Is IT Capable of Building a National Electronic Health Records System?


A better electronic medical records system seems like a great idea. In fact, I've long wondered why I couldn't carry a little smart card or USB drive for all of my medical records, so that wherever I wind up, the doctors would have a complete patient history available for downloading.


It's what Star Trek's Bones would've wanted, isn't it?


I once thought so. But after reading Joe Bugajski's harrowing experience with electronic medical records, I think Bones would have scowled and retorted, "Dammit, Jim, I'm a doctor, not a information integration expert."


Bugajski, however, is an information integration expert. To be more precise, he's a senior analyst for the Burton Group in Application Platform Strategies and Data Management Strategies, where he focuses on information integration and quality, enterprise architecture and data-access strategies, among other things.


He's exactly the type you'd expect to support President Obama's plan to build a new electronic health record system for the military.


But in a recent Burton Group blog post, written as an open letter to Obama, Bugajski had this to say about the plan:

Whereas Star Wars and Star Gate movie fantasies provide great fun, witnessing you, a world leader, spew delusional visions of a nation-covering, interoperable, secure, private, reliable, accurate, and instantaneous electronic health care data network is at best terrifying and at worst pernicious.

Bugajski's harsh assessment isn't politically based, at least not in an obvious way. Instead, Bugajski drew this conclusion after investigating the technology shortcomings of electronic management systems after a personal near-death experience. In particular, Bugajski believes there are serious impediments to data modeling in electronic health records management systems:

Good models require stable data and good data modelers. Unfortunately, health care data is unstable. Sadly, good data modelers are scarce.

But in his personal blog, Bugajski widens the net of blame to include:

  • The IT systems architects, whom he said failed to correctly capture business requirements;
  • A lack of a reliable conceptual data model; and
  • Independent software vendors (ISVs), whose products, he writes, "fail to support end-user requirements - real doctors, nurses, technicians, and pharmacists."


He also goes into greater detail about what happened at the urgent care and Stanford Medical hospital, where failings in the electronic health records management system used at both facilities almost cost him his life. Despite the presence of a hospital e-records system, Bugajski had to give 11 full medical histories during his 28 hour stay.


At first, his tale makes you question the competence of Stanford's medical staff. But Bugajski came to believe the technology was actually hindering the staff:

I finally understood the problem everyone was having when the heroic ICU nurse explained what she was doing while working with the hospital's electronic health records system. It explained why so many caring, competent, knowledgeable, and talented medical professionals behaved so strangely when interacting with patients. It was because they were fighting a horrible data model. It was that data model that nearly killed me.

Bugajsk estimated the doctors and nurses wasted between 40 and 60 percent of their time trying to make "the system do something useful for them."


He's not alone in concluding these systems may be more trouble than they are worth. Pediatrician Anne Armstrong-Coben recently outlined her problems with these systems in a New York Times Op-Ed piece, concluding that:

...the computer depersonalizes medicine. It ignores nuances that we do not measure but [that] clearly influence care.

Admittedly, you could argue these are the personal observations of two people. No matter how expert they may be, it's just their opinion. But Bugajski is an analyst, so he didn't just stop with his experience. He researched the problem further:

Since the time of my illness, I met and spoke with a dozen medical professionals and health care IT experts. They unanimously confirmed my sickbed analysis of the faults with electronic health records. Most longed for handwritten charts hanging at the foot of every patient's bed ... now, so do I.

Still, I couldn't help but wonder: Is technology really the problem-or are workers using technology as an excuse for poor customer service? It's a question I've been debating a lot recently, both with myself and some of my IT Business Edge colleagues. It's an important question for us, because it affects how we cover the issue. If it's the former, then you have to focus on improving the technology and getting IT to step up to the plate. But if it's the latter, IT is just the fall guy for bigger business problems, and that's an entirely different article.


Were these doctors really so busy typing information into a system, they couldn't listen to the patient and simply take action?


Or perhaps, as Burton Group analyst Chris Howard suggested after reading Bugajski's post, it's a bad pairing of business culture and technology:

Health care culture and style of work, especially in fast-paced emergency settings, may resist the intrusion of technology beyond that which attaches to the patient's body. To ask a doctor or nurse to divert their attention to data entry or retrieval takes them away from their primary goal, even though that data may contribute to the overall care of the patient. In effect, the technology becomes a distracting third party to the provider-patient relationship.

I suppose the bottom line is that it doesn't matter. Whether it's the technology, the medical staff or a bad mix of the two, electronic medical record systems apparently aren't working.


That raises another question: If these systems don't work in smaller scenarios, are we really ready to launch a national electronic medical records system?


Bugajski seems to suggest not without more work-and lots of it. It's not going to be easy. It promises to be the "biggest data integration challenge ever undertaken by the IT industry," according to Bugajski.


If it is to succeed, Bugajski said Obama will have to send the IT vendors packing and recruit "our nation's best system and data architects to report for duty."
His personal blog post included a long list of suggestions, but on the Burton Group blog, he sums up his recommendations with this:

Mr. President, before your administration pours billions of our grandchildren's yet to be hard-earned dollars into the biggest, scariest, and most wasteful boondoggle of an IT project the world has ever seen, please instruct your health IT experts to carefully analyze the strengths, weaknesses, opportunities, and threats (SWOT) associated with building a national heath information network using today's technology. Tell them to take the simplest steps first. Make them prove results in small projects.

It's good advice. I hope someone's listening, but I also hope other IT analysts and data experts will offer their experience on this issue, before we're stuck with a system that hinders, rather than helps.