(Note to readers: also see my Jan. 7, 2010 followup post "Socky the Meditech Sockpuppet on Vacation?")
At "Are Dissmissive Industry and Government Reactions to Physician Concerns about EHR's and other Clinical IT Simply Perverse?" I observed that cavalier dismissals of physician reports on HIT unusability and difficulties fit quite well the definition of "perverse:"
Merriam-Webster dictionary:
Perverse (adj).
Etymology: Middle English, from Anglo-French purvers, pervers, from Latin perversus, from past participle of pervertere
Date: 14th century
1 a : turned away from what is right or good : corrupt b : improper, incorrect c : contrary to the evidence or the direction of the judge on a point of law
2 a : obstinate in opposing what is right, reasonable, or accepted : wrongheaded b : arising from or indicative of stubbornness or obstinacy
3 : marked by peevishness or petulance : cranky
4 : marked by perversion : perverted
In a later post, "An Honest Physician Survey on EHR's" I reported on the comments submitted by hundreds of physician members of the American Association of Physicians and Surgeons (an organization mainly of physicians in private practice who strongly support physician independence and other conservative views, founded in 1943) in a 2008 survey about HIT:
AAPS - PHYSICIAN ATTITUDES & ADOPTION OF HEALTH INFORMATION TECHNOLOGY (PDF)
The common theme in their feedback was how HIT in its present form disrupted private practice physicians, distracted them from the physician-patient relationship and impaired their ability to properly care for patients. See the above-linked post and AAPS survey report.
An anonymous, usually lively and even combative reader "IT Guy," who claims to be an IT professional at an HIT vendor, on occasion leaves comments to my HIT posts.
These are typically in the form of unsubstantiated refutations of the material in the posts, and ad hominem attacks in the unmitigated defense of HIT, e.g., referring to this writer as "a teaching professor at a major university who has virtually no understanding of statistical analysis" or as a "grandstanding self-promoter" (See, for example, here at January 5, 2010 8:53:00 AM EST. Read the entire thread.)
In the latest case, "IT Guy" commented on my report of the AAPS HIT survey responses as follows:
IT Guy said...It's the March of the Ludites.
Thanks for a very funny post.
I failed to see the humor in dozens of adverse comments about HIT from private practice physicians, and replied with a link to my initial post about HIT industry perversity mentioned above, which elicited the even more perverse response:
IT Guy said...No one is dissmissive of legitimate concerns. Luddites are a different story. Most of the "concerns" in that diatribe are of the Luddite variety.
In other words, a survey of physician concerns is a "diatribe" and it is up to the "IT guys" to determine which physician concerns are "legitimate" and which are of the "Luddite" variety.
"IT Guy" remains anonymous and has been so since he first started posting comments here, despite prodding to reveal his identity to better facilitate an understanding of where his/her viewpoints arose. He/she has neglected to do so.
Even the blogger profile is blank, click to enlarge:
Now, I welcome anonymous comments and have a thick skin - to a point. When the comments go ad hominem or perverse, I do consider deleting them.
However, when such comments are potentially revelatory of major issues, I promote and amplify them - as now. Read on.
This person also apparently uses the anonymous moniker "Programmer" at the HIStalk blog where he similarly attacks my comments made under my actual name S Silverstein or under MedInformaticsMD. The HIStalk site owner actually edited out defamatory comments made about me in Oct. 2009 at HIStalk comment #28 at this HIStalk comment thread and apologized for this entry on his blog:
#28 Programmer [at HIStalk blog - ed.]Now, back at HC Renewal see this combative comment thread where "IT Guy" a.k.a. "Programmer" refers to that removal, and repeats the above statistical faux pas and ad hominem ("just to make sure I read the whole thing"), and adds another ad hominem for good measure. I let them remain. (Comment dated October 20, 2009 1:35:00 PM EDT.) HIStalk's "Programmer" and HC Renewal's "IT guy" are apparently one and the same.
October 20th, 2009 at 11:57 am
Getting to the core of this posting, I repeat, when such comments are potentially revelatory of major issues in HIT, I promote them - as here.
The raison d'être for this posting is an interesting pattern:
Before "IT Guy" posts comments at HC Renewal, "hits" appear from a major health IT vendor's IP in our publicly-accessible Sitemeter log, with outclicks to the comment sections of posts where "IT Guy's" comments then appear.
For example:
Domain Name (Unknown)
IP Address 12.11.157.# (Medical Information Technology) [Meditech - ed.]
ISP AT&T WorldNet Services
Location
Continent : North America
Country : United States (Facts)
State : Massachusetts
City : Milford
Lat/Long : 42.1544, -71.521 (Map)
Language English (U.S.)
en-us
Operating System Microsoft WinXP
Browser Internet Explorer 6.0
Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648)
Javascript version 1.3
Monitor
Resolution : 1024 x 768
Color Depth : 32 bits
Time of Visit Jan 4 2010 11:49:49 am
Last Page View Jan 4 2010 12:55:12 pm
Visit Length 1 hour 5 minutes 23 seconds
Page Views 12
Referring URL
Visit Entry Page http://hcrenewal.blogspot.com/
Visit Exit Page http://hcrenewal.blogspot.com/
Out Click 0 comments
https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true
Time Zone UTC-5:00
Visitor's Time Jan 4 2010 11:49:49 am
Visit Number 643,748
At the time of the outclick, there were "0 comments" to that post, as shown in the log above. Shortly after, IT Guy's aforementioned "Funny March of the Luddites" comment appeared ... as comment #1.
Likewise today, several "hits" appeared from IP 12.11.157.# with outlinks to the comment thread, for instance as seen below when only 23 comments were present, mostly from "IT Guy", Dr. Poses and myself:
Domain Name (Unknown)
IP Address 12.11.157.# (Medical Information Technology)
ISP AT&T WorldNet Services
Location
Continent : North America
Country : United States (Facts)
State : Massachusetts
City : Milford
Lat/Long : 42.1544, -71.521 (Map)
Language English (U.S.)
en-us
Operating System Microsoft WinXP
Browser Internet Explorer 6.0
Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648)
Javascript version 1.3
Monitor
Resolution : 1024 x 768
Color Depth : 32 bits
Time of Visit Jan 5 2010 9:38:07 am
Last Page View Jan 5 2010 9:57:40 am
Visit Length 19 minutes 33 seconds
Page Views 3
Referring URL
Visit Entry Page http://hcrenewal.blogspot.com/
Visit Exit Page http://hcrenewal.blogspot.com/
Out Click 23 comments
https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true
Time Zone UTC-5:00
Visitor's Time Jan 5 2010 9:38:07 am
Visit Number 644,308
After that, more comments from "IT Guy" appeared starting with ... #24.
The pattern has remained consistent.
Now, the evidence is circumstantial but it does not take a Sherlock Holmes to realize it is quite likely this commenter is an employee of a healthcare IT vendor named in the above links, Medical Information Technology, Inc., a.k.a. Meditech.
I am concerned that a possible employee of an HIT company - any HIT company -- might find physician concerns about HIT as serious as those expressed in the AAPS survey "funny" and "of the Luddite variety." I also am concerned that an employee might think that in situ pre-post evaluations of the technology need not take into account possible confounders.
If this person is an HIT vendor employee and IT professional at this HIT company or any other -- I think it likely he/she holds such a position at some HIT company and such attitudes -- then a number of questions are raised:
- How common is this attitude among HIT vendor employees? Is this a systemic problem?
- How do such attitudes translate into satisfying customer requests for remediation of HIT defects and problems?
- Should HIT vendors be doing better due diligence in their hiring practices to assure they hire IT personnel with a service mentality and who understand that clinicians are the enablers of medicine, they the facilitators? (A point my graduate healthcare informatics students are taught and grasp readily.)
At the very least, perhaps employees of HIT companies (such as the one in the logs above at Meditech, whoever they may be) should pay more attention to improving HIT, rather than spending 1 hour 5 minutes 23 seconds reading 12 posts here during business hours.
"IT Guy" is welcome to continue submitting anonymous comments, but if they contain ad hominem they will be deleted.
-- SS
Addendum 1/5/10:
A HC Renewal reader with an MBA non-anonymously relates the following (emphases mine):
In reading this thread of comments I have to believe IT Guy is a salesperson. My only question is: Were you assigned this blog or did you choose it? We had this problem a number of years ago where a salesperson was assigned a number of blogs with the intent of using up valuable time in trying to discredit the postings.
In my very first sales class we learned to focus on irrelevant points, constantly shift the discussion, and generally try to distract criticism. I would say that HCR is creating heat for IT Guy’s employer and the industry in general.
I find it sad that a company would allow an employee to attack anyone in an open forum. IT Guy needs to check with his superiors to find out if they approve of this use of his time, and I hope he is not using a company computer, unless once again this attack is company sanctioned.
Steve Lucas
I think that is an interesting possibility - someone paid to disrupt. It fits, and again invoking Sherlock Holmes, there is the means, the motive and the opportunity. Time for another definition:
Sock puppeting: "the act of creating a fake online identity to praise, defend or create the illusion of support for one’s self, allies or company." (NY Times)
If true (unfortunately for the salesperson), I make this observation:
To most of the readers of Healthcare Renewal, who find a focus on irrelevancy and irrationality to be signs of foolishness and hysteria (we clinicians have seen it all, by the way), this salesperson has nothing to sell.
Another perversity also comes to mind. If what Mr. Lucas suggests is indeed occurring, a company behind such actions would be exhibiting self destructive behavior in trying to disrupt and discredit those who could actually help them to make better products and be more competitive. I remind that patients are the true "customer."
It also follows that, if this analysis is true, the defamatory attacks left at HIStalk and here at HC Renewal would have been made with foreknowledge of their falsity and with malice.
Not a particularly wise HIT vendor strategy with the HIT industry under investigation by US Senator Grassley (see Oct. 2009 PDF letter to a number of vendors and management consultant firms here).
Having worked in pharma, however, another self-destructive industry due to its internal pathologies, I've seen worse done to critics. Incidentally, another probable blog troll/sockpuppet comment from that industry is in the comments section at this Jan. 2008 post.
-- SS
Yes, it’s that simple. If you select for pre-IT and post-IT data and use a large enough sample size the other factors with equal out. If the sample size is large enough you should have a relatively small margin of error.
[i.e., "Programmer" -- who I soon show is also "IT Guy" -- opines that in comparing clinical adverse event rates pre- and post healthcare IT installation, all you need is a large enough sample size, which then nullifies or cancels out, for example, changes occurring over time that are not related to the intervention, and other potential confounders in a pre-post comparison. If only evaluation studies in healthcare informatics were that simple ... it is concerning that IT vendor personnel might have such beliefs - ed.]
And the fact that a teaching professor at a major university has virtually no understanding of statistical analysis makes me say “at least I don’t have to worry about losing my job to one of his students."
[Latter sentence was removed by HIStalk owner - ed.]