Healthcare // Electronic Health Records
Commentary
4/1/2014
09:06 AM
David M. Denton
David M. Denton
Commentary
Connect Directly
LinkedIn
RSS
E-Mail
50%
50%

Doctors Are Drowning In Data

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.

[ Should be obvious: EHRs Must Solve Real Problems.]

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.

(Source: Flickr user jfcherry)
(Source: Flickr user jfcherry)

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.

Some systems limit the number of choices to describe things or use unnatural language or simple checkboxes to convey things previously communicated by narratives. While computers may be able to use this data, humans who have to use the information to decide what is going on have a harder time reforming the story from this cryptic information.

Additionally, ICD codes often lack the specificity required to communicate what is going on. Patients who once had 16p11.2 microdeletion syndrome suddenly have a diagnosis of 758.33 OTHER MICRODELETIONS. A patient born with an unbalanced AV septal defect, pulmonary atresia, ventricular inversion, and bilateral superior vena cava who underwent patch augmentation of the left PA and placement of a central shunt, followed by a bi-directional Glenn and finally a Fontan procedure is now synthesized down to 746.9 UNS ANOMALY HEART. (Unfortunately, ICD-10 isn't going to make this a lot better.)

While these codes can allow computers to quickly generate reports, they often simplify or group things together in ways that aren't useful to care providers. Much can be lost in the translation, making it impossible to appreciate the uniqueness or specificity of a problem needed to make

Next Page

David M. Denton is a board-certified pediatrician and member of the American Academy of Pediatrics. He is a partner of the Pocatello Children's Clinic in Pocatello, Idaho, and is affiliated with Portneuf Medical Center where he currently serves as the medical staff ... View Full Bio

Previous
1 of 2
Next
Comment  | 
Print  | 
More Insights
Comments
Newest First  |  Oldest First  |  Threaded View
KryptiqCareManager
50%
50%
KryptiqCareManager,
User Rank: Apprentice
4/2/2014 | 6:50:17 PM
Re-focusing attention on the patient
"Within seconds, I knew the medications he was on and had been on." This single line captures the sense of gestalt that physicians seek in preparation to attend to their patient. As the author rightly points out, the lethal combination of misinformation and too much of it has effectively made this "within seconds" gestalt extremely  elusive. Any tool that seeks to aid the physician's preparation for a visit should strive to a) simplify the available information to enable rapid visual assimilation – think red, green and yellow. It should impose no more than 15 seconds of cognitive burden. And b) To only draw attention in the context of what needs to happen; not a wholesale recounting of all available information. This is where leveraging evidence based guidelines can help – subject to the earlier constraint a). These two steps can help make some of the information in the EHRs more useful and the physician more productive. And it is not just the physicians, but the entire care team surrounding the patient that needs access to such information. Ultimately, these tools will need to help amplify the role of the physician by making the patients' care team more successful.
DonK403
50%
50%
DonK403,
User Rank: Apprentice
4/2/2014 | 12:41:25 PM
Drowning in Data
Good article David.  We spend so much time designing EMRs to accumulate every little crumb of data, yet spend little time trying to figure out how to extract that data in a meaningful way.

There is a lof of work with 'Big Data Analytics'

http://healthcareitsystems.com/2013/05/artificial-intelligence-and-healthcare-analytics/

...however this would not help someone in your situation. All of this data noise eats up a tremendous amount of time and actually takes cycles away from treating patients.
dentdavi
50%
50%
dentdavi,
User Rank: Apprentice
4/2/2014 | 10:59:31 AM
Re: Data
You are right. Managing data well and having useful interfaces for dealing with it is something that happens very well in many industries.

Currently healthcare IT consists of a hodgepoge of poorly designed and poorly interconnected products. These products were 'mandated' by threats of decreased reimbursement and penalties. They were not ready to be used in the real world. See my article - http://www.informationweek.com/healthcare/electronic-health-records/ehrs-must-solve-real-problems/d/d-id/1113823?

Believe me we have been working on trying to get better software, but vendor lock in and mandates have created an artificial market for these products that has squelched development. In the meantime we have to manage more data with tools that can't do it. For some reason, healthcare seems to have a shortage of developers who understand the problems well enough to create useful products.
anon6656322472
100%
0%
anon6656322472,
User Rank: Apprentice
4/2/2014 | 7:36:05 AM
Data
Being able to properly filter a Google search is basic computer literacy. 

As for the too much and wrong information with client data, you have bad software.

American health care will eventually come into the the modern era. Until then you would do better to campaign for suitable software, not less information.  
dentdavi
50%
50%
dentdavi,
User Rank: Apprentice
4/1/2014 | 5:49:21 PM
Re: Isn't Everyone Drowning in Data?
Certainly wouldn't want to imply that health care providers are more inundated with data than any other profession. However, one of the unintended consequences of excessive data without filters is missing important information, resulting in medical errors. This is a real problem than hasn't been solved by EHR. I am on the committee that reviews these cases in our hosptial. We have had some significant problems directly related to missed information that was buried in poorly organized EHR's or mis-information from data that was copied and pasted over and over again. This certainly could happen on paper, but happens much better on electronic systems. Finding the important often becomes a treasure hunt, but sometimes you don't even know you are supposed to hunt for a treasure. There is nothing to tip you off that something important hides within. 
anon4146962068
50%
50%
anon4146962068,
User Rank: Apprentice
4/1/2014 | 4:01:26 PM
Isn't Everyone Drowning in Data?
I'm sorry, but I don't feel sorry for doctors "drowning in data".  Every profession is.
madhu_v
100%
0%
madhu_v,
User Rank: Apprentice
4/1/2014 | 3:54:26 PM
Re: Coding System
It is always a tough balance between usability (templates), functionality (ability to provide the necessary info related to the uniqueness of medical diagnosis) especially in a high-traffic area like HCP's office as opposed to say an office-based usage. There is a need for speed but at the same time, accuracy, completeness. There is no easy way to do a UAT and be able to accomplish the mission. The healthcare space is ripe with opportunities to improve and articles like these highligt that need to mature as the entire HC space moves on.  

 

Very interesting and a pragmatic need !!
Elaine Herrmann
100%
0%
Elaine Herrmann,
User Rank: Apprentice
4/1/2014 | 11:58:23 AM
Re: Coding System
Using EHR's poses challenges that stymie medical record abstractors yet hospital reimbursement depends on accurate reporting. Documentation is often duplicative as everyone is diligently documenting, and none of them at the same minute and second, while the auditor drowns in information. No longer is it simply finding "a needle in the haystack". It is how many needles of the same information are there, and which among the needles is the accurate one. If the correct response isn't found, or doesn't exist, compliance is lower ( as are, possibly, Administrator's bonuses). How does a physician manage the care of a patient with a diagnosis of "intracerebral hematuria?"
CHFH
100%
0%
CHFH,
User Rank: Apprentice
4/1/2014 | 10:53:35 AM
Coding System
Natural language is a coding system. Soon we should be able to extract the relevant information for the various stakeholders from a record written in natural language. We should not need to force the doctor to adapt for the machines - the machines should adapt to the doctor.
Register for InformationWeek Newsletters
White Papers
Current Issue
InformationWeek Tech Digest - July 22, 2014
Sophisticated attacks demand real-time risk management and continuous monitoring. Here's how federal agencies are meeting that challenge.
Flash Poll
Video
Slideshows
Twitter Feed
InformationWeek Radio
Archived InformationWeek Radio
A UBM Tech Radio episode on the changing economics of Flash storage used in data tiering -- sponsored by Dell.
Live Streaming Video
Everything You've Been Told About Mobility Is Wrong
Attend this video symposium with Sean Wisdom, Global Director of Mobility Solutions, and learn about how you can harness powerful new products to mobilize your business potential.