We are often faced with organizations wanting to transmit PDF documents. This is superficially attractive as the presentation is usually good and it’s a single file. Is there a problem going down this path?
I think it’s a huge dead end. Australia started eHealth with a local format called PIT which in its day was a great advance, but it is now slowing down adoption of atomic HL7 reports for the simple reason that its presentation abilities, with coloured text and simple yet powerful text formatting commands are better than the equivalent HL7 V2 Free Text format. Users see the PIT reports as superior because of this and to a human reader they are, but there is no atomic data at all. Does human view-ability constitute meaningful use?? I think not. We need atomic data to allow for decision support and most of the future value lies with decision support. While pdf can contain text components most pdfs generated by a variety of Health applications do not.
PDFs I have seen of late are also commonly 5mb in size, which contrasts with a HL7 version of the same report being under 10K. With terabyte hard discs you may say so what… However in my clinical practice we have over 2 million clinical reports and when you multiple 2 million by 5MB you start to see scalability problems appear.
While having a PDF display version of a report is a good option it is unacceptable not to have the same data in atomic format. I want the Clinical decision support engine to be able to know the patients Ejection Fraction is on 30% before the patient is lines up for a colonoscopy as a routine request. PDF echo reports without atomic data prevent this type of activity and lack meaningful use capabilities.
We desperately need some leadership and governance to stop this happening. Every new device on the market appears to output a PDF report and often there is no way to access the raw data. This is not good enough but in the absence of governance this is becoming the norm. It may be a lot harder to export raw data but it’s essential if we are going to “move forward”
PDF risks becoming the new PIT of healthcare, all show and no go, and not meaningful use. Luckily at the moment most PMS systems are quite bad at importing PDF files automatically but this may change.