Electronic health care record systems are widely and frequently claimed to reduce injury and death due to prescription errors, since they are able to detect and warn for interactions between products. This claim is largely nonsense, because of the following: Interactions between products are not the only dangerous effects we have from bad prescriptions Interactions [...]

Prescriptions made in classic EHR systems have no context of “why” and “for what”. The only information about the reason for the prescription is an entirely optional field on the physical label informing the patient about the purpose of the medication. That is far from sufficient. The drawbacks due to the lack of a structured [...]

I’m at point 2 in the list of problems we need to solve. You can also find this text, possibly improved, on the iotaMed wiki. As new discoveries are made in medicine, we need to get these out to “the factory floor”, so they are applied in practice. If there’s a new more efficient diagnostic [...]

Let’s expand on the first item in the list I made in the previous post. I called this item “Lack of overview of the patient”, and that’s actually a pretty serious understatement of the problem. What we get in most electronic healthcare records systems is an evenly thick layer of prose stretching from a variable [...]

As the interest in iotaMed and the problems it is intended to solve clearly increases, we need to get our ducks in a row and make it simple to follow and to argue. Let’s do it the classic way: What is the problem? What is the solution? How do we get there? Let’s do these [...]

…um, at least as far as medical records go. SQL remains useful for a lot of other things, of course. But as far as electronic medical records are concerned, SQL is a really bad fit and should be taken out back and shot. Medical records, in real life, consist of a pretty unpredictable stack of [...]

When designing new system architectures, you really must design for updating unless the system is totally trivial. This isn’t hard to do if you only do it systematically and from the ground up. You can tack it on afterwards, but it’s more work than it needs to be, but it’s still worth it. I’ll describe [...]

Before I get into today’s topic, I’ll just have to point you to a review of the Apple iPad by a doctor. Main point: it fits in a regular white coat pocket. Very important. In Sweden, we do have a problem, though, since doctors in general aren’t allowed old fashioned white coats, but go around [...]

As is simply too painfully obvious, current EHR systems aren’t fit for purpose. There is a serious defect in the domain analysis, so that fundamental concepts such as “disease” and “clinical guideline” are simply missing from the EHR domain analysis. Let’s discuss the parts in this highly simplified diagram. The objects in green are unique [...]

There’s a reason why our medical records systems don’t work and that reason goes back quite a way. As I’ve mentioned before, it goes back to when IT people started implementing the paper records in computers, assuming the paper records contained a complete model of the medical management of the patient, which they didn’t. Automating [...]