Doctors Are Drowning In Data - InformationWeek

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Healthcare // Electronic Health Records
Commentary
4/1/2014
09:06 AM
David M. Denton
David M. Denton
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Doctors Are Drowning In Data

Technology isn't enough to improve healthcare. Doctors must be able to distinguish between valuable data and information overload.

good clinical decisions. Many systems don't allow any other details beyond the ICD-9 codes and terms in problem lists so that, for instance, in the case of UNS ANOMALY HEART, the provider knows nothing useful about the patient. In our rush to codify everything, we must not forget that uniqueness matters, and there is not a coding system designed that can surpass natural language at this time.

While misinformation creates distrust, too much information can conceal the pertinent. In a standard week, I receive charts from one or two new patients entering my practice. As a representative example, an electronic printout from a leading EHR vendor was faxed to my office last week (because the other practice and my group are on different EHRs that can't exchange information electronically). The chart consisted of 102 pages of information about a previously healthy five-year-old female who had been seen for healthcare maintenance and several sick visits during her short life. She had no chronic conditions or serious illnesses. It contained pages of anticipatory guidance, patient instructions, a long review of systems, release forms, timestamps, and generic advice about conditions. The only useful thing I could find in the printout was her immunization record, but I wasted 10 minutes discovering this.

Interestingly, in the same week, I received a faxed paper chart from a doctor who has been holding out against the trend toward digitization -- 10 pages of dictated notes and a summary page on a nine-year-old patient with asthma and a seizure disorder. Within seconds, I knew the medications he was on and had been on. I had an EEG and brain MRI report, and a good sense of his developmental status and asthma severity.

These are two extremes, and I certainly am not here to imply that paper is better than electronic data. I could have found two opposite examples to make the reverse point. The takeaway is that EHRs need better summaries and filters so that we can find and use the data we need. A few final examples illustrate this.

I often receive emergency department (ED) reports on my patients. As any provider in our community will tell you, these are onerous reports. Something as simple as an ear infection arrives as five to 10 pages of timestamps from every person who interacted with the patient in any way. Struggling through these reports, I can't always find out the diagnosis and treatment, but I always know which nurse, doctor, and lab technician saw the patient and the minute and second they did.

Finally, thanks to our health information exchange, I receive labs in my EHR every day from patients assigned to me at birth, while hospitalized, or while seen in the ED, who I have never seen before. There are often abnormal labs, so I have to decide what to do. Did someone else see and deal with these? Do I need to track down this patient and figure out what is going on? I spend no less than 30 minutes a day managing these issues. I also get copies of all labs and studies from patients I have cared for in the hospital. I have already seen and dealt with the labs, but have to look at each of them again, and go through the multiple-step process of signing them off, one by one, in our EHR. I am busier because of these things, but not a better doctor.

Information helps us learn. Information helps us make better decisions. Being able to get the right information helps us make the best decisions. The medical chart has become a source of information for insurance companies hoping to perform quick audits to minimize payments, for researchers hoping to capture data and perform studies, for patients interested in getting more information about their conditions, and for administrators hoping find new ways to cut costs.

With all of the new eyes looking at electronic health data, we must not forget that its primary purpose is to document useful information so that providers can provide high-quality care by having pertinent and correct information available. Finally, we must remember that each patient identification number represents a real human with his own beliefs, biases, struggles, and desires who is hard to represent by a few checkboxes or templates, especially if those templates aren't edited to reflect the truth.

Download Healthcare IT in the Obamacare Era, the InformationWeek Healthcare digital issue on the impact of new laws and regulations. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but IT priorities are also being driven by the shift.

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

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CHFH
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CHFH,
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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.
Elaine Herrmann
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Elaine Herrmann,
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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?"
madhu_v
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madhu_v,
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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 !!
anon4146962068
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anon4146962068,
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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.
dentdavi
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dentdavi,
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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. 
anon6656322472
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anon6656322472,
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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
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dentdavi,
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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.
DonK403
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DonK403,
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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.
KryptiqCareManager
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KryptiqCareManager,
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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.
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