Thursday, February 04, 2010


Until you have tried to develop a computer application, you will not appreciate the number of steps involved in the most mundane of human activity. Take, for example, paying a bill. That routine chore involves getting access to the bill, a checkbook, and a pen, picking up the pen, filling out the several blanks on the check, etc., etc., etc. If you were to program a computerized robot to pay bills, you would have to identify all of those steps and give the computer specific instructions on how to carry out each one.

If you want to computerize a more complex function, like managing a personal bank account, it is important at the beginning to define clearly what it is you are trying to do and then confine the project to that. It is easy to become enamored with the capabilities of the computer and complexify the situation by wandering off into the other things it is theoretically possible to do, even though they were not part of the original goal.

I am reading Chaos and Organization in Health Care by Lee and Mongan of Massachusetts General Hospital. Beginning on page 76 is a section entitled EMRs (the acronym for Electronic; i.e., computerized Medical Records). Here are some of the things they mention that EMRs can do:

Collect and store information about patients.
Give clinicians the ability to retrieve these data when needed.
Order tests and medications.
Guide physicians in the safest and most reliable choices.
Help physicians keep track of patients’ needs.
Communicate with other providers.
Communicate with patients.
Help physicians comply with preventive and chronic care guidelines.

In order to computerize these functions, each requires a much more specific definition. Then all the steps involved in each would have to be identified and their sequence charted out.

Can you imagine trying to do that? It would be hard to find a wall large enough to do it on.

No wonder hospitals have been so slow to adopt the EMR.

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