Page 553

62
Effective Information Transfer for Health Care:  Quality versus Quantity

Gio Wiederhold
Stanford University

Statement of the Problem

This paper addresses two related problems created by the rapid growth of information technology: the loss of productivity due to overload on health care providers, and the loss of privacy. Both occur when excessive amounts of data are transmitted and made available. These issues are jointly related to a trade-off in quality versus quantity of medical information. If quality is lacking, then the introduction of modern communication technology will increase health care costs rather than constrain them.

Background and Problem Description

The online medical record is rapidly becoming a reality. The technology is available and social barriers to acceptance are disappearing. Access to online patient data during a treatment episode will become routinely accepted and expected by the patient as well as by the provider. The image of an expert, in the popular view, is now associated with a computer screen in the foreground, and medical experts are increasingly being included in that view. Eventually, online validation of health care information may become mandatory. A recent court case involving a physician who had failed to use available information technology to gather candidate diagnoses was decided in favor of the plaintiff 1R, presaging new criteria for commonly accepted standards of care.

The rapid growth of the Internet, the improved accessibility of online libraries, and online medical records all provide huge increases in potential information for health care providers and medical researchers. However, most beneficial information is hidden in a huge volume of data, from which it is not easily extracted. Although the medical literature, largely through the efforts of the National Library of Medicine, is better indexed than literature in any other scientific field 2R, the volume of publications, the difficulty of assessing the significance of reports, inconsistencies in terminology, and measures to protect the privacy of patients all place new barriers on effective use and result in what is sometimes called information overload. This overload means that diligent research for any case can require an open-ended effort, likely consuming many hours. We consider that the current and imminent presentation of information is of inadequate quality to serve the practice of health care.

Unfortunately, the pace of development of software to provide services that deal effectively with excessive, convoluted, heterogeneous, and complex data is slow. Since the problem in the preceding years has always been access, there is a lack of paradigms to deal with the issues that arise now. Before, when voluminous medical data had to be processed, intermediate staff was employed, so that the health care provider was protected both in terms of load and responsibility. Staff at research sites filtered and digested experimental results. Staff at pharmaceutical companies filtered for benefits and effectiveness. Government agencies monitored lengthy trials. Publishers required refereeing and editing. Students and interns discussed new reports in journal clubs. Collegial interactions provided hints and validations. But our networks encourage disengagement of intermediaries, and while most of the intermediate filtering tasks are aided by computer-based tools, there is no common paradigm that ensures the quality of information products.