Problem: lack of overview

Let’s expand on the first item in the list I made in the previous post. I called this item “Lack of overview of the patient”, and that’s actually a pretty serious understatement of the problem. What we get in most electronic healthcare records systems is an evenly thick layer of prose stretching from a variable point in the far past to some point in the near past, without any bumps or changes of scenery. It’s like a collection of badly written novels, intensely unreadable and intensely boring. And somewhere in there is that one fact you really need to know about, but since you don’t know what you’re looking for, you’ll never find it.

There is no overarching structure to it. You’d think that if a patient’s life, from a doctor’s viewpoint, is a sequence of medical problems that either are solved and thus in the past, or ongoing and still present in the future, that is what we’d see, but no, that is not what we see. Instead we see, for some reason only a government bureaucrat could fathom, a tree structure of how healthcare is organized in your area. That one administrative or political statement (what else can it be?) follows us around all through the medical record system, occupying prime user interface area, presumably to make sure you never once forget how many departments there actually are in your organization, and what they are called. It’s as if the most critical knowledge you need while treating uncle Bob’s diabetes is how many kinds of ear, nose and throat departments we have and what their names are and under what other larger department they reside. It could be useful for the postman, though.

(Click on image for full size.)

Just look at this screenshot from Cosmic. Most other EHR systems have the same layout, so Cosmic isn’t any worse than any others in this respect. As you can see, the workflow seems to be:

  1. Select a department
  2. Read everything that happened to the patient at that department in reverse chronological order
  3. Repeat from step 1 until you’ve read it all (unlikely) or you grow old and die (more likely)

Or, possibly, select “All physician notes” and then try to guess which departments were not included (yes, there are some, but they’re not going to tell you which ones unless you beg for mercy). This is obviously not the way we want to learn about a patient medical history. The only reason I can think of why EHR systems are built this way is because some bureaucrat who habitually views healthcare as a collection of departments, but has no idea of how a patient is actually diagnosed and treated, got the ultimate say in how the system was designed. Whatever the case may be, it’s a perfectly useless structure of an EHR.

What it should have been is a view of diseases, and then an outline of criteria, treatment options, and followup according to current science. We’ll get to that when discussing solutions later.