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For every complex problem there’s always a simple answer….

2 April, 2013 (20:53) | Computers are Magic, Datasets, Logical Priority Standardised Q&A, Patient-Centered Care, perinatal data, primary data, secondary data | By: rupertfawdry

….which is always wrong!!

Karl Le Roux’s recent article reinforces what I have always said: that data collection must never be prioritised above improving individual patient care.

Clinical computer systems which put individual care first will always be complex, not just because different disciplines have different needs, but much more because branching questions are essential. As an example, an audit on the duration of the second stage of labour depends on many previous questions, most notably: “Was there a labour?”, “Time and Date of Start of established labour (Best estimate is quite adequate)? etc.

The choices at each fork in the flow of questions means that expert advisory committees, however erudite, cannot achieve the uniformity required since each will differ in its recommendations. None of the expert datasets so far has shown any evidence that the “experts” understand what computers can and cannot do. Every perinatal dataset still seems to assume that “Computers are Magic.”

It is more important than ever to carry out a detailed analysis of the ideal flow of questions and the precise wording, as created by clinicians, of every request for data and every allowable answer option.

Free text must be permitted wherever appropriate, especially under such headings as “Other” or “Unknown.”

Improving paper systems is cheap. Upgrading software is very expensive. For this reason we first need to facilitate high quality paperwork. We need greater access to best practice in paperwork, such as in the Standards for the design of hospital in-patient prescription charts (Academy of Medical Royal Colleges) and the Collected Examples section of our own EEPDwiki. Once we can get it right on paper, then we can  concrete our knowledge into digital formats.

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