There are a lot of hopes placed upon the role of healthcare IT to address the ills of the healthcare industry, some are legitimate, many are not. One such limitation I call the Coss Conundrum which goes like this.
Suppose for a moment that you and I are in a business arrangement in which your responsibility is to beat me unmercifully about the head and shoulders with a stick; my responsibility is to provide you with a stick. Just how big a stick would you expect? If you’re thinking anything bigger than a standard yellow pencil, you’re likely to optimistic.
Here in lies the conundrum. The stick, in this case, is healthcare provider information, and it is here where the government’s efforts run up against the pragmatics of broad based implementation. Why would any private practicing physician pay money for an information system if, like the conundrum suggests, the practitioner feels that the information may be used like a stick with which to later be beaten? Few will speak of this out loud, but the issue is real and legitimate. Any mishandling of patient clinical data, either to violate the privacy of the patient, or even to punish the choices of the practitioner, results in the same limitation.
Using information needs it’s own sets of ethics and guidelines. The technology, thought considerable, for the EMR is not sufficient to understand, there remains the evolutionary psychology and professional ethics to provide the assurances required for adoption.
Tom
