Editor's Note: For funding and support information, please see the JAMA article.
Editorial: Missing Clinical Information - The System Is Down
In an accompanying editorial, Nancy C. Elder, M.D., M.S.P.H., of the University of Cincinnati, Ohio, and John Hickner, M.D., M.Sc., of the University of Chicago Pritzker School of Medicine, Chicago, comment on the study on missing clinical information.
"Why do current systems have such poor communication of data that are essential for sound medical decision making? Part of the reason lies in the disjointed nature of health care in the United States. Most family physicians practice in small, independent groups of 10 or fewer physicians. To complicate matters, in 2001, 75 percent of primary care offices reported having 3 or more managed care contracts, and one-third of practices had more than 10. These contracts often dictate referral patterns for consultation and testing so that primary care offices must communicate with multiple laboratories, imaging facilities, consultants, and hospitals. These communications are not standardized -- some offices may make personal telephone calls, others may correspond by letter or fax, and still others may use e-mail or have digital interfaces that allow real-time transmission of data. It is not surprising, therefore, that Smith et al found less missing clinical information reported by clinicians practicing in rural areas where health care is divided among fewer separate entities. The use of an electronic health record has potential to decrease the amount of missing clinical information but cannot solve all of the problems," they write.
"Until effective systems of health information technology are in place, some low-tech tactics can help avert some of the problems noted by clinicians in the article by Smith et al; these can be applied immediately. The first step toward improvement is awareness that a problem exists, a
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Contact: Tonya Ewers
303-724-1524
JAMA and Archives Journals
1-Feb-2005