Too much data can overwhelm physicians and harm patients

One of the supposed strengths of electronic medical records is better tracking of test data.

In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily.

But a recent study, as written in the WSJ Health Blog, says otherwise.

Apparently, a study performed in 2007 found,

VA doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third of the total, during the study period. In 4% of the cases, imaging-test results hadn’t been followed up on four weeks after the test was done. Another study, published in March in the American Journal of Medicine, showed only 10.2% of abnormal lab test results were unacknowledged, but timely follow-up was lacking in 6.8% of cases.

Consider that the VA has what is considered the pinnacle of electronic systems — their unified, VistA program that permeates all their hospitals and clinics.

Apparently the problem is one of alert overload:

Hardeep Singh, chief of the health policy and quality program at the Houston VA’s health and policy research center, led both studies. He tells the Health Blog that doctors now receive so many electronic alerts and reminders — as many as 50 each day — that the important ones can get lost in the shuffle.

This is not unlike the alarm fatigue issue that I recently wrote about.

Too much data — whether it is written or on the screen — can overwhelm physicians and potentially place patients at harm. Curating test results by prioritizing abnormals, will really be the true power of electronic test reporting.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.cliffsedge.net Cliff Zugay

    There is no such thing as too much information. The problem is in the handling of information. We only heard about this information for overload for doctors when the government started taking control of healthcare. It sounds suspiciously like a push toward less information and less costs. I can’t imagine any business that benefits by less information. Especially medicine.

  • http://fastsurgeon.blogspot.com JF Sucher, MD FACS

    Mistaking data for information is the most common error that I encounter when discussing clinical informatics, and Cliff Zugay’s comment is a great example. Data are not information. Data must be collected, sorted, synthesized and analyzed before it becomes information. This is the job that computers are meant to perform, yet there is very little to none of this happening in clinical informatics.

    The VA’s VistA is a great example of just how bad the problem remains. Calling VistA the “pinnacle of electronic systems” is akin to calling the telegraph the pinnacle of communication systems. Sure… you can communicate, but the receiver gets a bunch of data that requires significant work and expertise to translate each dash and dot into usable information. There is a serious lack of vision and effort by the EMR industry to move us from the telegraph to mobile comms. The reason being… it’s easier just to ask our health care team to “work harder” and be “more efficient”. We continue to pick up the workload, making up for the lack of helpful systems.
    HighTech Surgeon

    • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

      I totally agree. There is constant talk about “innovation” in the EHR industry and it mainly refers to iPhones and iPads and all sorts of gizmos, all displaying the same data, some inclorful pleasing ways, others in drab gray. The real innovation has to be some sort of intelligence in processing and prioritizing and somewhat digesting the mountains of raw data. Not sure anybody is paying attention to that right now…

    • http://www.cliffsedge.net Cliff Zugay

      I understand that many EMR systems evolve from electronic billing systems, since that was pretty much the only framework available to developers. Do doctors find that true, and if so, has that created deficiencies in EMR systems?

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Hopefully, still within my own career, I will look back on the EMR our practice implemented last month, saying, “remember how clumsy our first system was?” My heart is still in the paper chart. EMR came in promising solutions to problems we weren’t having. This is true of lots of medical ‘reforms’.

    • r watkins

      You’re hoping you have to replace the (I assume) mega-expensive system you just bought? I know lots of docs who are on their third EMR and still have no chance of qualifying for “meaningful use” kickbacks.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    “EMR came in promising solutions to problems we weren’t having”

    I absolutely love this sentence… :-)

  • David Hager, M.D.

    Our Information Management guy on site notes a historical influence upon the design of EMRs. In his experience, EMRs were often outgrowths of billing/coding software, and so reflected the programming biases of people who thought like bookkeepers and accountants (rather than clinicians.)

    My experience has been that EMR products reflect the world view of programmers – gnomes in back offices churning out stuff that makes sense to them … so they assume it will make sense to end-users.

    Atop that, I think administrators (by nature of their jobs) have more opportunity than clinicians for input into what they want from an EMR. Then, there are bureaucrats, auditors and politicians who want EMRs for their own purposes.

    Where is the clinician in all this?

    Stuck with nonsensical products of non-clinically driven product designs.

    I look actively forward to a time when patient database structures and interfaces are standardized to a point that changing application/GUI layers becomes simple. Agreement on such standards could seriously alter the EHR landscape.

    When vendors know clients can change products at will, market forces will drive them to develop clinician friendly and less expensive products. EHR vendors would need to substantially shift gears and compete not just for initial sale … but also for client retention.

    As it is now, once caught in the spiderweb of a vendor’s proprietary, idiosyncratic data structures/interfaces, the cost of product change becomes prohibitive. After initial sale, incentives get turned backwards and the client lacks the ultimate problem-solving tool … threat of vendor change.

    • http://swdunn.blogspot.com Steven

      Before retiring, my job was to act as an ‘interpreter’ for the programmers. I was an estimator and so I knew what kind of software we needed. The programmers only knew programming. They were terrible at ‘estimating’. And they were constantly surprised by my requests to change the software. They would do it with some complaining but were happy once they learned that the estimators loved it and used the program. But very few companies have an ‘interpreters’ cost in the budget when it comes to designing software…yet it would be money well spent.

  • gzuckier

    Note that the military requires a form http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2807-1.pdf for every visit, where the patient fills in complaints, history, symptoms, etc. and the medical provider fills in the response. I don’t know what happens to the form after it gets filled out.

    For concise, human-being-oriented information delivery, see http://hcil.cs.umd.edu/trs/96-04/96-04.html
    and/or
    http://www.edwardtufte.com/tufte/lancet_p1

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