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Blind Spots Can Kill . . . Patients

December 21, 2010
by Joe Bormel
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Having access to the right, relevant information at the right time is key

Blindspots–Where Does Healthcare Information Technology Help?

Most of us who work in clinical healthcare information technology (HCIT) share a basic vision. This vision can be reduced down to a couple of extremely basic, fairly self-evident, non-arguable propositions.

First, if we patients, family members, doctors, nurses, and those other folks we rely on always had complete, accurate, up-to-date, and relevant information, our healthcare system would be much better. And second, having that information would inexorably lead to better decisions and therefore better care.

Invisibly built into the vision are a few painful assumptions including: • The technology is affordable and fast-enough, i.e. pretty much instantaneous. • The people issues are straight-forward and non-blocking such as an interest in and willingness to change, and to be trainable concerning arbitrarily complex systems and processes. • All of the major stakeholders agree on the explicit definition of what is meant by "our healthcare system would be much better."
Our vision on the third point above is that we can, given the will, time and money, transcend or otherwise overcome the limits implied by these assumptions.

For the sake of this discussion, let's assert that our vision is just simply true, that the information is good, it leads to better care, and all that's missing is the deployment of readily available, affordable technology.

In my next few blog posts, along with comments from conversations with a few friends, we're going to explore a series of subtle issues, the blind spots, associated with going from always having access to the right and relevant information at the right time, to the necessary interpretation and translation actions that enable us to exploit that information. Here are a few of the bigger obstacles, landmarks and questions we'll encounter during our journey:
1. Patient safety and medical diagnostics error literature has recognized more than 30 biases and fallacies that lead all of us, including doctors, to take correct information and come to incorrect conclusions. (See my Swan and Turkey blog post for a simple, brief example.)
2. Although potentially rational, humans do not act perfectly rational, nor should they. A Nobel Prize winning economist, Herbert Simon has more so say there.
3. We use conscious thinking and reasoning, as well as semiconscious "thinking" to get to many important conclusions. There are a wide variety of important issues in semiconscious thinking that won't necessarily be improved simply by improving the delivery of information. One term for a way computers might help is called decision support. Other terms that incorporate the concept of guidance include workflows and checklists.
4. Along with semi-consciousness is the notion that at least some of the skills and knowledge to use information are readily teachable. The question is, can information technology play a role in all forms of just-in-time teaching and learning?
5. Lastly, in our journey to better care, are there relevant differences about how generalists use information versus sub-specialists, e.g. cardiologists or infectious disease physicians? If there are, when if ever does better care result from seeing one or the other first to get the right diagnostic and therapeutic interventions? What testing should a patient get before seeing either or both for clear cut problems like blood appearing in urine?
Simply delivering relevant information reliably, while important, is only one contribution of healthcare information technology. As we pour billions of dollars into using HCIT to help us attain the evolving staged definitions of Meaningful Use, this might be a good time to explore the sometimes complex journey to better care.
Enjoy the ride, but watch out for blind spots!
Joe Bormel, M.D., MPH
CMO & VP, QuadraMed

Before I go on with this short history, let me make a general observation —
the test of a first-rate intelligence
is the ability to hold two opposed ideas in the mind at the same time, and
still retain the ability to function.
One should, for example,
be able to see that things are hopeless and yet be determined to make them otherwise.

--F. Scott Fitzgerald

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