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Dismal or Delusional?

January 29, 2010
by root
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To the Editor

Re: The Dismal Failure of Informatics in Healthcare

Let's face it. Anyone who says Informatics has done for healthcare what it has done for the financial, entertainment and retailing industries either would have a hard time keeping a straight face or is delusional. “Bar codes” that were introduced 50 years ago are being hailed as the recent “big advance” in bedside health care. This is occurring while everyone else is going to RFID! And, HIT hasn't lowered costs as promised (HCI Jan 2010).

There are two major problems in healthcare delivery that make healthcare informatics almost impossible. First, everyone is unique and second there are no “laws” in medicine. Lawyers have the same problem with uniqueness of every client but they have standards, i.e., laws that they must abide. There are no such standards in medicine.

The paper medical record was declared useless for research, documentation, etc in the 1970's. So, what makes a useless paper record worth anything just because it is digital? In fact, “macros” that produce page after page of “medical documentation” at the click of a single button have made it impossible to discern what the clinician really did. More has not been better!

Free text has been the Achilles heel of healthcare informatics. Free text is not easy to index and search and there are billions of megabytes of it in healthcare. Synonyms and medical abbreviations are rampart and impossible to automatically interpret. Dyspnea, shortness of breath and its abbreviation -“SOB”(!) are used interchangeably to mean the same thing.

Healthcare standards were started in the days when a T-1 line was more than anyone could ever want or use and not relevant today. The bitways, middle ware and applications are obviously there for informatics systems. Just look at the other industries cited.

What is lacking in healthcare informatics is critical thinking. The W3 organization (e.g., semantic Web) and National Library of Medicine (e.g., Unified Medical Language System) are working on projects that could streamline healthcare informatics and possibly make it work. Yet, I don't see or read anything about them in the healthcare information literature. Healthcare is still in the days of Prolog, Dialog and AOL instead of the World Wide Web, Internet and beyond era. Why?

Best Regards,

Fidel Davila, MD, MSMM, FACPE, CPE

VP for Medical Affairs


Little Rock AR

Healthcare Informatics 2010 February;27(2):7