Joe Bugajski: The Data Model That Nearly Killed Me - what does this mean for "meaningful use"?

Danny Sands posted to Facebook a link to a blog posting (March 17) at Syleum.com written by Joe Bugasjski and entitled "The Data Model That Nearly Killed Me."

• Follow this link to the blog posting

The posting provides a very human and disturbing set of circumstances depicting one view of how things can go wrong when an information technology professional becomes ill. Although the posting addresses the "data model," within the story are examples of flawed processes, internal communication, inadequate hand-offs, and, arguably, poor communication among the patient, and the many providers who tried to help. One could argue that the right term here is " systemmodel" where the system routinely has access to medications, allergies, laboratory tests, and other core information.

Echoing the spirit of the National Resource Center Report, Bugasjki states that " The root cause of these problems is the failure by information technology (IT) system architects to correctly capture business requirements. There also is evidence that no one ever produced a reliable conceptual data model."

He lists a number of observations - copied verbatim from his posting (but the graphics and the narrative are essential to understand his position; please read his full posting ).

1. Incoherent database design isolates patient information from one department to the next and from one organization to the next. This wastes time and increases errors because medical personnel must enter patient information into a unique view of the system that corresponded to user identity and department - this prevents one medical professional from seeing patient information input by another medical professional.
2. Patient information is easily lost inside the electronic records system
3. Hard copy patient information becomes dissociated with the electronic record
4. A healthcare professional’s work pattern is not reflected in either the system design or data model - people spent considerable time searching and data reentry
5. No master data management (MDM) in evidence - Production of a consistent record of me as a patient required the ICU nurse to copy data from multiple database views into the in-patient record
6. Admitted in-patient records are treated differently by the system than out-patient or ER record only patients - no information about my medical history gathered during a prior visit to ER was available to my doctors or nurses.
7. Nurses and doctors do not have ready access to listings of pharmaceuticals which wasted much time while they searched for information about my daily medications - lists of medications in the system are limited to those at the hospital pharmacy.
8. No support existed for recording allergies differently than to ambient source and foods - Lists of allergies were not in drop down menus although these are well known by allergists and drug companies.

What Bugajski has experienced is the absence of a patient-focused care delivery system. He's shown yet another example of what happens when data are not "liquid" and available easily and securely across his many sites of care. A few elements - providers, medications, allergies, could - if made uniformly available ease the complexity and "data loss" he cites through complex system designs.

I would argue that his story is just a sampling of what needs to be done and that some simple priorities, "data utilities," and work flow patterns could ease the risk dramatically. Not everything has to be done to avoid errors and delays; if just some of the important tasks were routine and data were available, a significant majority of these concerns could be addressed because health care professionals would have far more time to think about care and less trying to understand what all has gone on.

From reading the story, it appears that he sought care at very solid institutions but that the system as a whole failed him.

Addressing simple things in a systematic way could do much to address the problem. Meeting the foundational data needs of this individual would, in my opinion, constitute "meaningful use."