question that, going forward, medicine will be using information tools,” Bria says. “However, I believe it's becoming also very apparent that we need a modulation and a proper regulation of information technologies used in day-to-day care.”