JASON and the EHRnauts

October 21, 2014 in Medical Technology

I thought I was done with JASON and the EHRnauts for a little bit, when this query popped into my inbox via Will Ross over at Redwood MedNet.  He points to this bit of wisdom:

From the report:

To the extent that query capabilities are included in MU Stage 3, we are at an awkward moment in standards development: Older standards such as XDS/XCA are mature but inherently limited, whereas newer API-based standards are not yet ready for large-scale adoption. We believe it would be detrimental to lock the industry in to older standards, and thus, we recommend that ONC mobilize an accelerated standards development process to ready an initial specification of FHIR for certification to support MU Stage 3.


I love it when people raise the point about limits, without delving into what those limits are.  It always sounds so authoritative.  Yes, documents are limited. 

Here are some of the limitations of documents:

  1. You can only operate on what appears within documents.  
  2. You have to have some idea about which documents you want.  
  3. When dealing with multiple documents, you have to deal with redundancy and ambiguity.
  4. Documents are coarser grained than some problems want to deal with.

There are also benefits to documents:

  1. A document can be operated on by a human using very little technology (Human Readability), or by a computer.
  2. Documents link each fact reported to an encounter or visit, a healthcare provider and and institution (Context).
  3. A document provides the complete record of the encounter or visit, not just individual parts that can be interpreted out of context (Wholeness).
  4. The content of a document can be retrieved at any point in time in the future in a way that is repeatable (Persistent).
  5. A document links data to the organization that gathered, uses and manages it (Stewardship).
  6. A document can be signed by a healthcare provider (Potential for Authentication).

Anyone who has studied CDA will recognize where these properties come from.

Now, as to the limits, all of these can be overcome, the question is who does it.  The fundamental organization of data in an EHR around information documented during an encounter isn’t likely to change whether you look at a large grained document-centric approach, or a finer-grained data item-centric approach.

You’ll only ever be able to find information that has been gathered, or the fact that it hasn’t been gathered.  The document based approach means that you need to look at several documents to determine that for a time period, a finer grained approach means that the system you ask for that information must look at all data items in that time period.

You will always have to have some idea about what you want to ask for.  In the document-centric approach, that can be based on document metadata such as who, where, what or when.  Those questions are often asked at the first level of the physician’s workflow in their search for more information.  Finer-grained approaches will allow more detailed questions to be addressed that come later in the evaluation of the patient: Did they have this test? If so what were the results? Was ____ ruled out?  When was the last time ___?

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Article source: http://www.healthcareitnews.com/blog/jason-ehrnauts

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