Understanding Context and Metadata with EHRs

February 3, 2014

To understand why EHRs have the trouble they do, you need to understand the concepts of context and metadata. Here's help.

For the past few months, I've been working on a technical paper that attempts to explain why EHRs have the trouble they do and what might be done to solve the problems once and for all. As I've mentioned before, it all has to do with confusing information and data. EHRs treat data as highly valuable while, for all intents and purposes, minimizing the value of information.

I know that everyone calls EHRs information systems but then, the Chinese call the air pollution in Beijing "haze." EHRs are, and always have been, data systems with narrative notes riding along in the rumble seat. Of course, having collected all that "data," it's not always clear what it means. Remember, data is information devoid of context and metadata (the informative stuff). When you can't figure out what the data means, your only recourse is to the narrative. Hopefully someone described the context and provided enough extra "stuff" (metadata) to allow you to make sense of the data.

Now, there are those words context and metadata again. They keep cropping up, but I'm not sure people really have a handle on the concepts involved so I'm going to try to remedy that.

First, context. While in the shower and for no reason at all, I got thinking about Arlo Guthrie and "Alice's Restaurant." It was probably news of Pete Seeger's passing. If you recall the song or movie, there's a passage that goes: "Sit down on that bench that says Group W .... NOW kid!! ... Group W's where they put you if you may not be moral enough to join the army after committing your special crime, and there was all kinds of mean nasty ugly looking people on the bench there."

Knowing what the Group W bench is, is context. You would assume that data indicating that someone had been assigned there means that it is highly likely that they are a "mean nasty ugly" criminal type. You might be wrong, but that's context. If I write "diabetes" in the family history, you know it's a family member that has it, not the patient - but it raises their risk. That's context.

Second, metadata. I was having breakfast with my friend, the Catholic chaplain, this morning before clinic when his pager went off. The message contained an item of data: "A patient has requested to see the chaplain." What did that mean to Father J? He had no idea; there was no metadata like who, where, or when. After 30 minutes of digging around, he tracked down the metadata, understood the message, and called to verify that the patient had, in fact, requested a chaplain visit. Well, not only was there no metadata, the data turned out to be wrong. No one knew which patient had made the request.

Back in Alice's Restaurant, and before the recruiting depot and the Group W bench, Arlo has thrown an old mattress at the side of a road because the dump is closed for Thanksgiving. Dumping being an infraction, the sheriff "took 27 eight-by-ten color glossy photographs with circles and arrows and a paragraph on the back of each one explaining what each one was to be used as evidence against us."

The images of the rubbish are data. The circles and arrows and the paragraph on the back are metadata. A picture of the mattress alone would not be as convincing as evidence as the picture plus the metadata.

In our daily activities, context and metadata are readily available. We have grown accustomed to using them without a second thought. Maybe that's why people lose sight of the necessity to record that stuff along with data. Maybe today's computers make it so difficult that we've given up trying. Whatever the explanation, context and metadata are the keys to meaning. We know that instinctively but are not conscious that we know. Now you know.