I spent most of the afternoon trying to get one measurement from our database for patients that take a certain medication. Since our data warehouse (i2b2) does not support this I had to delve into a backup of the SQL database that hosts the original records.
The schema for our clinical database is reasonable and a person with a working knowledge of SQL and some relational database experience like myself can grasp it quickly. However, the way the schema is used is flabbergasting. And I’m not completely sure if it’s our installation, our users, or the end-user software. But for example, when people enter a medication order erroneously, I would expect one of two sensible things to happen:
- The medication order is deleted and an appropriate entry reflecting this is added to the audit log (I’m not sure if our EHR supports this), or
- The medication order is followed by an immediate cancellation order (which our EHR supports).
However, our clinical system in its infinite wisdom stores this occurrence as discontinuation orders. Yes, those that mean “Mrs. Smith? You know that medication you are taking? Please stop taking it.” So we have patients taking drugs legitimately and then stopping for infinitesimal, or 0, amounts of time. So instead of canceling orders we have to do date arithmetic in SQL. And hope that we are interpreting what we see in the data tables correctly.
Don’t get me started on the measurements. “The measurement’s wrong? Why, let’s just enter a new measurement and leave the wrong one there! Flags and deleting are for sissies!”
[...] Filed under: Exploring the depths — Dr. H @ 9:15 pm In the end, getting the data required in my previous post took me approximately an entire day. During that day I had to pore over the data schema for [...]
Pingback by Data cleaning cost « Mine That Record — December 3, 2009 @ 9:16 pm |