The AMDIS Connection: The Ape Brain Meets the Medical Semantic Web

Better communication is more than simply a matter of putting all necessary information together in one place. I’m reminded of that every time I come to work at the VA facility in Tampa, where everything’s there, in the VistA EMR, but there’s so much there that it’s impossible in a one-hour outpatient visit—never mind the usual allotted 20 minutes of outpatient clinic time—to complete a review of what’s happened since the physician last saw the patient.

This results in a lot of reliance on patients advocating for themselves, and into that domain, we’re introducing more technology in the form of the PHR, and talking about uploading and downloading information. But even the most computer-savvy patients still aren’t experiencing a seamless process where they can walk into the room, plug in and download everything that’s happened since their previous visit. Although we’re in an era of constant connectivity and Twittering everything, the way we practice medicine has not kept up with diversity of location and settings where we’re seeking and delivering care.

In terms of information exchange, we’re migrating from RHIOs to HIEs, but we’re just changing the acronyms—we haven’t figured out how to homogenize the approaches we have for sharing the information so that it can consistently occur no matter where it’s captured.

Technology is now available to provide always-on connections to the internet, and tens of millions of Apple iPhones have been sold—never mind RIM Blackberrys and Google Androids. It’s clear we’re talking about a revolution in personal information capture and availability. It’s also clear that is not yet a seamless information web that links with EHR information or with PHR information. And all of that is going to be necessary if we’re going to truly have comprehensive information, increase safety and improve the quality of care we deliver. 

The smartphone revolution could point the way toward patients’ participation in the capture and communication of their healthcare information. There is now real hardware and software that can do that integration, but we haven’t gotten to the point where we can bring all of that together in a useful way. You could dump everything into a giant database, or you could use just-in-time links to connect all possible sources of information, but you’re still talking about humans who have to assimilate the important elements of each bit of information.

We’re already drowning in an excessive amount of data in healthcare. The good news is, to get to the information that’s most relevant to us at the right time, we may not need anything more amazing than appropriate tagging or indexing of information. That concept isn’t new: Hyperlinking of information has won the day in mainstream search engines, although it hasn’t happened within the context of medication documentation and communications yet.

Indexing and tagging of information isn’t the sexiest idea, but without it, the safety web and quality web that we so need and want won’t happen. The need for a medical semantic web of information is becoming more urgent, as our technologies are becoming far more effective at reaping information, yet its representation is still to the poor ape brain. We need to have some other way to say, ‘look here, this is the important part.’

Otherwise, all we’ll do is create terabyte-size sources of information that we poor humans can’t possibly assimilate in a timely way.

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