Friday, May 10, 2013
This Seems To Me To Be Some Very Interesting Commentary. Views Welcome.
This appeared a few days ago.
By Joe Weber
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.
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.
Posted by Dr David G More MB PhD at Friday, May 10, 2013