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The missing link

iotaMed forms the missing link between Evidence Based Medicine, epidemiological research, quality registries, the patient's access to his records, and the medical record proper.

Evidence Based Medicine (EBM)

Evidence Based Medicine produces new medical knowledge at ever increasing rates. It is very difficult for a practicing physician to keep up. It's amazingly difficult to even know when you're falling behind. What is missing is a direct link between new medical knowledge and the immediate plan and documentation for the ongoing care of the patient. Most, if not all, current systems for distribution of medical knowledge require an active search by the doctor for new knowledge, using a multitude of mutually independent systems, without knowing exactly what he is looking for. In other words, all these systems, however sophisticated, depend entirely on the doctor initiating the search and to know what he is looking for and how to go about it. This principle simply doesn't work, as evidenced by an average delay between the initiation of a medical study or trial and the penetration of the result in medical practice of 17 years!

iotaMed changes this situation radically. Using iotaMed, the medical record actually consists of evidence based plans. This leads to an immediate awareness in the doctor of the current state of knowledge as it applies to the exact disease or issue he is managing for his patient. Any change in medical practice due to new findings wil l result in a modification of the clinical guideline which will be automatically signalled to the doctor at the next encounter with the patient. iotaMed is the only system that promises to automatically inform the doctor of relevant changes to medical knowledge, at the right time, the right place, and at the right level of abstraction.

Epidemiology and registries

There is a need to reuse data from medical records for epidemiological and quality oversight purposes. In our current systems, this is extremely difficult since the necessary terminology and structure is missing. A great number of failed projects also attest to the difficulty of implementing these structures on the existing records. It is increasingly obvious that what is missing is an input structure for medical information, but it has proven just as difficult to provide a useful structure that delivers the necessary information to external systems.

iotaMed turns this question around, and thereby finds the answer. We shouldn't try to provide a structure for external registries and then try to make them useful in clinical practice. The key lies in providing the clinically useful structures, and only then try to reuse them for other purposes. iotaMed issue templates turn out to be exactly that structure. These templates provide a clinically useful tool, which not so coincidentally turns out to work almost flawlessly for the purposes of epidemiology and quality registries. This only goes to show that as long as you don't reason out the correct data structure and relationships in an information handling application, even immense amounts of work will not get you the desired results. iotaMed issue templates, however, make extracting data almost trivial while still being perfect for clinical care, which is a very important sign that the right structures and semantics were established.

Patient's access to his records

There is an increasing pressure to provide the patient access to his or her records, but current EMR systems are unsuitable for this. Since they in principle only contain the patient history, with very little reference to future planning, the patient will even in the best of cases only discover what has already been done to him. What most patients need to see, however, is not what was done, but why it was done and what will be done. They also need to know on what basis these plans were set up, what the evidence is behind the plans, and what authority was responsible for the plan itself. Armed with this knowledge, the patient can ask for second opinions about the plan proper, instead of just guessing as to what planning was going on inside the head of the doctor, but was never written down in the records.

The second problem with giving the patient access to current implementations of the medical record is that the terminology and abstraction level of the language is only suitable to doctors. Worse, you can't force doctors to write in layman's terms for the benefit of the patient, since the records lose too much functionality in medical care if difficult but meaningful terms must be left out of the narrative. iotaMed, however, enables reuse of clinical information in different "issue templates", each adapted to a professional role or to the terminology level of laymen. This way, the patient does indeed have real access to the reasoning of the medical professionals without the need for a separate manual translation step or the compromise of the integrity of the medical record.

Forms the new, real medical record

As we already mentioned, current efforts to provide knowledge based support at the point of care result in systems that are loosely connected, or not at all connected, to the medical record proper. Any such connection always seems to be a clumsy compromise and does not cover more than a minor fraction of clinical situations. iotaMed solves this by not connecting to a preexisting medical record, but to replace it entirely as the primary tool for the physician. The legacy EMR system as such, however, remains the backbone to which iotaMed is connected and maintains its role towards all other clinical and administrative roles in the healthcare organisation.

By replacing the legacy record for the doctor, there is no need for the doctor to deliberately interrupt the normal clinical workflow to check up on the advance of science while seeing a patient. He will be alerted to such changes if they are relevant to what he is doing at that point in time. Similarly, iotaMed provides the doctor with the means to keep his collegues updated on changes to medical management principles in areas in which he himself is a leading expert.