By this time, most readers of Lab Soft News will be familiar with the rapidly expanding Volkswagen scandal whereby the company has knowingly modified the software installed its on-board car computers for years. Emission controls on its vehicles were being activated only when they were being tested and deactivated then when the cars were being driven on the road (see: Volkswagen: The scandal explained). In this way, the cars were able to meet regulatory emission requirements but also achieve better fuel mileage on the road while contaminating the air with nitrous oxides, imperiling the health of many people.
Car manufacturers like Volkswagen regard their software, consisting of millions of lines of code, as proprietary so this massive fraud has escaped detection for years.The company is finally being brought to justice by the EPA which enforces much stricter emission guidelines than the environmental regulatory bodies in Europe and Germany. The latter have a cozy relationship with Volkswagen and the boundaries between company and German government are fuzzy at best. This scandal will ultimately cost Volkswagen many tens of billions of dollars and irreparable harm to its reputation and is emblematic of corporate greed.
Now consider the parallels with the EHR companies whose products are critical in the management of most hospital and office patients in the country. Such software, also consisting of millions of lines of code, is viewed as proprietary by the EHR companies and, as such, is protected from close scrutiny. Recent evidence has emerged that these EHR companies include "gag clauses" in their contracts with hospitals with severe penalties if hospital personnel discuss their EHRs in public (Gag Clauses in EHR Contracts Documented; Concerns Raised about Patient Safety). Given that all of the software, manuals, and even screen shots are viewed as proprietary, this amounts to a total prohibition of public discussion of EHR problems. Such discussions are confined solely to the vendors themselves. Recent blog notes have raised the topic of the "Epic police" who enforce these contractual gag orders. Here's an example from HIStalk about a problem this past April at HIMSS (see: From HIMSS 4/16/15):
...[a HIStalk reporter] reported an encounter with the “Epic police” this week. Epic was demonstrating in the Interoperability Showcase and...[she]...snapped a photo of what Epic was publicly displaying. Someone from Epic came up, said nobody’s allowed to take pictures of Epic’s screens, and then demanded that the photo be deleted from the camera while they stood there to verify. That sounds like Soviet-style overstepping big time, especially since...[she] was attending as a journalist – if you are showing your product on the big screen, if HIMSS doesn’t prohibit picture-taking in the exhibit hall.... and if the person taking the photo doesn’t work for an organization that has signed a confidentiality agreement with Epic, then I don’t believe Epic people have any legal basis for detaining attendees and demanding that they delete photos.
Here's more information about the "Epic police" from the KevinMD blog by Dr. David Mann (see: It’s time to remove EHR gag orders. For patient safety’s sake):
A couple of years ago I got beaten up by Epic and my hospital administration for publishing a tongue-in-cheek satirical review of the Epic EHR as a video game, complete with screenshots. Epic didn’t like the screenshots and ordered them removed. As it turns out, Epic has a squad of workers (some have referred to them as the “Epic Police”) whose sole job is to scour the Internet, looking for Epic screenshots, and then bullying the poster until they are removed. The whole sordid tale is told here. I am not the only one who has had this experience. Several of my colleagues have had run-ins with the Epic Police, with similar results.
I am sure that a sizable number of patients are harmed on a yearly basis by EHR software. Such injuries are usually not the result of software bugs alone but rather faulty interactions between physicians/nurses and the EHR software. For the harmed patients, however, this distinction provides little solace. Because of contractual gag clauses, such errors will usually be discussed and managed by hospital personnel and/or reported to the EHR vendors who will theoretically make the necessary software changes across their client base to avoid future errors. We need a bette resolution of problems such as these. I am opposed to rigid regulatory control over EHR software. The current inadequate EHR products would probably become even more fossilized with strict FDA oversight. However, just imagine the long-term consequences of the Volkswagen malfeasance if the EPA had not stepped in. None of this skulduggery might ever have come to light. We urgently need open and public discussions of the various problems associated with EHR "proprietary" software (see, for example: Reducing EHR "Wrong Orders" by Limiting the Number of "Open Charts"; NYT Op-Ed on EHR Interoperability Blames Vendors and Greedy Hospitals).