Raising questions

Researcher Ross Koppel started an uproar in 2005 when he and a colleague coauthored an article in the Journal of the American Medical Association that found a first-generation computerized physician order entry system (CPOE) at the Hospital of the University of Pennsylvania was simultaneously creating new errors even as it reduced others.

Just three years earlier, the Leapfrog Group, a healthcare initiative of the Business Roundtable, had provided a major boost for CPOE, launching a promotional campaign to encourage its high-powered corporate leaders to lean on local hospitals to adopt the then-rare CPOE systems as a way of improving their employees' healthcare quality and controlling their company's healthcare costs.

Koppel's bombshell—he's now an adjunct professor of sociology at the University of Pennsylvania—brought down the wrath of information technology boosters. The Healthcare Information and Management Systems Society, a health IT trade group, challenged the study's “methodology and its subsequent outcomes,” and criticized its authors for their “limited view” and not “looking at the big picture.”

Undeterred, Koppel, who holds a doctorate in sociology from Temple University and serves as Penn's principal investigator in the school of medicine on the study of hospital workplace culture and medication error, kept stirring the pot.

In 2009, he revealed in another JAMA article that health IT vendors' contracts included “hold harmless” clauses that shielded software developers from legal liability for medical errors their systems caused, even if the developers had been warned about the defects.

“That got me major upheaval,” the worst of his career, Koppel recalls. “The vendors tried to say it was untrue. And they tried to show that by saying, 'Show us examples where we settle (lawsuits) on a problem.' ”

There are no open trials, Koppel says, because when there is a settlement on suits alleging wrongful death, the surviving spouse or family member signs a release, “the hospital doesn't want to talk about it (and) the vendor doesn't want to talk about it. All of these things are settled hush-hush. There are no public settlements available.”

In 2011, Koppel testified before a federal IT policy subcommittee that “usability” of EHRs had been “largely ignored” and that a program to test them for ease of use is needed—just as the Office of the National Coordinator for Health Information Technology at HHS has EHRs tested for functionality.

Last fall, in a scathing co-authored critique in the Wall Street Journal, Koppel and a colleague described today's clinical software as “generally clunky, frustrating, user-unfriendly and inefficient.” They added, it is “already common knowledge in the healthcare industry that a central component of the proposed health IT system—the ability to share patients' health records among doctors, hospitals and labs—has largely failed.”

Koppel says the entire focus to date has been getting doctors and hospitals to buy the software. Interoperability is added only “very slowly and very incrementally,” he says. The main federal push is to boost EHR adoption “like that big thermometer outside the United Way. It's a false measure of success. The result is we've created innumerable Towers of Babel. We've invested hundreds of billions of dollars in technology that can't communicate across the hallway.”

Had the IT systems first been made interoperable and easy to use, he says, physicians would have flocked to them without incentives.