NDA Journal 6 Ph.D., write that commercial electronic health records evolved from practicemanagement (i.e. billing) systems, with various modules tacked on. Physicians are locked into pre-internet systems that are not designed to link with third-party applications and do not even embrace existing modular architectures. Complex software that was never properly engineered “must be reimagined, reinvented, and reimplemented constantly.” Entrenched “legacy” approaches and other factors stifle innovation (NEJM 6/14/12). In the same issue, Spencer Jones et al. describe the “IT productivity paradox.” During the 1970s and 1980s, the computing capacity of the U.S. economy grew one hundredfold, while the rate of productivity growth fell to less than half that of the preceding 25 years. In the early 20th century, it took two decades to figure out how to realize the benefits of electricity, as factories initially replaced waterwheels and steam engines with large electric motors running the same central belt-and-pulley system. The breakthrough was to use small electric motors that provided power when and where it was needed. Individual autonomy, self-directed work teams, “home-grown” IT systems relying on user-centered design practices are suggested. Does this spell “fragmentation” and “decentralization,” instead of top-down central planning? The federal government may be using HIT to drive more standardization and tighter regulation and monitoring of physicians—with the sacrifice of professional autonomy and independent clinical judgment. But what if the current HIT bubble bursts, and better HIT helps physicians and patients take back medicine? HIT: The Bad and The Ugly Template Bloat: Pre-programmed template notes are a workaround for time-consuming data entry. Wordfor-word identical progress notes, even lengthy operative reports, are commonplace. The template includes what usually happens and what might happen, and notes may include pages of things that never happened (http://tinyurl.com/afgs23y). Virus-Infected Medical Devices: Software-controlled medical devices are increasingly interconnected and internet-linked. Many run on older operating systems that are vulnerable to hackers and cannot be changed, even to add antivirus software, because of fear of violating FDA rules. Malware is rampant in many hospitals, from drug compounders to image-archiving systems (http://tinyurl.com/d6jcx8j). 0 » Featured Article
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