Happy New Year! If you must drink, do it responsibly and safely. Which brings us to the issue of this Conclusion to a blog series that started here. How can Health IT systems help clinicians to consume/drink the liquid information that will increasingly flow to them? How can these systems help users protect both patient safety and clinician productivity?
The faucet has been opened.
It`s pretty easy to tell developers to send clinical data to others. It`s harder to recognize what to tell providers to do with what they receive. The trickle of information exchange hasn`t become a flood yet, but let`s be prepared! Clinicians want the data to be usable, not a hindrance. They need to do the good thing, but they can`t afford to reduce their content to see patients, and they don`t wish to be liable for negligence if they can`t read every son of every available electronic record for the patient. Policies and guidelines for realistic expectations and duties of clinicians to recover and read electronic information would be really helpful coming from medical, legal, and health information management professional associations.
Patient safety is impacted both if there`s inadequate information flow but also if there`s too much. We`ve heard of "alert fatigue" in clinical systems, and could present "information overload fatigue" too, where important data is obscured by "noise" that could go to errors or duplication as come in the absence of data flow. While the PCAST report on health information technology proposes applying search technology (good idea), that may be helpful but insufficient. I can "Google" anything, but how much do you or I feel beyond the 1st page of results, even when there are thousands of hits? I implicitly rely upon the seek engine to show the most relevant links first, since my sentence is limited. While a patient`s medical records are often less voluminous than data in web searches, even dealing with only 24 clinical documents per my personal health example requires indicators of relevancy to aid decision making. But if I don`t feel at Google search results page 2, it`s probably not a big deal, but the bet are often higher for patient care: who can determine what`s most crucial to record for a clinical encounter, especially since that varies depending on the encounter`s purpose?
Thankfully, healthcare and academic organizations make the want to harness this challenge. I was mesmerized by the findings from this medication reconciliation project at Partners Healthcare: "design of a new application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list." It was pioneering work at the time, and was a springboard for further research, such as refined aggregation algorithms based on more standardized data, and clinician-vetted UI techniques to reduce cognitive load and add value.
In 2008 when I helped interoperability and ambulatory workgroups (including physicians, nurses, pharmacists, engineers, and others) write the CCHIT certification criteria and roadmap through 2011, we proposed 2009 as a first tone in use of discrete data such as medications and allergies from C32 CCDs, but over that we shouldn`t be prescriptive about EHR functionality or workflow to hold such data.
Medications are only one illustration of information that needs to be reconciled after being exchanged. A new clinical data Reconciliation project at IHE offers hope to raise the case of clinical decision support for reconciling problems, allergies, medications, and more. It`s humbling to recognize that HIT isn`t so sophisticated or trusted to give clinical decisions, any more than web search can buy your next car automatically. Instead, we should apportion the results of inquiry to inform and make innovations that are then tried in multiple care settings, before even thinking about regulating and standardizing functionality. But I`m all for specifying how standardized information exchanges can be inputs to these innovative algorithms and UIs.
To give to my musical analogy, music isn`t just performing the notes in a score: but instead how the account is brought to living to meet the substance through the star of great performers. We shouldn`t try to become musicians into robots where every nuance is preprogrammed. Similarly, in HIT MU-sic, there`s room for the art as easily as the science!
If anyone reading this can stop to interesting research and experiences regarding consuming health information that`s exchanged, I`d love to learn around them. The results would benefit providers and developers EHRs and HIEs as well.
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