Tuesday, September 4, 2012

RHIOs and Health Information Exchange: A Call for Independent Scientific Research

Since publication of my commentary on Lenert, L., Sundwall, D., Lenert, M.E.,  Shifts in the Architecture of the Nationwide Health Information Network, Journal of the American Medical Informatics Association, Online First, January 21, 2012 - I have pursued correspondence with the authors of the "Perspectives" article cited above as well as with the editorial team of JAMIA.  Unfortunately, there has been no satisfactory response to  my concerns.  In light of this lack of editorial response, it appears that the misinterpretation of research studies in the article literature review is considered trivial - although in fact it is critical to support the authors' proposition that RHIOs offer a sustainable infrastructure for health information exchange in the United States.  This case in publication ethics raises some interesting issues.

In particular, the JAMIA editorial team seems to discourage any post -publication debate regarding papers appearing in the journal, even when legitimate concerns are raised by readers.  Most scholarly journals have policies governing the correction of errors identified in accepted publications. (For example, see  the Royal Society policies  - available at:   http://royalsocietypublishing.org/site/authors/policy.xhtml ) Organizations specialized in publication ethics such as the Committee on Publication Ethics (COPE : http://publicationethics.org - of which JAMIA is a member) and the World Association of Medical Editors (WAME: http://www.wame.org/ ) require that their members develop such policies.

The BMJ and other journals published in the BMJ system seem to encourage online post publication debate using the electronic function designed for that purpose. I would suggest that the editorial team of JAMIA follow their example. (See Richard Smith's interesting commentary on BMJ Group Blogs at http://blogs.bmj.com/bmj/2011/04/06/richard-smith-what-is-post-publication-peer-review/  .)

I first wrote an electronic response to this article – and  received an automated acknowledgement from JAMIA on April 7.  The text of my letter appears on my blog at http://eresearchcollaboratory.blogspot.ca/2012/04/commentary-lenert-l-sundwall-d-lenert.html - as well as the SCIVEE site where a recorded webinar of the JAMIA Journal Club is available: http://www.scivee.tv/node/46861

This article was subsequently republished in the July issue of JAMIA - without any corrections -  in  volume 19(4) pp. 498-502. A letter to the Editor has remained unpublished and without editorial response. One author's response to my comments was rather defensive in tone, while  members of the editorial team did not consider it their duty to address my concerns.  They seem to agree that articles accepted for publication in JAMIA should be considered beyond any further question or debate.  This attitude is unworthy of a scholarly journal, particularly in an interdisciplinary knowledge domain such as biomedical informatics. (See my response to the editor of CACM: http://cacm.acm.org/magazines/2012/7/151235-predatory-scholarly-publishing/fulltext )

My unanswered email communication with the editor is copied below:

This is just to let you know that I have submitted a response  to the JAMIA article: Shifts in the Architecture of the Nationwide Health Information Network, Journal of the American Medical Informatics Association, Online First, January 21, 2012.

One author has answered my review,  as copied below.  He seems particularly offended by my comments regarding his reporting of research by Adler-Milstein et al. in 2008 and 2011 to support the census of RHIOs in those years (100 and 200 active organizations-respectively).  My intention is certainly not to be rude, but to point out that it is essential to have carefully read research cited in published studies - particularly in interdisciplinary study.  I am surprised and disappointed that  neither the article authors nor the JAMIA reviewers of this manuscript appear to have read Adler-Milstein's research.  I have noted that JAMIA rarely encourages any electronic dialogue on published articles, but in my opinion, thoughtful comments should always have a place in public policy debate.

Many thanks for your kind consideration...

One author's response:

This article has triggered a great deal of discussion. Our article went through 3 rounds of peer review at jamia with more than150 specific comments by reviewers, some quite hostile. Before you accuse them of error and me of mis representation, you better have a good argument. The fact the RHIOs, conceived before meaningful use, and not well funded through HITECH don't meet the requirements is not surprising. I think you should perhaps consider whether the strength of evidence for MU in your arguments. I think the evidence for RHIOs impact, flawed as it is, is far better than for MU regulations. These comments are simply rude and have not place in academic discussion.

I agree with your thoughts about organization theory and governance needing more attention.
Rather than critique the absence of work from your field, why not tell us what it has to say? The business model for RHIOs and for national exchange should be that of a public utility. I would be interested to learn about organizational theory relevant to that model. I agree that the governance of voluntary participation RHIOs is difficult.