The problem is in the data

Legacy computer systems were almost always funded by one department and developed to meet that department’s needs. There was little incentive to make them compatible with earlier systems except to provide necessary means to exchange results of computations.

EMR systems are now attempting to bring together information based on the treatment of a single patient from systems that were designed to manage a single clinical or business process. Two choices: standardize the data or develop a system solution. Standardizing the data just from this point forward would be huge and expensive project and would of course make all of the historic data essentially worthless. Microsoft’s Amalga system has been receiving a great deal of press coverage as a system solution to deal with disparate data formats and types. The system was developed in 1996 at Washington Hospital Center and was acquired by Microsoft in 2006.

Amalga’s Web site focuses on the stand-along organization:

Microsoft Amalga HIS EMR consolidates data from across the organization to tell the complete story of a patient’s history, condition, and progress.

Complete story within the organization, but hardly the “complete sorry of a patient’s history.”

On the other hand, another Amalga Web site says: information in the patient’s EMR can be sent “to the patient’s personal HealthVault record” where the patient can share it with other health care professionals.

Maybe we are not to far away from a system solution to the data problem. Microsoft has a well publicized solution. There are probably other solutions that are not well publicized but can also assist in dealing with the problems in the data. Microsoft has often been a dominant player but has seldom been totally free from competition.

While on the topic of Amalga there is one other part to the story. The uses and users of EMRs have become diverse enough that it is almost impossible to fully define what is wanted and needed – even if we could, it would change. By analogy, who would have expected that the iPhone would have led to more than 50,000 applications? How many unforeseen applications will there be for ERMs?

One example of an unforeseen need is a response to swine flu and the need to track cases and exposure in the emergency department of El Camino Hospital:

Within a matter of hours, clinicians at El Camino modified a few fields within Amalga to capture information specific to possible flu cases coming through the hospital’s busy emergency room. The result is a real-time dashboard that is keeping hospital officials appraised of possible swine flu cases at El Camino and will help them respond appropriately should one or more cases be confirmed. Clinicians are praising Amalga for the solution’s flexibility and the way it can be adapted to meet specific organizational needs as they arise.

Microsoft has announced plans to provide guidance to other Amalga customers so they too can immediately begin using the solution to monitor flu activity. This could prove especially valuable where Amalga has been deployed to gather community-wide clinical data. One example of that is the Wisconsin Health Information Exchange where more than a dozen emergency rooms in the state are now able to share real-time clinical data thanks to Microsoft Amalga.

In one product there is a possible solution to part of the problems with the data and an excellent example of the need to build flexibility into EMR systems.

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