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Blog: My kind of cranky

Professionally speaking, I am a connoisseur of a certain kind of crankiness.

I like to listen to people who don't like the deal we've been handed and are willing to grump about it.

Decorum may make the world turn smoothly, but noisy people make it change. Often, they also make my job more fun.

A lot of people in leadership pay lip service to the ideal that they're open to new ideas, but we all know from experience that many are not.

In the magazine this week are short profiles on four of the squeakiest wheels in healthcare information technology—three physicians and a researcher with a doctorate in sociology. They are Dr. Lawrence Weed, Dr. Scot Silverstein, Dr. Deborah Peel, and Ross Koppel, Ph.D.

Each are self-professed fans of health information technology, but each have bones to pick with current systems and practices.

Weed, the father of the SOAP note and the problem-knowledge coupler, has been working since the 1960s to improve healthcare by helping physicians put their brains and training to optimal use. And yes, that decade, the '60s, is correct. For the few in the healthcare industry who don't know Weed, the professor is 89 years old and, if I could buy even a quarter of his mental faculties, I'd trade in all of mine.

Silverstein, teacher, software developer and expert witness, is, as a blogger, devastating in his criticism about IT and patient safety issues, and for good reasons. During the course of our telephone conversations and e-mail correspondence for his profile, Silverstein forwarded me a de-identified copy of an e-mail he said he'd just received—while we were on the phone—from a physician in the Midwest who offered up a blistering critique of a market-leading EHR system. Silverstein says he gets them all the time.

Dr. Deborah Peel is no stranger to the health IT community. Peel has been named by readers four times to Modern Healthcare's annual list of Most Powerful/Most Influential People in healthcare. She's been pounding away for more than a decade on behalf of patients, asking government and industry to place a greater focus on patient privacy concerns, particularly the restoration of patient consent, which was stripped away by HHS from the main federal privacy rule under HIPAA in 2002. But Peel said she sees in technology solutions to many of the privacy problems we face.

Ross Koppel's research first came to my attention back in 2005 when he took a lot of flack for research that concluded an aging computerized physician order-entry systems at a Pennsylvania hospital was not only reducing errors, but also was introducing a limited number of errors as well—something you'd never see in the sales brochure. Koppel caught flack for that piece from IT boosters, and has been catching it for other works ever since.

The criticisms from all four of these health IT iconoclasts can sometimes be harsh, but as veteran informaticist Dr. William Bria said, they should be listened to, nonetheless.

I agree.



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