Health Information – what exactly IS the problem?

Do we know what problem we are trying to solve with all of our discussions about health information, IT, and meaningful use?

Depending on which group you are following, the problem might be:

  • Lack of training and change management upon implementation of an EMR
  • Lack of workflows that work for the clinician as they perform patient care
  • Interference with the physician – patient relationship, and the time it takes the physician to document patient encounters
  • Systems that do not make use of the information available in narrative documentation
  • Lack of discrete data
  • Systems that do not communicate with each other
  • Cost
  • Increased information requirements for coding driven by ICD-10-CM, POA indicators, and other changes that require the HIM to have MORE information when template-driven EMRs mean physicians sometimes provide less information
  • Lack of information available to the patient for his/her own care
  • And on and on and on….

If no one agrees on what the problem is, how do we create a solution?

The problem isn’t lack of documentation. We have handwritten notes, and history and physical reports, and operative reports, and consultation reports, and letters to referring physicians, and ED reports, and discharge summaries, and lab reports, and x-ray reports, and social service notes, and physical therapy notes, and dietary notes, and medication orders, and nursing notes, information in the HIS, the RIS, the PACS, the document management system, the inpatient EMR, the physician practice portal, the primary care provider’s written notes, the consultants notes, the anesthetists notes, the surgeon’s notes….

Good gravy –  we’ve got documentation coming out our ears!

BUT – none of it is connected!

EMR implementations and “meaningful use” sound like beautiful things…but if this EMR doesn’t talk to that EMR, and that EMR doesn’t talk to the HIS, and some documents are updated and printed from the transcription system because the EMR can’t format a letter, so the changes to that letter never get to the EMR, and the inpatient system doesn’t talk to the outpatient system, and none of the systems from one facility talk to the systems at another facility – have we really solved the problem?  Where is the source of truth for patient’s health information?

See that is the key I think…

We used to think in terms of paper documents. Written or dictated and transcribed; printed or uploaded through an HL7 interface, we thought in terms of documents. In many cases we still do.

Now “discrete data” is the buzzword of the day. To hear many people speak, “discrete data” is supposed to be the solution to all of our problems.

But just as documents are disconnected, so are discrete data points. When we have discrete data, we still don’t have INFORMATION.

Look up the terms “data” and “information” and every source will tell you that data in and of itself is NOT information.  Data doesn’t become information until it has been processed in a way that applies context and meaning. Knowing the patient’s temperature tells you nothing about the patient’s general health. Knowing that the patient’s blood pressure is normal doesn’t tell you the patient is healthy.

Some of us think the answer is to use NLP to extract discrete data from narrative reports and then keep the remaining narrative somewhere else in the EMR….

Let’s think about this.

We need the information from the narrative because the disconnected data points have no meaning without context. And the physician can dictate that narrative relatively conveniently. But the narrative isn’t available in the EMR – so we can’t get TO the narrative. And if the narrative IS in the EMR, we can’t get to the information IN the narrative. So we ask the physician to enter the information into the discrete fields of the EMR himself. But the EMR doesn’t provide the means for him to do this easily. So let’s let the physician continue to dictate. But now we’ve got that narrative report, and we can’t get TO the information in the narrative. Oh wait, sure we can. We’ll use NLP to pull discrete data FROM the narrative to put it IN the EMR, and now the information IS available…but oh wait, we just decided that discrete data is NOT information, but we DO have information in the narrative report, but we can’t get TO the information IN the narrative report, and we can’t share the information in the narrative report, so we’ll apply NLP to get discrete data FROM the narrative, which we can then put IN the EMR…


The solution to the healthcare information problem (if only we could agree on what the problem actually is) seems to be…

… to provide useful information in a way that does not interfere with the doctor – patient relationship, and which is readily available to all the consumers of health information.

With so much information available in so many different systems…how does any user of health information wade through it all?  If users can’t find the information that is “meaningful” to them…is any of it “useful”?

We need technology to ENHANCE the workflow of the humans who use it. We need it to capture truly meaningful and useful information.  Not collections of documents and not collections of data points, but actionable, accessible information. And then we need the tools that allow us to make use of that information.

What does the MTSO do in the meantime?

  • Understand what problem you are trying to solve, and commit. Are you trying to solve the physician’s problem?  The HIM’s problem? The CFO’s problem?
  • Create a strategy and a roadmap to address that problem – a strategy that is complete and end-to-end.
  • Create alliances and partnerships that support your goals. Why partner with a company that is driving away your business and driving your prices down by turning you into a nameless, faceless commodity?
  • Research your options for technologies that support your strategy.
  • Don’t get sidetracked. Have a checklist at the ready. Understand the need for a Chief Strategy Officer (maybe you) whose job it is to keep your company from straying.  Does every process or change you plan to implement support your strategy?  For example:
    • If your strategy is to provide ease of use for the physician, don’t get sidetracked into processes or technologies that reduce costs for the healthcare provider, but which force physicians to adopt practices that interfere with their work.
    • If your strategy is to support standards and meaningful use, don’t get fooled into adopting methods that reduce costs, but which do not support meaningful documentation.
    • If your strategy is to reduce costs for the healthcare provider, don’t get pulled into supporting service levels that increase your costs.
    • If your strategy is to improve the usefulness of information for HIM purposes, don’t be tempted to adopt requirements that will allow you to deliver the rock-bottom price, but which will do nothing to ensure that the HIM has better information available to them.

Til next time,


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