Friday, May 30, 2014

This Is An Issue We Have Yet To Get Our Heads Around Information Overload. We Need To Sort The Difference Between Information and Data.

This appeared a little while ago.

Doctors Are Drowning In Data

4/1/2014 09:06 AM
David M. Denton
Commentary
Technology isn't enough to improve healthcare. Doctors must be able to distinguish between valuable data and information overload.
As a doctor, I know the value of information, but I also know what's worse than not enough information: misinformation or too much information. In this information age, we seem to have plenty of both.
No matter what you think or believe, you can find proof of it on the Internet. You can also find a million and one ways to decorate your living room, making it overwhelmingly impossible to decide which ideas to use. The Internet is great at quenching our attention deficits by providing novelty at every click. Indeed, we can spend hours reading, watching, listening, or commenting without accomplishing anything at all. On the other hand, we get access to excellent resources and minds, beyond what was possible in a non-connected world.
Modern medicine also struggles with managing information. In our lust for data, we have created systems that store every keystroke, scan, or import, in a limitless cloud. Discrimination is no longer necessary. The pertinent and the frivolous are stored side by side. We no longer have data; we have "big data." This allows the detection of trends and patterns that could never be identified with our smaller data sets. We are just beginning to understand its power.
Interestingly, however, while computers are great at sorting through data quickly and efficiently, humans aren't. In fact, "more," often clogs our ability to discern and decide. Additionally, computers can't distinguish good data from bad data. At present, humans are still required to use the data to make decisions and care for patients. Until we have computers that can form therapeutic alliances, be compassionate, diagnose conditions, and provide and coordinate reasonable treatments, we are still dependent on fallible biologic beings to provide our medical care.
One of the hopes of electronic health records (EHRs) is that they will revolutionize medicine by collecting information that can be used to improve how we provide care. Getting good data from EHRs can occur if good data is input. This doesn't always happen. To see patients; document encounters; enter smoking status; create coded problems lists; update medication lists; e-prescribe medications; order tests; find, open, and review multiple prior notes; schedule follow-up appointments; search for SNOWMED codes, search for ICD-9 codes, and find CPT codes to bill encounters (tasks previously delegated to a number of people); and compassionately interact with patients, providers have to take shortcuts.
To simplify the more cumbersome and involved process of documenting in EHRs, we use templates, checkboxes, and default reports. This standardizes the entry and ensures that all of the necessary bullet points are included. While this documentation allows more accurate CPT coding, it often doesn't reflect reality. Numerous patients with abnormal physical finding or other distinguishing features suddenly have normal exams except for the specific abnormality surrounding the chief complaint. Comatose patients are often "alert and oriented," and all ear infections look exactly the same -- "red and bulging." Template-based records are notorious for including things that were never done, such as performing a complete physical exam on a patient who came in with a splinter in a thumb. Or the record might detail a full review of systems -- including questions about exercise-induced chest pain and feelings of anxiety -- on a visit with a two-month-old.
Lots more here:
This is a very interesting article indeed and shows just how good intentions can lead to just absurd overkill and how computers can generate so much data and pretty much hide a lot of the useful actual information.
Mandatory reading in my view.
Interestingly there is no mention of the information management task physicians face in assessment of clinical research information that guides practice. A whole other can of worms I reckon.
David.

3 comments:

Anonymous said...

There's only one thing worse than Jane Halton being Secretary for Health and that's Jane Halton being Finance Secretary. She is a well known bully and the expectation is that there will be a mass desertion from finance if she gets the job.

http://www.smh.com.au/federal-politics/political-news/abbott-prepares-for-major-shakeup-of-public-service-20140530-399un.html

"Health Department secretary Jane Halton is the strong favourite to replace Mr Tune. Professor Halton has served as the head of health since 2002."

Anonymous said...

Tony Abbott wants to clean up the public service and that means starting with the culture. The first place to start is at the top and work down. Not all public servants are bullies. Those that are and have a reputation as such need to be moved on - else cultural change will not be possible. Moving a bully from one portfolio to another does nothing to address the deep seated problem. The religious orders have proven that in abundance.

Bullies intimidate, berate and destroy people until the victim either mirrors the bully's behaviour or leaves to maintain their dignity, sanity and self respect.

Those that are left behind do the bully's bidding out of fear and programs that should have had successful outcomes get destroyed in the process.

Anonymous said...

One particular senior bully ordered a subordinate to do something that was against the law. When they refused they were stood aside. Eventually the subordinate was re-instated because, if they had taken the bully to court, the bully would have been seen to have broken the law and would have been fired.

The bully is still there. The subordinate has moved on, but not too far.

The Public Service is very good at protecting its own, but can only do so much. When the spotlight of publicity increases, what are strong rumours can easily turn into career stopping facts.