To avoid damage to communications from working satellites, the NASA Orbital Debris Program tracks half a million pieces of space junk that orbit Earth. The debris is an accumulation of flotsam and jetsam dating back to the first space programs. As the adoption of electronic health records continues to expand and the number of patient encounters continues to grow year by year, health care is compiling its own flotsam and jetsam. Increasingly at risk are the integrity and quality of patient health information.
When we gaze at the clear night sky, we see the brilliance of its celestial bodies, not the orbiting debris. Similarly, when we turn off our clinic computers, all seems simple and serene. In contrast, during the "paper days," volumes of crumpled papers falling out of multiple charts on a single patient were an eyesore, and someone would have to tidy them. With electronic health records, the problem is more sublime.
A bright millennial I know was quite matter of fact about my realization. He explained that this is simply the nature of the digital age and that space junk is not limited to electronic health records. All of our computing devices are rife with old contacts, unremembered partial drafts of emails, blocked junk and deleted but not trashed information. There are old, expired and unused apps, countless duplicate photos now filling not only hard drives, but also the cloud.
Just like in the movie "Gravity," this past week I took a spacewalk and tried my hand at cleaning up a few charts. What I found under diagnoses, for example, was that each provider and each specialty had created its version of the same illness. In one chart the patient’s lower back pain was described under 13 different codes. Really just one or two would do. By the time I finished cleaning a chart for an elderly gentleman who had received care for several years from multiple providers, I was able to condense 47 diagnoses into 11.
Comparable problems arise with regard to which medications someone is actually taking. New medications are automatically added to the list, but someone has to take the trouble to delete older ones that are no longer taken.
Yesterday I interviewed a prominent vascular surgeon who is now close to retirement. As electronic health records became popular, he opted out. Today he still writes out his paper charts. The problem, he complained, is that when you ask for hard copies of electronic health records, you get so much meaningless paper that it is difficult to find the actual information you are looking for. In the old days it took more time to write out a paper chart, so you would record what was important.
To be sure, there are still great benefits in electronic health records. Most of them have a confidential "in basket" for secured communications between providers. It is easy to look up test results, avoid duplicating diagnostics and pull up previous medical notes, but electronic health records bring drawbacks together with their efficiencies.
The NASA Orbital Debris Program Office has taken an international lead in monitoring and in developing the technical consensus for adopting mitigation measures to protect users of the orbital environment. The same needs to happen with electronic health records.
Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
