Wednesday, August 31, 2011

Query This

Why is it, with all the billions of dollars poured into health care information technology, that doctors can't query the information they hammer in to the computers themselves directly? Is it because our hospital administrators are scared of what we might find?

I am constantly amazed that I can't even query my work volume statistics. Despite the thousands of diagnosis and procedural codes that I have to enter on a computer to get paid, I'm not allowed to find out how many pacemakers I've performed for sick sinus syndrome versus complete heart block. I can't determine how many atrial fibrillation ablations I did last month without asking an administrator to "pull the data" for me.

Medicare gets the data.

The billers get the data.

Why can't I?

Should patient care information be valued less than billing data?

Don't get me wrong, there are plenty of good things that highly integrated electronic records can do for patient care, but seeing that doctors are the ones providing the care, shouldn't we be able to query, without restriction, any and all fields available pertaining to patient care? If I can program an Excel spreadsheet on my laptop to perform a nearly infinite number of queries, whay can't our billion-dollar electronic medical record companies make it just as easy for those providing the care to do the same?

Who knows, maybe we'll be able to find some improvements as a result.

Or might the potential that we find that all those information technology jobs are inefficient just too threatening to those in charge?



Jeremiah said...

What your asking for is a "Requirement", more importantly it is a "Business Requirement". Those requirements where defined and prioritized a full 12-18 months prior to any actual technical work. (Provided your implementation is anything close to normal for projects that size).

Most likely it is one that was shut down by the administrative side of the business. Since you are then required to rely on them for the information that you seek.

No going to argue about the inefficiencies of IT. However I doubt the decision to exclude that functionality (that is obviously built into the software) has anything to do with them.

*If it matters I have a decade of IT experience including support and Project management.

Keith said...

Just another way for you to be locked into a proprietary product where you need your "friendly" IT company to give you the data, usuually at some exorbitant cost.

Current iterations of health IT are not designed to give improved quality (although this is the selling point for these very expensive systems). They are designed to maximise billing by populating notes with such excessive data that they become almost worthless (all for the prupose of upcoding visits) and capturing every 10 dollar tylenol tablet that is dispensed. Giving doctors access to their data has no advantage to healthcare organizations that are purchasing these EMRs and all the better for our wonderful leaders to retain and manipulate this data to their own devices rather than to have anyone else have unfettered access to it. Its all about the money and nothing else.

DrWes said...


I appreciate your prespective. I don't doubt for a second that all data entered is retrievable, but the prospect that data is purposefully being withheld from the people doing the care, if indeed this is the case, is concerning, particularly since doctors' compensation is increasingly tied to productivity. Further, what chances to optimize care exist when data are sequestered in such a fashion to administrators only?

Many eyes on the reported data might see things differently. The opportunity to verify care delivery and policy initiatives based on verifiable data extends far beyond pure "business" interests and fosters an aire of collaboration rather than servitude.

Named Just Bob said...

Dr. Wes should, without restriction, have access to HIS data. It's HIS, because they are HIS pts. If you could find all the pts that presented with arrhythmia just out of the blue with no history and no obvious predelictions, and tracked their succeeding heart related diagnoses and treatments, imagine the kind of insight that might be gained. The possible connections between one condition and the onset of another condition later on. WOW! Think of it!

emmy said...

Wow! That sucks that you can't query the information. Patients stay constantly frustrated that we are restricted to access of our medical information. Sad to think our doctors are too.

Dennis said...

A handy flash drive in your coat pocket might be handy when entering data...

Screw them

Jeremiah said...

Dr. Wes,

I had one more thought on this. The restricted access to information that should readily be available is generally linked to a misapplied security policy.

You mention that you want to be able to run queries on your personal laptop. There is normally a requirement for the proper sanitation of the data before it leaves the confines of the hospital controlled infrastructure. This is to protect the hospital first and foremost. After all medical professionals have been suspended and fired for incredibly minor "perceived" HIPAA offenses.

If you want to have access to the data, I would suggest you ask if there is a hospital owned laptop that can be checked out of assigned to you. Then they "control" the environment and you get to crunch the data.

Where I work this would be similar to our work machine policy. They own the machine and I am liable for everything done with said machine. Leads to interesting situations when law enforcement (think customs/border patrol) asks to access your machine and I have to have them call our legal office for an NDA (non-disclosure agreement).

If the hospital is unwilling to allow you to access your records within the confines of their own infrastructure then there is a very serious problem. Either they are ignorant or hiding something. Both should require a detailed audit either way.

Anonymous said...

They decide if you were right or wrong, remembered or forgot, were on time or late, had a good outcome or a poor one, if your patients like you or not, and this is all can be changed if need be as suits them.

That's what happens when you go work for The Dark Side.


Anonymous Intern said...

I'm an Emergency Medicine intern who has a few years experience in retrieving data from our department's EMR database and let me tell you how difficult it can be!

The proprietary vendors do not foresee anyone else tapping into the data except themselves. The database is setup to interact with the frontend application just so and here we are trying to find our way through the forest, query it, and present it in an actionable manner. This is not as easy as it seems.

We have written our own applications, reporting system, dashboard, and metrics collections outside of the EMR. Our next goal is to make this as simple as possible so that end-users such as physicians as yourself have an easy interface to this data without knowing how to write programs, navigate databases, and dealing with IT issues.

The reality of it all is that these databases are waiting to be mined but it takes expertise in both medicine and informatics to do so. However, very few individuals have knowledge in both fields to make it happen.