If patients die as a result of health information technology (HIT) defects, the clinicians will be liable—not the vendors. Hospital administrators have signed contracts with “hold harmless” clauses that protect their HIT vendors.
At the same time, like a Soviet-style Ministry of Information, the vendors demand secrecy about the defects. Some hospitals maintain lists of HIT defects, which might contain thousands of items, some of which pose considerable risks to patients. But they are contractually bound not to disclose them (Health Care Renewal 3/26/08).
“Enforced nonsharing of software problems is an industry norm,” write Ross Koppel and David Kreda, although anathema to improving patient care or to evidence-based medicine (JAMA 2009;301:1276-1278).
Vendors avoid liability by relying on the doctrine known as “learned intermediaries,” they note. Users are medical professionals with the expertise to recognize the errors and protect the patients from harm.
Though supposedly the panacea for correcting inefficiency and medical error, “implementations of HIT are massively complex and fraught with delays, errors, resistance, work process redesign, frustration, and outright failure,” they observe, citing numerous references.
There has been very little change in the difficulties with HIT over the past 35 years, writes Scot M. Silverstein, M.D., of Drexel University, College of Information Science and Technology. Those responsible for HIT are not held to the same standards of accountability as clinicians are, though both patient wellbeing and institutions’ financial resources are at risk. Dr. Silverstein has developed a website about “what has been shown best not to do.”
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