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Former Medscape and Journal of the American Medical Association Editor Dr. George Lundberg had this response to Dr. John Haughton's opinion piece on government Health IT spending. ("Stimulus Bill Offers Docs Big Incentives but Demands Effective Use.")

"There are many reasons why physicians in general (excluding
pathologists, radiologists, intensivists, anesthesiologists,large
multi-specialty groups) have not yet embraced healthcare information
technology. I refer interested readers to for Blake Lesselroth's unique take
on the barriers to full clinician adoption of HIT
and how to overcome
some of them.

 Dr. Robert Rowley's post  on his company's advertising based  electronic medical record system ("Freenomics and Healthcare IT') prompted this response from Scott Shreeve MD

I was an early critic of Practice Fusion when I first heard of their business model. However, I have come around for many of the reasons that Dr. Rowley and Dr. Kibbe mention. In fact, I would suspect that I am the only commenter on this section that has actually used the software in to take care of patients (Crossover Health personal health advisory service).  Getting a tool (an EMR) into the hands of providers (much better than paper) who can use it to improve patient care is a good thing. The fact that the tool comes with some branded messaging is tolerated because the price (free) and the ease of use is so compelling (installed in minutes).

In terms of software, I have found the features/functionality of the software to be sufficient for now, the look and feel to adequate, and the rate of ongoing development to be intriguing (several key updates over last several months). There are definitely some holes that need to be plugged, some functionality that needs to be added, but overall I find it from an EMR perspective to be "good enough".

In terms of business model, the adware component is irritating. They have flashing ads for vendors, devices, drugs, and non-medical things like mortgages. I consider all of this "collateral damage" and just completely tune it out. I never have and never plan to click on any of the ads and just mentally block them out. Again, if this is the way to help "subsidize" my use, then I tolerate it voluntarily. If it becomes too distasteful, than I can pony up $250 per month to have no ads. I know this going in and accept it at face value.

In terms of ethics, come on man. Do you think I am going to start prescribing something because of an ad that I am ignoring? The detail people are much more influential because they develop a personal relationship, buy you food, and provide peer reviewed studies that can alter your decision making. I just don't see that same type of connection or influence from impersonal ads that I am ignoring anyway ….

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  1. I agree with Dr. Kibbe’s “clinical groupware” concept, and I applaud it. “Groupware” jibes with my biases:
    1) that clinically useful electronic health records will be market-based, not government-based;
    2) that web-based clinical records will outpace, out-hustle, and eventually submerge propriety records;
    3) that for every complex problem, there is a complex understandable solution;
    4) that health record systems that do not allow multiple parties to communicate are basically useless.
    Kibbe’s “clinical groupware” solution reminds me of the principles enunciated in the book Edgeware: Insights from Complexity Science for Health Care Leaders (VHA, Inc, 1998).
    These insights include,
    • Good-enough vision – build a good-enough vision and provide minimal standards rather than trying to work out every detail.
    • Tune to the Edge – Tune your place to the edge by fostering the “right degree” of information flow, diversity and difference, connections inside and outside the organization, power differential and anxiety.
    • Multiple actions – Go for multiple actions ar the fringes, let direction arise rather than believe you must be sure before proceeding with anything.
    • Chunking – Grow complex systems by chunking by allowing complex systems to emerge out of the links among simple systems that work well and are capable of operating independently.
    For every complex situation, there is a complex solution requiring collaboration and cooperation, and it is usually right.
    P.S. – By the way, as this is posted, I read in the WSJ re: the Senate’s stimulus bill,”The deal jettisons or pares back a number of items Obama wanted. Funding to computerize health records is all but gone, as is a national study on the comparative effectivenss of health treatments.”

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