Initiatives like nationwide, integrated e-medical records won't happen until we get beyond closed, proprietary architectures. Business intelligence is a solid place to start.
Healthcare IT is a good place to be these days. While IT budgets in many verticals have been tightly reined, healthcare is enjoying multiple government mandates. This has resulted in an infusion of funds to modernize and integrate IT infrastructure, applications, and data.
However, we aren't starting from a high ground. There are multiple challenges to attaining a 21st century-grade IT environment. Among them:
Errors abound: Information management systems and computerized physician order entry (CPOE) applications accounted for a staggering 84% of the 43,372 computer-related medication error records in a 2006 study of the United States Pharmacopeia MEDMARX database.
Proprietary, closed architectures still rule: Hospital information management applications are often based on hierarchical databases that don't speak common query languages like SQL or MDX--the basis for all modern business intelligence tools. Even worse, some of these applications aren't architected with separate data and application logic tiers.
No data transparency: Applications with proprietary, hidden data models don't allow for plug-and-play interfaces with standard data integration technologies like ETL (extract, transform, load) and CDC (change data capture). This environment encourages ex-developers of these proprietary, closed applications to take advantage of their inside knowledge of how these apps work to make a living building custom interfaces for clients.
Incomplete standards: Data exchange standards like HL7 only work for about 80% of the content (and that's for administrative data, it's even less so for clinical data). The rest must be custom integrated every time.
Huge chunks of master data management are missing:MDM, a key to effective BI applications, works mostly for patient information and maybe billing codes, but not for anything else, like drugs (good luck trying to find a standard code for 200mg ibuprofen gel coated caplets), conditions, and treatments (there's no such thing as a "standard treatment" for a particular ailment--it's all subjective). For example, one senior healthcare IT manager tells me that glucose tests are coded differently in every single lab system she looked at, so her team spent countless hours coding mapping tables.
The world is vendor, not user, centric: True, most of the state-of-the-art (i.e. proprietary) healthcare applications are very powerful and function rich, but few vendors seem to care about integrating with other vendors' applications.
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