hoot72

Hospital (John Halamka on behalf of Beth Israel Deaconess Medical Center) to Patient …

we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their records to Google Health in a few keystrokes.

And so Patient Dave tap, taps and what does he see?

There’s the ambiguous …

everything I’ve ever had. With almost no dates attached. … So the “anxiety” diagnosis was when I was puking my guts out during my cancer treatment. I got medicated for that, justified by the intelligent observation (diagnosis) that I was anxious. But you wouldn’t know that from looking at this

and the plain wrong …

some of the conditions transmitted are things I’ve never had

Why?

the system transmitted insurance billing codes to Google Health, not doctors’ diagnoses. … insurance billing codes bear no resemblance to reality. … basically if a doc needs to bill insurance for something and the list of billing codes doesn’t happen to include exactly what your condition is, they cram it into something else so the stupid system will accept it.

Then there’s the missing …

I got over my surprise about what had been transmitted, and realized what had not: my history. Weight, BP, and lab data were … not in Google Health. … no medication history

and the dangerously missing …

the allergies data did NOT include the one thing I must not ever, ever violate: no steroids ever again (e.g. cortisone) (they suppress the immune system), because it’ll interfere with the immune treatment that saved my life and is still active within me.

A Boston Globe reporter fleshed out another problem - medical codes …

accuracy gets lost in translation. His cancer had at one point spread to his skull, but there is no code for that, so the hospital probably instead used the code for metastases to the brain or spine … “Chronic lung disease” probably refers to the bronchitis … “Anxiety disorder” apparently referred to the anxiety deBronkart [Patient Dave] complained about during intensive chemotherapy … “Aortic aneurysm” was probably a slight widening of his aorta

As an aside, the Globe also passed on some received wisdom - records will improve as more precise coding language is adopted in the coming years. John Halamka added his two cents worth too. Um. Oh codes, oh codes.

Anyhow, the conclusion …

the data that arrived in Google Health was essentially unusable

Oh this brought many comments, touching on most aspects of Health Records. Some decried the bill-centric nature of Health care and its current IT. And Information is not data was a major point - in other words, even if the raw stream in Google were accurate, it could be misleading. It would have to be filtered. Of course, there was a call for greenfield solution(s), that legacy systems themselves … have to be replaced with modern systems. Begone old Health IT again!

To go geeky - and particular to this blog - was Dave expecting to see his HL7 v2.x data - his health, not billing records? With this data - and were Google to interpret it - would he have seen something close to a Continuity of Care Record or at least a crude summary?

Interoperability has meant Billing for too long. Raw patient data - labs, observations, the lot - needs to come out into the open, in all its crude, lopsided glory. Then the sculptors could get to work. Most wouldn’t work for Google - they’d be in hospitals and clinics which could finally tend to that most important resource, their patient data, smug in the knowledge they could access it, all of it, with ease.