Last Friday, I had an opportunity to spend part of the afternoon with Dr. Don Detmer (right) during his visit to Microsoft Research. If the name isn’t familiar, Dr. Detmer is a surgeon and the immediate past president of AMIA, the American Medical Informatics Association. He is also Professor of Medical Education at the University of Virginia. You can learn more about his distinguished career here.
As fellow clinicians and champions for greater use of ICT (Information Communications Technology) in health and healthcare, Don and I hit it off immediately. We also agreed that the missing piece in the use of ICT in clinical medicine today isn’t so much the “I” but rather the “C”. In fact, when Don talks about CT he doesn’t mean those big pieces of imaging equipment that scan your body; he’s talking about Communication and Collaboration technologies for clinical workflow.
You see, we’ve gotten pretty good at capturing data and storing it electronically. Where things still break down is in how we use that data and share it to improve care quality and patient safety and avoid the inherent costs associated with not doing so. How is all that data helping us if we don’t have equally powerful tools to make sense of it all and more importantly, to communicate what we learn across the care team and to our patients? Furthermore, how does all this electronic information we are capturing contribute to clinical research and scientific discovery?
Let me refer to something going on in my own family to illustrate the point. Two weeks ago, my elderly Aunt who seldom has headaches said she was having, “the worst headache of her life”. When it persisted after administration of the usual remedies and she also began to experience visual symptoms, I could only recommend that she immediately consult her physician or go to the ER. It was after hours and her personal physician wasn’t available so she went to the ER. The doctors there were sufficiently concerned that they ordered a CT scan of her head (not the one pictured above). My Aunt was told that the CT appeared to be normal, but might not show acute thrombotic changes or very small hemorrhages. They also recommended a consultation with an ophthalmologist the next day. The eye doctor didn’t find anything wrong with her eyes, but proclaimed there was definitely something going wrong in her head. My Aunt said that her eye docotr ordered lots of blood work and told her to follow up with her personal physician. More than a week later, she’s still waiting for someone to tell her what is going on in her head. It seems her family doctor is waiting to receive information from the ER, imaging center, and laboratory. In other words, the data is available, it’s just not being communicated. Clinical workflow is broken because the community physicians caring for my Aunt don’t have the communication and collaboration infrastructure to work seamlessly as a care team.
The above is but one small example that reinforces the point on which Dr. Detmer and I so vehemently agree. It’s not so much about the “I”, it’s about the paucity of CT in clinical practice. And, I don’t mean computed tomography!
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
The problem also stems from the lack of quality standards for the EMRs currently on the market and no application that easily transfers the EMR to another provider. For instance to send medical records currently, a provider office prints a paper report of the lab or MRI from their EMR , faxes the paper report to the requesting provider and that office scans it back into the requesting doctor's EMR. (Not to mention paper files that still exist.) So while HL7 required the EMR to "talk" I agree they still dont communicate. In most EMR products on the market this is overcome by the electronic fax application that can fax the image. But not all EMRs on the market have that application. Further, alot of providers dont know what to buy or how to choose an EMR that streamlines this process and we still have a majority of providers who dont see the necessity of a large paper practice conversion to EMR.
Also one of the mechanisms within a "good" EMR is the patient follow up system. In the case of your Aunt the doctors office needing reports would get a faster response if one staff member was positioned to call daily or multiple times daily requesting the information. Often with an EMR the "task list" gets printed out or written on a message pad and sits on someones desk. With a "good" EMR the task is on a bullentin board, the doctor and office manager check the progress throughout the day and see to it the continuity of care includes persistent and continuous follow up.
I think Jill's comments form the route of the problem. Until we can mandate that new systems must provide suitable interfaces for 'selected' processes we will keep going round this loop. This applies to all systems, whether medical or simple administration, but we also need the processes to be exposed to other 3rd party applications rather than just a transfer medium.
Who is going to define these interfaces, how long and how far should this progress before becoming a requirement. The likelihood is that we'll (I'll) keep complaining about the poor integration.
Good post, For instance to send medical records currently, a provider office prints a paper report of the lab or MRI from their EMR , faxes the paper report to the requesting provider and that office scans it back into the requesting doctor's EMR. (Not to mention paper files that still exist.) So while HL7 required the EMR to "talk" I agree they still dont communicate.
There is so much technology within the healthcare industry, even outside of hospitals. I think that the care home industry in particular has been boosted hugely by the latest generation of professionals who have such great understandings of technology.