The Broken Records of Health Care
A colleague of mine was presenting yesterday and used the metaphor of our “broken health record”. Not a new description, true. But used well as a great little metaphor during his presentation. It is used to discuss the fragmentation of a patient’s record across silos created by maintaining separate portions of the record at different locations.
But I got to thinking, the record is broken in different ways still. Definitions vary, so even IF we pull the pieces together we aren’t all singing in the same key. Lab tests with different normal ranges aren’t being graphed together properly. Even within my own EMR, depending on where a patient goes to get lab tests, results in the record may be coded, come in an ascii text documents or are returned on paper to be scanned into the chart. That feels broken – and that’s just lab results.
Diagnoses are certainly worse than lab results in terms of definitions and codes – tempo, instruments, and song are all different when you try to tape the record back together. Things like SNOMED will help, but in my neck of the woods, there is not a strong understanding of the depth that one will need to do to implement it effectively. Current state for many clinics with EMRs is that they have been building up a list of “coded” typos in their diagnosis tables for years. How those will ever be turned into music is serious question when we start integrating those electronically.
The broken record metaphor really doesn’t hold together, of course. At least not in Canada in this day and age.
It isn’t that the record WAS whole and now it is fragmented. It is more like we each sing our own piece of the song after being told what note and phrase the last person said. Now with EHR initiatives we are hoping it’ll fit together like the songs on Sgt. Pepper’s Lonely Hearts Club Band. (EDIT: or as a reader mentioned, perhaps a better example of an integrated album is The Wall, which does of course fit even better.)
Really, it is more like playing telephone than it is like making an album.
We need to work on common, standard, clinically and technically interoperable definitions to make sure we’re all singing the same songs before we can effectively stitch them together coherently.
Privacy issues, of course, are always raised when we talk about single records. Patients WANT to keep parts of their record separate. True. I have had several patients over the years who come to me for STD issues or Viagra prescriptions and not their GPs in order to keep some things more personal. But we can handle that with a single record with proper limits. To keep the analogy complete – isn’t that what the B-side is for?
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Hi Morgan
First, I’m sorry for creating a bogus account. I don’t like it at all when I’m asked to log in to post a comment, it only wastes my time and makes me taking care of one more account, which I don’t particularly appreciate…
Anyway, I like your blog, and share a lot of interests with you. I specially liked the music analogy in this post and I’m sure you’ll correct the error in the name of the album (Sgt. not St. Pepper’s), however, IMHO, Sgt. Pepper’s is not the best example of songs that are fit together nicely to tell a story. I’d recommend checking out Thick as a brick, Tales from topographic oceans, The lamb lies down on Broadway, or The Wall (in no particular order of course). Having said that, I’m not even sure if at this point we need to sing the same song, we need to learn to sing first, have we learned that?
vp
25 Apr 09 at 12:37 am
Hi vp
Apologies for both the spelling and the account generation — I have removed it now. Really it was a way to try and reduce spam early on, but I have found a plug-in that should help with that now. So you can forget this account.
You’re right, there are several other albums that might be better. I think I was listening to that album at the time of writing that post.
Are we singing yet? Perhaps not. I know some days i feel more like I am screeching (or sounding like a broken record, to keep the metaphor) than singing any song. I still hope we can think of the electronic health record more like an album that fits together. I meet many people who, while they design these records, are not thinking of the big picture and we need that.
–Morgan
priceless
25 Apr 09 at 5:51 am