[MUSIC] Hi again, this is Bruce Darrow and the topic is examples of What Makes Health IT Hard? So I'm going to use two examples here, one to start for comparison of what information sharing looks like in the banking Industry where the data is very well describe in the standards to exist. The financial data example is how many dollars you have in the bank. And I'm going to list the scenario as follows. Let's say that in January, you have $100 in bank A and you're going to deposit to deposit $200 in bank B and $500 in bank C. Then in June, you come back to bank B and you deposit an extra $500. You close your account at bank A and put the $100 that used to be in bank A in bank C. Then in October, you go back to bank C and you withdraw $200. Let's what see what would look like if you go to different banks. Because the information is shared immediately as needed and because the value of a dollar is well-defined, no matter what bank you go to in January, all of them are going to show the same balance for you, which is $800. When you come back in June and you make a $500 deposit to one of your banks and move your money around with the other two, it doesn't matter. The total amount of money at all of your banks is going to be the same at $1,300. And when you go back after taking out $200 in October, you're going to be at $1,100. At no point will you be able to take out more than the sum total of all your money at those banks from any of your locations because they have the ability to check with one another. And to make sure that they have an accurate sum total at any given time. Let's compare this now with an example of how different electronic medical record systems might take account of a patient's allergies. For this example, I'm going to describe the following. In January, a patient might go to a doctor and say, I have no allergies to medications but I am allergic to cats. And when I was prescribed a medication called lisinopril, I had a side effect that made me cough a great deal. In June, after taking some other medications, the patient may come back and say, I had some bad reactions to medications and now I have allergies to both penicillin and aspirin. In October, the patient might go back to either the same doctor or a different doctor and say, well, I went through a process to desensitize my allergy and so I'm no longer allergic to aspirin. If you now think about how your allergy record might look in different doctors' offices based on this same information, here's what it might look like. In January, one doctor hearing this information might say, you have no allergies. A second doctor might say, well, Lisinopril is a side effect but I'm going to note it here as an allergy so that I can get a warning any time I or somebody else tries to prescribe it to you. Also, I'm going to put down your allergy to cats. Even though it's not a medication, it is an allergy that you're reporting and I'm going to put it as part of your record. Then in June, when you go back and you have the additional described allergies to aspirin and penicillin, you might have both of those allergies listed. But you might have one doctor who also lists an allergy to Lisinopril and another doctor who lists an allergy to cats. Then in October, you might have one doctor who lists cats, Lisinopril and penicillin and another doctor who only lists penicillin. So these were six different doctors offices within the period of a year and six different allergy lists for the same patient. And there's no really good way for them to keep an accurate running total at any given time of what your true allergies are because there are new allergies being added, old allergies going away. And then there's information that some offices might consider allergies and other offices might not. So, if you think about this as only one of the many examples of data types within in the healthcare industry for which there is no standard definition. You begin to see the kind of complexity that is involved in maintaining accurate healthcare records for a single patient across multiple episodes and locations of care. [MUSIC]
