Does clinical engagement have an end point?

Campaigns such as eHealth Insider’s CCIO initiative have led to a raft of clinical staff becoming more formally engaged with NHS IT. But is there a line between clinicians becoming engaged in healthcare technology and actually building their own systems in an attempt to support an entire department or organisation?

I read with fascination an article on The Health Care Blog  titled ‘Why doctors should stay out of the business of building EHR’s.’  Author Fred Trotter, a healthcare data journalist argues: “It is now 2013. It is time for doctors to stop ‘writing their own EHR’ from scratch. They need to bow out of this in favour of people who have developed expertise in the area.”

He bases his arguments on decades of working in the electronic health record (EHR) industry and adds that while clinicians may believe that they are EHR experts, the likelihood is that they are instead an EHR expert user.

He writes: “This difference is not unlike your relationship with your favorite thoracic surgeon. Or for that matter, your relationship with the person who built your car. The fact that you are capable of expertly evaluating and using EHR products does not mean you are qualified to build one.”

He adds that the ethical situation that clinicians are putting themselves in by becoming more deeply involved in development and build is a complex and difficult one.

“Performing heart surgery without being a heart surgeon, building and driving your own car without being an automotive engineer and a doctor coding their own EHR system from scratch all have the same fundamental problem: “You might be smart enough to pull it off, but if you don’t you can really mess up another person’s life. Make no mistake, you can kill someone with a shoddy EHR just as easily as by performing medical procedures that you are not qualified for or by driving a car that is not road-safe.”

Although, Trotter’s controversial views will no doubt exasperate and even rile clinicians who have become more involved in NHS IT, he has a valid point in raising the question of where a clinician’s engagement starts and, if necessary, should finish. Is there a point where the IT guys should step forward and say, ‘we’ll take it from here’ or ‘we’ll engage with you at critical times in the design and implementation process’ or should the healthcare professionals be given the opportunity to literally build their own solutions if they are doing so to meet a precise, personal need?

Trotter highlights several dangers in allowing clinicians to do this, he adds that a feature that may frustrate one clinician may be of benefit to another user and, moreover, it may be in place to protect a patient. His view is perhaps more that no single person or group of individuals from the same background can build an EHR on their own. Building any software is a technical and long process irrespective of whether you know what you want to achieve on behalf of your community.

Perhaps a more constructive point that he raises, is around open source, which he likens to a ‘kit car’. Open source bridges the gap of ensuring that the fundamental components are there but that clinicians can adapt and build to create the features that they require to support them. Meanwhile, experienced health IT professionals either within their own organisation or at a commercial level are there to offer support while ensuring the basic fundamentals are put in place.

This therefore results in clinicians providing much needed clinical input but also being able to utilise the existing resource of experienced IT staff to find a solution while ensuring they have the time they need to care for patients.

So, I’m looking for comments – is there a specific role for clinicians in IT and should that role be limited in any way?

Keen to hear your views…..@highlandmarktng