Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Dr. Lyle on Information Overload 5/1/09
One thing you said the other day caught my attention – you said all that Twittering left you dazed and confused from information overload. I think we can all understand that feeling, and I would apply that analogy to the risks of interoperability. In other words, we better be careful what we wish for! Because if I get every piece of data for every patient, I will never get through my day.
As a primary care physician, I usually have about 10-15 minutes with each patient. Depending on their main complaint, I only need selected information. If I’m seeing someone for an acute sinus infection, I usually just need to know their active allergies and meds. If I’m seeing someone for a follow up to their three chronic diseases, I want the above, plus recent labs, tests, and recent specialty reports if relevant. If I’m seeing a brand new patient with a complex illness and I have an hour to work with them, then I would want all of the above, plus (maybe) notes from all past evaluations, drug history records, lab trends over many years, etc.
As you can likely see where I’m going, most outpatient care visits don’t need “everything”, and in fact, those visits would be ridiculously long and confusing if I had to wade through every piece of information ever accumulated on a patient. With that said, I can see a future what a computer might even intelligently summarize for you. And I have no problem with interoperability as a nice long-term goal.
We really need to prioritize our resources with respect to EMR adoption. If interoperability helps make local interfaces easier, then I am all for it! But it seems like those interfaces are reasonable enough already, and that the focus on interoperability is a much grander scale. I think the forces behind that movement (“grand interoperability goals”) need to better justify why that is more important than other things to help make a local EMR project work (e.g. more usable systems, more consistent clinical decision support knowledge, quality metrics defined and reimbursed, …) Are others talking about this, or am I going after a sacred cow?
Lyle Berkowitz, MD is an internist and healthcare informatics expert. He is Medical Director of Clinical Information Systems for a large primary care group in Chicago. He also blogs at Change Doctor.
Your issue (a good one) isn’t about interoperability. It’s about the functionality of an EMR to let you parse information to get to what you need without wading through unrelated information. Good ones do that.
Lyle,
Great post! It seems like so much of our interaction with the EMR is not for patient care, but rather for the benefit of insurance companies and attorneys. With respect to interoperability, the goal of having all data “available” should not intrude on efficient and meaningful doctor-patient interaction. Lyle, you have been an evangelist for changing the way we interact with data. Your comments cut perfectly through the frequent off-base technical discussions on this subject.
Interesting comments from Dr. Lyle Berkowitz. While I think he makes a relevant point about info-overload, I can’t help but think about the need to evaluate workflows in a primary care practice and the need for a medical team directed by a physician, etc. (i.e. PCMH). If physcians and nurses/MAs and ancillary staff work together, then the doc can specify which of the multitude pieces of info he needs for each type of patient visit and have team members locate only that and tee it up for these visits. It needs to be a team effort or we will get overloaded.
As Dr Lyle’s post implies, the problem is the ongoing perception that we should be interoperating “records”. Actually, what we need to be sharing is the patient’s Care Plan. The only data worth sharing is that which relates to the Plan of Care, whether there be several chronic conditions, or a single acute condition. Allergies, meds, lab tests — their value is only relatiive to a plan of care. A shared or Virtual Care Plan would provide a new paradigm for arranging and displaying the patient’s medical data as much more than simply elements of an electronic “record”.
Amen, Bignurse, amen.
Dr. Lyle, (forgive me, Brahmans) there is nothing sacred about a cow who leads us down a wasteful path. Thanks for highlighting a smarter priority for EMR adoption resources. Dr. Diamond’s differentiation of “availability, not
intrusion, of EMR data” should become a new rallying cry for clinicians.