A computer security specialist speaks out on VistA content protection or digital rights management in a medical environment: ‘…the field of medical imaging either bans outright or strongly frowns on any form of lossy compression because artifacts introduced by the compression process can cause mis-diagnoses and in extreme cases even become life-threatening. Consider a medical IT worker who’s using a medical imaging PC while listening to audio/video played back by the computer (the CDROM drives installed in workplace PCs inevitably spend most of their working lives playing music or MP3 CDs to drown out workplace noise). If there’s any premium content present in there, the image will be subtly altered by Vista’s content protection, potentially creating exactly the life-threatening situation that the medical industry has worked so hard to avoid. The scary thing is that there’s no easy way around this – Vista will silently modify displayed content under certain (almost impossible-to-predict in advance) situations discernable only to Vista’s built-in content-protection subsystem…’

(Slightly updated: 12/12/05) Does it bother anyone that for years, Health Information Technology (IT) successes implied by the news and even in casual conversation may largely be an illusion? Does it bother anyone that Regional Health Information Organization (RHIO)’s might be failing at a very high rate? It is important to ask the question given the United States rich history of failure and two notable successes with large scale Health IT.

For example, the announcement of a hospital going ‘all digital’ or rollout of a multi-million dollar record system makes great press releases but is it actually working years after the parade is over?

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Slashdot has a posting that links articles that are calling the UK National Health Service $12-24 billion project the ‘Biggest IT disaster ever’ in the making: ‘…Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies…’

A great example of the problems that you have with using a proprietary license for your EHR has been posted on GPLMedicine.org
From the main article: (McGoverns) tech support contract with Boca Raton-based Dr. Notes was originally for $1,200 a year but the company wanted her to pay $5,000 a year. When McGovern refused, the company didn’t give her an updated monthly password needed to access the program and view records, she said. You cant make this stuff up.’

Fred Trotter

Health Data Management is reporting that Regional Health Information Organization (RHIO) are not working: ‘…information technologies being used in the projects to exchange health data among disparate computer networks may not be compatible with each other…Most state programs have yet to actively engage a wide spectrum of stakeholders and actually begin exchanging clinical data, according to the report…’ This was predicted six months ago in a Linux Medical News editorial entitled: “RHIO’s and the Illusion of Health IT Success” with such choice lines as: ‘…RHIO’s makes disparate, local healthcare entities into mini-standards organizations. This is something they are almost always ill-prepared to do. RHIO’s will make strategic decisions (if they are able to make decisions at all) based on local politics, local needs and whatever information they can muster at the moment. Vulnerability to a good sales pitch at the time of decision can ensure a sub-optimal solution…’

It looks like a botnet attack has shut down a California Intensive Care Unit. According to this Slashdot posting. Ah the sum of all fears: a snot nosed kid bringing down a system that people’s lives may depend upon is here.

While not directly related to FOSS in medicine, CIO magazine has an article on what can happen if an organization fails to act on upgrading/changing critical systems (in the case of Comair, a $20 million loss and 1,100 flights delayed or canceled) as well as how such systems can become completely enmeshed in the business it serves: ‘…Unfortunately, you can’t see a crew management system age the way you can see an airplane rust. But they do. “These systems are just like physical assets,” says Mike Childress, former Delta CTO and now vice president of applications and industry frameworks for EDS. “They become brittle with age, and you have to take great care in maintaining them.” Parallels can be drawn between the airline industry and medical computing. This link courtesy of Slashdot.

An anonymous reader wrote in with these un-edited comments: ‘…WE ARE HAVING EXTENSIVE ———-EXTREMELY EXPENSIVE ISSUES WITH WEBMD/MEDICAL MANAGER WITH OMNIDOC / OMNICHART OUTRAGEOUS PRICES FOR “SUPPORT” WE END UP DOING OURSELVES. ANY WORD ON ANYTHING TO HELP. If you will please take out my name and email address…fighting webmd and issues with these products but must use them every day. The Webmd conference each year in Florida is the biggest group of angry owners i have ever seen…’ Linux Medical News had a discussion about what to do. One reader comment may be salient: ‘…overall the software is not better or worse than other commercial software solutions.
All of the above is another way of saying that from my perspective all of the commercial software products for medical practice management are substandard, which is why i am looking to open source software. in other words, my first reason for considering open source software is not cost but software quality… There has been no new information that I know of since Federal Agents Investigated in 2003.

A St. Petersburg Times story states: ‘… A $3.5-billion computer overhaul at veterans hospitals across the country is poised to fail unless the Department of Veterans Affairs makes drastic changes, according to a closely guarded government study obtained by the St. Petersburg Times .

The multiyear project is designed to modernize almost all phases of hospital computing at the VA, including appointment schedules, lab reports, drug prescriptions and a clinical record system already widely admired as one of the best in the world…’ Perhaps they should have read Things You Should Never Do by Joel Spolsky.

The Washington Post has an article on how Cedars-Sinai reverted to pen and paper after an electronic medical record deployment misfire and is now a ‘cautionary tale’. This is worth reading with all of the attention and money these systems are getting. Note the $35 million dollar price tag with nothing to show for it: ‘…For every doctor, nurse and executive here, there is a different explanation of what went wrong. The technology, created in-house, was clunky and slow. Only a fraction of the 2,000 doctors with privileges at the hospital were involved in developing the system, even though they faced a dramatic change in the way they practiced medicine, from jotting notes on a clipboard to logging onto a computer to type in their treatment and medication orders. Training was insufficient, and administrators opted for what Hackmeyer called a “big bang” implementation rather than switching one ward at a time…’