Thursday, April 30, 2009

Information Overload: Don't over-encourage national interoperability

I posted on this subject at HIS Talk Blog (link), and thought I'd expand some more. Basically, I was saying that while many are crying out for national interoperability so that we can have ALL THE DATA, ALL THE TIME on ALL THE PATIENTS... I am asking for a reasonable minute to think about what that might actually mean for real world docs. In other words, interoperability is important (particularly locally), and we need to spend some time on it, but we currently are obsessed with it in an unhealthy way - and we need to rethink our priorities (e.g. make EMRs more usable, cheaper, faster...).

Specifically- most care is (or should be) delivered via a relationship with a primary care doctor and their network of doctors and hospitals. We want an EMR system that connects all those folks ideally, but we could be overwhelmed by a system that connected us with every single piece of data that happens with the patient across the world.

Of course, we can certainly play the anectdote game of "a complex patient was visiting Florida and fainted and because the other hospital had access to all her data, they were able to do the work up quicker, better, cheaper..." - but let's review why this is an interesting story, but not a fact that should drive too much of our resources:

1. That situation simply does not happen in the vast majority of care delivered... most healthcare is local. Yes, people travel and need medical care- but we should not be focusing our energies and monies on just that particular situation. Rather, let's put that energy and money into the 99% of time where healthcare is an outpatient and their primary physicians and their primary hospital.

2. Even when it does happen, doctors are resistant to going onto another system to look for more data. There is the problem of "data overload", AND they usually want to recheck everything anyway - they often don't trust what "another institution says"... especially if they can get reimbursed to check tests again. In other words, change the reimbursement system to favor a shared culture first, then start offering the technology to make it happen.

3. We have other options... when this situation does happen to a patient of mine, I can usually call that Florida ER and tell the attending all they need to know in a 3 minute phone call and maybe fax them some key documents. OR - the patient can just keep a card in their wallet with all the pertinent info... that's cheap interoperability that is always available!

So if we want to talk about interfaces and interoperability, let's keep the eye on the ball - start with local systems first... worry about national systems later... and use the extra time and resources you've saved (government especially) to help make EMRs more usable - because sharing data is meaningless if we don't get good data into the system in the first place.

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