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.