Information Technology Reference
In-Depth Information
heard them all (many times!) and the one I've heard the most is “Perfect is the
enemy of good” (Steve, according to Wikipedia this is commonly attributed to
Voltaire's poem,
La Bégueule
). This is a very hard concept for many people to
accept. Particularly hard if they are very detail oriented perfectionists, as many engi-
neers and computer scientists tend to be.
So, in this case, what is good enough? The designers of the EHR certification and
Meaningful Use programs clearly tried to answer these questions. All certified
EHRs must be able to produce a CCD. While the actual information content of a
CCD is not tightly defined by certification (e.g. the content is not tightly specified in
most cases and data that would ideally be structured may be in free text) this is
clearly a large step forward. It means, in essence, that every EHR can present at
least key clinical data in a manner can be reasonably well understood and used by
outside systems creating, in essence, a virtual distributed database consisting of all
deployed and certified EHRs.
This is not just a theoretical possibility. A startup company I advise
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has suc-
ceeded in mining data almost exclusively from CCDs to create a quality metric
reporting system that is installed and in use commercially in a number of medical
practices. Of course they had to build software that would curate the data into a
standard enough form to do it, but that can be done, particularly for the limited
dataset needed to satisfy a well defined set of quality metrics. The hope is that the
ability to largely avoid custom interfaces will substantially reduce the cost and com-
plexity of implementing and installing such systems.
We have also seen the emergence of DIRECT as a simpler way to think of infor-
mation exchange. It does not have many, or even most, of the sophisticated privacy
or patient indexing characteristics of the central model. Information is not aggre-
gated, curated, standardized and annotated to allow the kind of one click access to
an entire distributed patient record found at the VA or in Indianapolis. However, it
works and it should be sustainable. In time, just as social networking has grown
more technologically sophisticated, so will the use of DIRECT.
Taken together, these changes may have real and substantial ramifications. We
have talked about quality metric reporting. In
Chapter 7
we looked at systems that
are being developed with the expectation that they could query this entire virtual
database for clinical research, public health reporting and other important reasons.
That is another really big step forward. While things are far from perfect it is rea-
sonable to expect that, in time, the bar will be raised as everyone gets plugged in and
more comfortable in this new world of more open data exchange.
Will the underlying EHR systems become more modern, easier to use and sim-
pler to install? One would hope so. However, real reinvention is very difficult within
an ongoing business that also has to respond to customer, market and regulatory
demands and keep its investors or shareholders happy. Significant innovation most
often happens when new entrants come along. They can start with the proverbial
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Full disclosure, I have a small financial interest in it so I won't specifically mention it here.
