Monday, December 13, 2010

Can Single Source of Truth work?

@tonyrcollins asks if any healthcare IT system can provide a Single Source of Truth (SSOT)? In his blog (13 December 2010), he discusses a press release claiming that an electronic healthcare record system from Cerner Millennium Solutions is a "single source of truth", citing the Children’s Cancer Hospital Egypt 57357 (CCHE) as a success story (via Egyptian Chamber).

My first observation is that even if we take this success story at face value, it doesn't tell us much about the possibilities of SSOT in an environment such as the UK NHS that is several orders of magnitude more complicated/complex. I'm guessing the Children’s Cancer Hospital Egypt 57357 (CCHE) doesn't have as many different types of "truth" to manage as the NHS.
  • one type of patient (children)
  • one type of condition (cancer)
  • a single building
My second observation is that if a closed organization has a single source of truth, it will never discover flaws in any of these truths. If a child is given the wrong medication, for whatever reason, we can only detect the error and prevent its recurrence by finding a second source of truth. The reason SSOT has not been successfully implemented in the UK is not just because it wouldn't work (after all, lots of things are implemented that don't work) but because there are too many people who know it wouldn't work and are sufficiently powerful to resist it.

My third observation is that single-source of truth may be a bureaucratic fantasy, but responsible doctors will always strive to get best-truth rather than sole-truth. People in bureaucratic organizations don't always stick to the formal channels, and often have alternative ways of finding out what they need to know. So perhaps the Egyptian doctors at CCHE have managed to preserve alternative sources of information, and the "single source of truth" is merely a bureaucratic illusion.

See my previous post What's Wrong with the Single Source of Truth?

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