Friday, May 10, 2013

This Seems To Me To Be Some Very Interesting Commentary. Views Welcome.

This appeared a few days ago.

Will Electronic Records Cure Health Care?

APR 29, 2013 12:48pm ET
Until we are totally confident we know how to design and deploy EHRs in a manner that will substantially improve health care, why would we want to proliferate these expensive systems?  The thinking is that EHR interoperability will solve health care's crisis. But ask yourself:  Whenever you've received inadequate care, what was the root cause? Was it (1) because your doctor couldn't access a medical record that was in some other doctor's office? Was it (2) because your doctor did not have access to the clinical knowledge that would have led to accurate diagnosis and/or effective treatment? Or was it (3) because medical science, itself, just does not know enough?
Of those three causes for suboptimal healthcare, I believe the first one (lack of EHR interoperability) is actually the least impacting. For most clinical episodes, the treating physician is not truly handicapped by not being able to see what’s in some other physician’s record of your prior care. The second one seems to be considerably more instrumental. No physician can learn all she or he needs to learn, remember all that was learned, and apply it effectively during a brief clinical encounter. So we should clearly enable access to whatever is currently known by medical science, by providing computer-retrievable knowledge at the point of care. Not to do so is just plain foolish … or professionally arrogant.
The third cause, in my opinion, is actually the most significant deficiency in health care. Medical science just does not know enough. The reason for this is that health care does not learn from its own experiences. No one is retrospectively analyzing all the clinical encounters every day, to determine the early signs of what eventually become definitive diagnoses. No one is evaluating what treatments actually work best for various conditions, and under what circumstances. Medical science only moves forward via controlled clinical studies, which are too targeted and expensive to be our only strategy for advancing the science. We need to mine the data on real-life clinical encounters--nationwide. If you doubt this assertion, think about hormone-replacement therapy.  The message here is that data interoperability, attained through a standardized clinical vocabulary, is more critical than operational interoperability.
More here:
The two sections I have bolded I find ring especially true. I have written in the past about the increasingly complex knowledge management task faced by clinicians.
The second bold section points out that one of the reasons we are not able to actually practice scientific evidence based medicine is that we simply don’t have the information to do so. I would add that there is also an issue with the patient who has more than one disease as diseases can interact with each other in complex and very difficult to understand and predict ways.
Really thoughtful stuff.
David.

11 comments:

Anonymous said...

We need to accept that medical records wether on computer or otherwise will never be "The truth, the whole ruth and nothing but the truth". The sooner we accept this and act accordingly the better.
---- Tim C

Paul Fitzgerald said...

I think that the Big Data play beginning now is going to help in finding the relationships between a variety of different pieces of data. Finding unknown unknowns is going to be part of the key - we don't always know what we are looking for, so tools that allow flexibility and scope to look at things without direction are needed.

Anonymous said...

Unrelated, however I notice a lengthy "maintenance" outage on our old friend the PCEHR.

Of note is that it does not state as normal, that my records will be available? This would suggest a major build being implemented. I have seen no announcements, is this a case of another failed attempt by Accenture to build services for consumers and providers?

Does anyone out there know? And if so what is it my elderly mother will wake up to tomorrow?

Anonymous said...

Maintenance and an Upgrade:

This service is temporarily unavailable
The Personally Controlled Electronic Health Record System is undertaking essential maintenance and an upgrade from 10pm Saturday 11th May 2013 - 9am Sunday 12th May 2013 (AEST).

The Personally Controlled Electronic Health Record System will be unavailable during this time.

We apologise for any inconvenience.

Contact the eHealth helpline on 1800 723 471 for assistance during this period.

Anonymous said...

I believe it is to integer grate the prescribing and dispensing as well as the little heard of National Child EHealth Record.

What ever it is is they have extended the outage window from 9.00am until 11.00am

I do hope your elderly mother was not relying on it for anything

Anonymous said...

Anonymous 10:17 am did you amend the service availability message ?

As of 19:19
The Personally Controlled Electronic Health Record System (PCEHR) is undertaking essential maintenance from 10pm Saturday 11 May to 11am Sunday 12 May 2013 (AEST).

The PCEHR system will not be available between 10pm Saturday 11 May to 11am Sunday 12 May 2013 (AEST).

We apologise for any inconvenience.

Contact the eHealth helpline on 1800 723 471 for assistance during this period.

Makes no mention of an upgrade? And should this not have been completed?

Accenture your simply the best

Anonymous said...

Anonymous 11.21 I think you meant 11:19.

I can confirm it is just for essential maintenance. I cannot verify the availability of the access to records as I am not sold on it being secure or meant to serve its intended purpose

Anonymous said...

It was complete about 10:15am, I visited my record.

Anonymous said...

Anonymous 12:29 that is twice you have misled. What is interesting is the lack of verification, probably an indicated that this system has lost it's value for all interested parties regardless of there stance, that is except those so committed to there own self preservation as in anonymous 10:15

Davis any chance you can dig up what is behind this

Anonymous said...

Login and take a look at your record. A whole bunch of new functionality has been added. I'm trolling through it all now.

Anonymous said...

Just as well the PCEHR is not a critical piece of health infrastructure. Saturday night is rather busy in Emergency, exactly when this sort of information might actually be important.