Sunday, January 3, 2010

What terrorism and healthcare have in common: Information

What do anti-terrorism and healthcare informatics have in common? For one thing, both suffer from having too many players operating in silos that are unable to communicate with each other.

Electronic medical or health records are being looked at as a way to increase healthcare quality, lower cost, and reduce redundancy and bureaucracy. And in a few places they may be achieving some of these aims. There are several other reasons to suspect that simply digitizing those manila folders full of scribbled notes and lab reports won’t really lead to much change. Perhaps the biggest reason was on display in a parallel information universe this past week.

The details of the so called Underwear Bomber from Nigeria who attempted to blow up a US airliner on Christmas Day have been discussed in great detail. But what is informative for the health systems researcher, is how poorly the US national intelligence information system was able to deal with several pieces of relatively basic information stored in different systems. National intelligence and healthcare have several infrastructure similarities here: In both cases you have information about individuals (patients in healthcare, potential terrorists in national security) being gathered by multiple institutions (a hospital, primary care physician, and several specialists; the CIA, FBI, NSA, etc…) Each of these organizations may have a perfectly well-functioning digital information system that can be searched, cross referenced, and used with relative ease within the walls of that individual institution. But for a system to function, it must be able to communicate with the other organs that make it a system. When you arrive at an emergency room, that hospital’s electronic medical record must be able to access the digital data that your primary care provider has amassed, as well as the cardiologist’s report about a recent test, and maybe a psychiatrist’s findings from a relevant appointment. Similarly, when the NSA hears terrorists from Yemen talking about a Nigerian bomber (which they did), they need to be able to cross reference that with the CIA description of a Nigerian in Yemen whose own father reported him as a security threat. But these agencies weren’t able to do that, just as most healthcare providers are not able to interlink their electronic data systems.

With national security we are talking about agencies with practically unlimited budgets, and the ability to access or develop technology that other industries don’t have available to them. You also have lots of political will and even demands that they do more, spend more, and use more technology. If despite these advantages, a handful of national security agencies cannot seem to effectively share electronic information in ordered to keep people from being blown out of the sky, then what are the chances that the thousands of healthcare providers across a nation can effectively link up and share data to learn something as mundane as the prescription meds you might be taking?

Technology helps, but apparently it alone won’t make us healthier. Or safer.

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