In healthcare, we’re flying blind

  | June 26, 2016

Several years ago, as recounted by Charles Duhigg in The New York Times Magazine, an irate father stormed into his local Target demanding to know why the retailer was sending his teenage daughter coupons for maternity clothes and cribs.
“Are you trying to encourage her to get pregnant?" he demanded.
The store manager called the father to apologize for the mix-up. But when he did, the father admitted that Target hadn't been wrong, after all: His daughter had confessed that she was, indeed, quite pregnant.
It turns out Target had devised an algorithm, based on purchase data of 25 products, that predicted, with more than 80 percent accuracy, whether a shopper was pregnant — and even which month she would be due.
Target isn't the only company that knows a lot about us. Uber knows that we're more likely to pay surge pricing when our phone batteries are almost dead. Netflix knows we're more likely to click on a film if the promo image features fewer than three people. Amazon knows what we want to buy before we know we want it.
And then there's healthcare, where we know so little it's killing us.
Our industry is bloated with data, yet starving for useful insight. An Epocrates survey my company conducted last year found that 95 percent of physicians experienced problems delivering medical care because they couldn't access the patient data they needed. Considering that medical errors account for more than 100,000 deaths each year, this lack of access to critical, timely information can have deadly consequences.
Ashish K. Jha, M.D., director of Harvard's Global Health Institute, wrote recently about a patient he'd cared for who was admitted for pneumonia, put on standard antibiotics, but died 72 hours later. Jha learned days later — after contacting the patient's daughter — that a different hospital had run labs on this patient two months earlier, and found that his pneumonia was caused by a rare strain of bacterium susceptible to just a few antibiotics, none of which had been used by Jha's team.
Of course, the previous hospital was on a different electronic health records system. So the admitting physician didn't know the patient had been treated for pneumonia before. Didn't have the lab results. Didn't have a view of the patient beyond his institution's four walls. He was flying blind.
While patient care falls victim to this lack of knowledge flow, so do the clinical and financial operations of our health systems. Most health system leaders, for example, have no clue that, on average, half of their referrals and consults are going out-of-network. (But we know, based on athenahealth data).
We also know from our data that every month, the average doctor has to chase down 35 missing lab results, 18 missing imaging results, and 12 missing specialty referrals. Aside from the cost, wasted time and frustration for doctors (who already spend 40 percent of their time on non-patient-facing work), think of the cumulative impact on patients as their care drops through crack after crack.
But after decades of disconnectedness and lack of knowing, things are beginning to change. At athenahealth, we're able to now pull data out of what were once closed systems so doctors can follow patients across EMRs. We're finally beginning to see the synchronization of basic information like medicine allergies, immunizations and encounters.
Retail clinics are moving the market toward change. So are new patient aggregators formed as an alternative to hospital monopolies, and technology advances such as the replacement of outdated HL7 interfaces with APIs.
I truly believe we've popped a hole in the medical information dam, and the kind of insight we've been starved for is beginning to flow through. The emergence of integrated healthcare information will allow for massive change in the performance of medicine as we know it — and new companies and technologies will enter to speed up the process.
Uber has changed how we get around. Netflix has changed how we watch TV. The difference, with healthcare, is that this necessary change can also save lives.
Jonathan Bush is President & CEO of athenahealth.
 
 

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While the current electronic system(s) Mr. Bush describes in his op/Ed are assuredly lacking in configuration they are, for the most part, better than the incomplete paper charts we used to have; which were most the time incomplete. Any EHR requires multiple interfaces and careful integration with disparate sources. While I agree with the overall premise of the article the author fails to address the monumental challenge of data security between disparate systems. Maybe healthcare could learn something about security from other more secure industries to better deploy the big data requirements of just in time algorithms.

Name: 
Jon Goates
Email: 
test@test.com

I liked these very hard questions and I’m in the 4th grade

Name: 
Abby mills
Email: 
test@test.com
Sorry to say, I think we've already blown it. I would like to think Athena is the answer but is it really? The few times the Federal Govt could have done something about this, they failed us. Obama took 187 million dollars and built a system that didn't work! The great information hwy for medicine is like the Gran Trunk in India. It should be like our Interstate Hwy System built under Eisenhower, who with the forsight he gained only from his experience from what he saw in the Autobahn invading Germany at the end of WWII. One system with one design, that of truly accurate and concose patient information. Unfortunatley, as corrupt as the expploitation of Niagara Falls, our own industry with dispartate interests, manuevering to better the other guy has us ending up at the same place; victims of our own secretiveness, and willingness to throw each under the bus for a buck, making the take over by Corporations vying for government dollars the fate of medicine. And who's to say that the liablility of that information being available would have been in a system to have a made a difference...if it was there "Somewhere" the doctor who treated this patient that died probably would have just ended up more liable. Patients should have had one record, concise and updated, and one patients could access so they could be part of their own heatlhcare as well, and take some responsibility to be their own advocates, instead of just looking for someone to sue when these "mistakes" in information happen...One system like Kaiser's with import and paste has and continues with all these systems only, creates documents pages and pages for just one note, with so much useless information it's "availablility" is worthless, and only creates more liabilites for lawyers to prey upon us with, who only have to show inconsistencies in a record to satify a jury that a bad result had to be the doctor fault...we should have a system doctor's approved of and were ASKING to use rather than gerimandering it adhesively, forcing us to use it, with all the liabilities heaped upon physicians and not the inadequacies of the data collection that set us up for failure, when it should help us to succeed. If we were all on the same system, at least we would have a collective voice in it operating the way we want it to, not the way some rules for billing or clever government audits designed to not pay us(to save them money) or other healthcare systems to make those of us in the trenches beholden to them all( and not pay us as well). Can Athena do all that and form a partnership that will stand with physicians for reimbursement as well as in court? I'd like to see it happen.
Name: 
B Pevsner
Email: 
wpevsner@earthlink.net
so listing all the failures what can you suggest to fix this messed up medical problem. You listed some who have tried (at least tried) but failed so please suggest some alternatives that you feel will fix this mess. We know what doesn't work now give some suggestions that will work.
Name: 
dorie white
Email: 
dorie.white@gmail.com
Absolutely agree with the above synopsis, very frustrating systems currently exist have little relevance to what we do except the “gotcha”
Name: 
Parul Jani
Email: 
pjanimd@gmail.com
The MACRA leadership is hopelessly lost. I’m expecting MACRA to effectively be dead by late 2018. Anyone that hasn’t seen this coming needs to follow the MedPAC reports. How long can the bureaucracy keep this ship afloat? Make your own guess as you follow what’s going on behind the scene. MedPAC Sinks Deeper Into the MACRA Tar Pit http://thehealthcareblog.com/blog/2017/10/20/medpac-sinks-deeper-into-the-macra-tar-pit/ Super Macranomics http://thehealthcareblog.com/blog/2017/10/26/super-macranomics/ On the Ethics of Accountable Care Research http://thehealthcareblog.com/blog/2017/08/25/on-the-ethics-of-accountable-care-research/
Name: 
Nancy Neighbors
Email: 
theNeighbors@knology.net
Maybe we (the patients/consumers) need to take responsibility so that the healthcare team has the information. What if the patient went back to THE SAME hospital in which he was just treated? What if the patient said,”By the way I had pneumonia in hospital X and I was sent home with IV abx?” Maybe the problem is the patient, “Consumer,” does not take responsibility? Would it matter if people gave an accurate health history? Are we so savvy with eTrade, iPhone and google app, plus know the latest from TMZ yet can’t keep track of what is really important and what may impact our lives?
Name: 
RDH
Email: 
Ironpellet@yahoo.com
There is a profit incentive to NOT SHARE information. And so it will continue, as long as healthcare data can be sold for profit.
Name: 
Jay
Email: 
jay@getauth.com

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In healthcare, we’re flying blind