Tens of billions of dollars are being spent to implement EMR's in healthcare. There's still a long way to go. Everyone seems to agree that EMR's will make things better than they were with paper. But it's hard to imagine that things will be better if the data is incomplete, inconsistent, and simply wrong.
The big strategic thinkers and powerful people who push EMR use ignore this issue. I guess it's a detail, beneath them, unworthy of their notice. But for anyone who lives in the world of software, numbers and math, data quality is the foundation on which everything is built. Ever hear of "bad data in, bad data out?" It's true!
I can run some personal tests on this issue because I'm being treated for a kind of cancer at one of the world's best hospitals, Mount Sinai. I'm getting excellent care and doing well. Mount Sinai is completely up to date with EMR's. It's clear from my experience to date that my excellent care has nothing to do with the EMR -- arguably, the good care I'm receiving is in spite of the EMR.
Let's look at some details. I recently waded through the hospital website to access my medical records. If whoever designed the website had tried to make it difficult for patients to access their records, they couldn't have done much better.
I finally managed to get a PDF for an encounter. The document makes clear that the hospital's computer graciously deigned to share information with me, the patient:
The document makes equally clear that information is missing. What information isn't here? We have to guess. What an attitude.
Think of an incredibly unpleasant, arrogant class of professionals. What did you come up with? My guess was lawyer. Even with lawyers, when you fire them and request your files they give them to you, minus snarky notes about how things "may be" missing.
There was a section with my name and address. Also how to communicate with me:
They included the identical number for Home and Mobile. You think the computer could have checked for that? This is one of the fatal flaws of the whole EMR approach: the patient is barred from entering and/or correcting his own data! In a sensible, modern system, I would have received an email or text asking me if this information was correct, and asking me to correct it if it's not. But an Enterprise EMR system with layers of security, bureaucracy, administrators, regulators and lawyers involved? Maybe next century.
Now we get to my meds. Here they are. Notice anything?
You may notice that information is missing from the second drug, losartan. What I noticed is that the dosage is wrong. What I have actually been prescribed is 100 mg tablets. This record is from the encounter with the cardiologist who prescribed the drugs! If it's wrong, anything can be wrong!
In my case, it makes little difference, since I'm on top of things. But not everyone is so fortunate, and this is just the kind of error that could, with a different patient and drug, have awful consequences.
Now let's look at my "social history."
It's wrong too. And I'm not allowed to correct it. If I did use alcohol, it's missing the amounts. But I don't use alcohol. If it were correct, it would be incomplete; but it's incorrect.
Finally, let's look at my plan of care:
An appointment. But that's wrong too! The appointment I actually have is for a diagnostic procedure, not what's written here, and the follow-up with the doctor is just missing.
Bad data wrecks everything
You want benefits from Big Data? Nothing good comes from data that's bad, no matter how big it is.
There is very little data exchange among EMR's, in spite of all the tens of billions of dollars that have been spent. Here is the latest stat from the government:
Do you think that's bad? In principle I think it's bad, until I consider all the inconsistent and incomplete piles of crap data that's sitting out there in EMR's. Then I think of the lack of interchange as being more like keeping the bad data in isolation so it doesn't wreck anything. And who's allowed to fix it? I'm certainly not allowed anywhere near it, even though it's my data.
Conclusion
What's the solution? Make health care providers spend even more time bent over computer screens than they do today, which is already excessive?
The core problem is that our whole approach to hospital, health care and provider automation is rooted in the ancient approach to "enterprise software" that was created in the days of mainframes, and lives on in the incredibly expensive, ponderous and user-hating world of modern healthcare IT. The data will become accurate, complete and high-quality when the systems are built correctly, using modern techniques, and when they interact with all concerned parties -- including patients!! -- to get their jobs done.
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