Navigating Healthcare – Patient Safety and Personal Healthcare Management

The Science of Medicine

Posted in Clinical Language Understanding, Clinical Narrative, EMR, Healthstory by drnic on July 26, 2010
Medicine is complex and providing the best possible care is a challenge, and it is getting more complex on a daily basis. I’m willing to bet that at least a few readers will still hold onto the belief that playing music, in particular Mozart, can improve brain function. IN fact searching Google Scholar reveals about 8,400 articles related to Mozart and brain function. There are even pages promoting the this concept “How to improve Brain Function“. But as this NPR podcast (The Mozart Myth and More) points out it all started with an one page article published in 1993 Francis Rauscher: Listening to Mozart enhances spatial-temporal reasoning. What followed took the researcher unawares with television interviews, lots of media attention and even some hate mail and calls (because she was misquoted that rock music was not good for brain function)! In fact this limited experiment (36 students total) were able to improve spatial temporal test – nothing else, not general intelligence.

It’s easy to misinterpret results and data and human nature probably pushes us towards believing in miracles and cures but what is important is we review the data carefully and base our decisions on science. In the blog “Bad Science” Ben Goldacre spends a lot of time and effort debunking myths and researching the the data to uncover the facts and interpret them correctly. He has exposed the Nutrition and Pills Industry and Fish Oil and a related piece on science and health reporting errors and this expose of Obvious Quacks. The challenge is we are deluged with information and sorting myth from reality is difficult for everyone from patients to clinicians.

For clinicians this problem is even more acute as they deal with debilitating work loads, time pressures and information overload that oftentimes are overwhelming even for standard cases. I’ve watched several colleagues recently treating patients an dealing with the information available in the electronic medical record (EMR). In all but a few instances the volume of data is overwhelming and processing this in the limited time available is a challenge. Add to this the need to verify existing data and update with new information and then capture the latest data relating to the patient which will become too much to burden the existing system of clinical care. Meaningful Use and the final rule making is pushing us towards EMR but for these systems to begin to address this information overload rather than add to it we have to find ways to capture clinical data without adding further work to the clinicians who is time challenged

As part of that initiative the Healthstory Project has created a vision of a comprehensive electronic clinical record that captures the all important data while retaining the complete patient clinical story. Part of the projects has been to develop a range of data standards for sharing that information and to date 5 draft for use standards have been issued and they are developing an additional 4 more. Getting the information into these formats will be a challenge and there are several efforts underway to facilitate this process. One of the members of the Healthstory Project Nuance (full disclosure they are my employer) is looking for pilot sites to test a prototype of their Clinical Language Understanding technology that is aimed at easing this burden and providing a bridge between the narrative documents generated currently by physicians and the structured data that is essential to fill these EMR’s that will help deal with the information Tsunami in medicine and help guide patients and clinicians in delivering the best possible care. There are other developments underway and I have no doubt over the coming months we will see a range of solutions aimed at plugging the doctor more directly into the clinical knowledge base to help them (to help the patient) make clinical decisions with all the information, processed and assessed each and every time we reach a clinical decision point. Some of this will be about user interfaces and we might even end up with a Neo like interface

Its not as far fetched as you might think). some of it is about work flow and processing of information but the building block for all these improvements is based on capturing and processing information from the clinical interaction.

What’s your experience been – have you got systems in place and have you developed work-flows to facilitate the clinical patient interaction? Has your doctor been able to capture information and process while you visits?

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