Tuesday, December 4, 2012

The EMR Strikes Back

From data to Yoda
If we look at the business world, they have one hell of a cool light saber called Business Intelligence (BI) - described by Wikipedia as the “ability of an organization to collect, maintain, and organize knowledge.” Because a company produces large amounts of information every day, BI systems provide detailed analytics and historical, current and predictive views of business operations. Why? Because increased visibility fuels better decision-making.

Well, that’s exactly what I thought I would find when, propelled by an initial eruption of great expectations, I first opened the EMR Pandora’s box. But heaven can wait.
On my reasonable wish list: I’d like disease monitoring to be data driven for instance. Or in the case of an outbreak, I’d love to know the number of patients over 50 who showed up with high-fever and difficulty breathing over the past 72 hours. But it seems like I’m speaking Chewbacca language or something. I’m not saying EMR vendors should follow the BI spaceship at the speed of light, but can we please have:
  • Searchable data. And by searchable, I mean searchable. Spanning patient history, completed reports and any type of document the system has ever dealt with. And using any field, any healthcare-relevant keyword.  Think Google, natural language, you know, the kind of crap that changed the world.
  • Dashboards. Ahh, dashboards. You know, the stuff that allows Han and Chewie to pilot the Falcon full speed all the while avoiding collisions. Physicians, Nurses, IT, Management: we each need our own, one that’s relevant with what we’re trying to achieve here.

If EMRs vendors can’t deliver that, well, they should go sell pizza instead. Then they’ll understand how fast a Memphis BBQ with no chicken gets you out of business.
Yes, it's a productivity loss matter. But that’s the sweet part. The main concern here is accountability. How come in two-thousand-bloody-twelve, I can't get a holographic view of what’s going on inside my ship? Here my humble take on it:
  • Because a hospital often has one EMR per department. And because, barring a few miracles, these systems have no clue whatsoever how to communicate with each other. It’s C3PO trying to have a conversation with Donald Duck.
  • Because most systems are no more than browsers for scanned images. Ask any salesman from a big money-making corporation how often he scans his sales figures, he’ll stop and stare at you wondering what you smoked last night.
  • When they’re not browsers, these systems, for some  odd reason, don’t feel the urge to structure data. And maybe the reason is they were built on the same mistake the business world made decades ago: they assume that capturing data in digital format is enough to create value. Bzzzz, wrong answer. If we trust the famous Wisdom Pyramid, data is Point Zero, it’s raw, dark material and it can’t be transformed into anything bright if it’s not structured (therefore searchable) to start with.


Source: Wikipedia ("The DIKW Hierarchy" a.k.a. "The Wisdom Hierarchy")
As a CMIO, I use this little chart as a constant benchmark to see where we are with various projects. Are we extracting relevant information out of the Black Star? Are we building a knowledge base to help Luke make informed decisions? Are we connecting parts or creating more silos for the dark side of the Force to flourish? And so far, I’m afraid the EMR hasn’t brought much spiritual fire to Yoda’s little hut.
In the best-case scenario, EMRs take us to the Obi-Wan level. But most of the time, it doesn’t even go beyond the Death Star. And we wonder why Jedis are losing their multidimensional cool. We’re promised a one-way ticket to the Swamp Planet but all we get is an army of Storm Troopers blocking the gate.
But even in the darkest of tunnels, there’s light. Yep, like in a good Hollywood blockbuster, I kept the good news for the end. Ready?
Here you go: you can buy an “EMR search engine” from a vendor that makes big bucks out of EMR broken promises. And the best part is: you will end up finding the budget.
May the F word be with you,

Jedi Nado


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