Thursday, August 26, 2010

Computers in Patient Care: The Promise and the Challenge

A 29-year-old female from New York City comes in at 3 a.m. to an ED (emergency department) in California, complaining of severe acute abdominal pain that woke her up. She reports that she is in California attending a wedding and that she has suffered from similar abdominal pain in the recent past, most recently resulting in an appendectomy. The emergency physician performs an abdominal CAT scan and sees what he believes to be an artifact from the appendectomy in her abdominal cavity. He has no information about the patient's past history other than what she is able to tell him; he has no access to any images taken before or after the appendectomy, nor does he have any other vital information about the surgical operative note or follow-up. The physician is left with nothing more than what he can see in front of him. The woman is held overnight for observation and released the following morning symptomatically improved, but essentially undiagnosed.

A vital opportunity has been lost, and it will take several months and several more physicians and diagnostic studies (and quite a bit more abdominal pain) before an exploratory laparotomy will reveal that the woman suffered from a rare (but highly curable) condition, a Meckel's diverticulum. This might well have been discovered that night in California had the physician had access to complete historical information.

This case is recent, but the information problem at its root seems a holdover from an earlier age: Why is it that in terms of automating medical information, we are still attempting to implement concepts that are decades old? With all of the computerization of so many aspects of our daily lives, medical informatics has had limited impact on day-to-day patient care. We have witnessed slow progress in using technology to gather, process, and disseminate patient information, to guide medical practitioners in their provision of care and to couple them to appropriate medical information for their patients' care.

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