From the Horse’s Mouth

Cross the healthcare technology chasm with computers? Evil Knievil had better odds when he tried to cross the Snake River Canyon on a rocket bike.

LarkinWhat are these people talking about? Don’t they know anything about technology? Those idiots should have asked me. Doctors. They think they know it all. Well, if they’re not smart enough to ask me before spouting off on the right way to use technology, I’m sure as heck not going to help ’em. I’m not volunteering until they say “Please!”

Sound familiar?

I’ll admit I felt a twinge of the sullen sibling routine as I listened to a press conference by an Institute of Medicine (IOM) panel announcing its recent report, “Crossing the Quality Chasm: A New System for the 21st Century” (which can be found at

“As medical science and technology have advanced at a rapid pace, the healthcare delivery system has foundered. Between the care we have and the care we could have lies not just a gap, but a wide chasm,” said chairman William C. Richardson, president and CEO of the W.K. Kellogg Foundation – the same Kellogg Foundation that helped create shared service biomedical technology programs in 1973.

How does the IOM Committee on the Quality of Health Care in America propose to make the crossing? With computers. Happy, seamlessly integrated information systems that share patient data without proprietary boundaries. And, with Kennedy-esque zeal, they called for the elimination of most handwritten clinical data by the end of the decade.

Cross the healthcare technology chasm with computers? Evil Knievil had better odds when he tried to cross the Snake River Canyon on a rocket bike. Any biomed could have told ’em that … and there’s the rub. It’s sad that a committee headed by the current boss of the philanthropic folks who provided the seed money that fertilized our multibillion-dollar healthcare technology management business did not know our industry exists!

In this issue we offer other stories of physicians who, frustrated by technology and convinced there was nobody they could turn to, took equipment issues into their own hands. In each case, their actions received widespread public approval and generated hand-wringing editorials in the daily papers decrying the absence of leadership in the management of medical technology.

For example, Lane F. Donnelly, MD, a radiologist who studied the techniques used for pediatric CT scans, learned that the mA settings programmed by manufacturers are based on average adult patients. (See p. 12.) Nobody had ever bothered to adjust the current for children, and as a result, kids got as much as five times the dose needed for a good image. Unable to get the technology support they needed, Donnelly’s team went ahead and created their own pediatric technique charts, and they went public. The public went ballistic.

Then there is the pronouncement by the American Heart Association’s Council for High Blood Pressure Research that the move to electronic and aneroid sphygmomanometry is ill-conceived. Why? Because the group was convinced that nobody was managing or maintaining the devices. (See p. 7.)

I asked the lead author of the editorial, Daniel W. Jones, MD, if he had spoken to any biomeds. He hadn’t. He wasn’t even aware there was an entire industry created decades ago so that he and his colleagues would not have to worry about the accuracy of sphygmomanometers. In fact, he seemed quite pleased to learn we existed.

Some of you may be saying, “Information system standards, radiology techniques, piddling little blood pressure cuffs? They’re not my job!” Wrong answer. Note that all of these stories made the nightly news. Patients want to know about the quality of their care. Near as I can recall, Tom Brokow has never broadcast a report on an ISO that saved 0.25 FTE through the elimination of bed inspections.

So, if you prefer to remain a cynical Dilbert and ignore opportunities to participate with clinicians, heed this: Dilbert’s TV show was cancelled.

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