{"id":103,"date":"2010-09-09T01:59:22","date_gmt":"2010-09-08T16:29:22","guid":{"rendered":"http:\/\/blog.healthbase.info\/?p=103"},"modified":"2010-09-09T02:26:27","modified_gmt":"2010-09-08T16:56:27","slug":"incoherence","status":"publish","type":"post","link":"http:\/\/healthbase.info\/blog\/?p=103","title":{"rendered":"Incoherence"},"content":{"rendered":"

A few days ago I singled out Integrating the Healthcare Enterprise (IHE), perhaps unfairly, in a posting about what seems to me to be widespread ignorance of \u00a0a profound issue in e-health – that of information usefulness ( or the lack thereof ). That might be hard to believe, given that the USA government has committed $25Billion to try to improve the “meaningful use” of \u00a0electronic health records. Although the definition of “meaningful use” is still rather vague, I have yet to see any evidence that the measures being adopted over there actually promote meaningful use. I contend that the major problem in supporting meaningful use is the lack of coherence in clinical information representation. $1000Billion won’t magically create meaningful use. Not until people understand the problem.<\/p>\n

With respect to IHE, when I say “perhaps unfairly”, it is because IHE builds on standards that are already being used to some extent in the particular health domains to which IHE contributes. I’m not saying IHE is more culpable than other organisations or the Standards Development Organisations \u00a0(SDOs) producing the underlying standards referenced by IHE. But because IHE are promoting adoption of their products without an overarching information architecture, they are too, in effect, building silos. The standards don’t standardise in a meaningful way!<\/p>\n

My concern, as outlined in a previous post<\/a>, is about the excessive and debilitating heterogeneity in information representation. I’d like to try to convey my concerns through the use of analogy – starting with three that hopefully will strike cords with clinicians; managers\/administrators; and IT personnel and software developers, respectively. Unfortunately I’m not able to think of a good analogy of incoherence in clinical practice (hopefully it doesn’t happen!) , so this analogy is a particularly lame one. I’d welcome a better one.<\/p>\n

Clinical<\/strong>: Imagine a clinician fronting up at the administration counter of her clinic\/ward and asking for the case notes for the very sick patient Browne, only to be told the following:<\/p>\n