With the advent of Michael Moore's new movie (which for purposes of full disclosure I have not seen yet), it's high time to weigh in on the health of Health IT (HIT).
My husband and I
returned from vacation in June to discover that my dad had had multiple strokes,
which led to hospitalization. I won't expound on the details as I plan to focus
on HIT, not on electronic health records (EHRs) or electronic data exchange.
Rather, my focus is on hospital-patient and hospital-family
communication—or lack thereof—and how technology could fix this
abysmal component of the system.
When he had the stroke, my Dad was
admitted to a small community medical center in southern New Jersey. He remained
there for 12 days and then was transferred to an acute rehabilitation center in
northern New Jersey, close to where I live. After an unforeseen problem arose,
he was transferred to a major university hospital, where my tale of
communication woe begins.
The caliber of the hospital staff at the
community hospital did not compare to that of the university hospital in which
the tenure and professionalism as well as patient care were excellent. However
regarding hospital-patient and hospital-family communications, the community
medical center trumped the university hospital. The patient information
capabilities at the university medical center were simply Byzantine. One might
think that a largely endowed teaching hospital would have better, more
streamlined communication, which could be state-of-the-art technology
enabled—not medieval.
Take for example the phone call I made to
obtain my dad's room extension. I literally waited in limbo on hold for an
operator for over 20 minutes (of course, I was multi-tasking while waiting),
listening to all the state-of-the-art medical services the hospital had to
offer. Service this! One would think that there would be either a human
instantly on the line or—and here's the trick—a voice response unit
that would allow you to enter the patient's last name and/or other identifier so
as to quickly and efficiently obtain the room extension number.
Provider organizations are so entangled in the muck and mire of
implementing EHRs that no thought has been given to the efficient and effective
communication of patient information (albeit, an oxymoron)or the
quality of the delivery of such. By the way, I did check the Web site of said
university hospital before beginning this tirade to see what Web services might
be offered—such as patient room or extension number look up—and
there was nada. However, you could schedule an appointment online. After my
experience with the phone system, I would not be inclined use the online
appointment feature.
Now many of you may be thinking that what I am
proposing would not be HIPAA-compliant. First of all, HIPAA has been mostly
misunderstood and moronically implemented, and the fact is that it sabotages
patients and their families more often than it protects patient information. A
voice-response system or a Web-based patient lookup service is the same
as phoning the hospital and asking for the patient's room number or
extension.
Having cleared that up, let's turn to quality delivery of
updated patient information to family members. Email, people! With all
the money being spent on medical technology and HIT, implementing an email
account for patients' families (obviously for those families who use email and
have Internet access) could provide a daily update on the patient's condition
(in layman's English), notification if the patient has been moved to another
room, etc. (At the university hospital, they moved my dad three times, forcing
us to play the juvenile game of "where did they hide the patient today?" This is
both demeaning and demoralizing to patients' families, who are already stressed
out beyond comprehension.) The email account would be password-protected and
would exist only for the duration of the patient's incarceration...oops, I mean
stay.
When they transferred my dad to a sub-acute (more nursing than
rehab), the university hospital forgot to ship him with his dentures and
glasses—and those were the only two personal articles he had with
him. One would think that a simple computer entry of the patients' personal
effects could be generated so that, when they are released or transferred, all
their belongings go with them.
While I am not an advocate of technology
for technology's sake, it seems to me that medical providers should focus the
lens outward to look at the bigger picture and consider how proven technology
could be used to improve the quality of the patient's family's experience as
well as that of the patient.
<i>wyzard wrote: You can access your health records online: your test results, all medications, weight, blood pressure are all available. </i> <p>To me, that is not friendly. It is downright scary!! <p>Dave
Geisinger Health System is highly computerized and very tech friendly. You can access your health records online: your test results, all medications, weight, blood pressure are all available. You can even leave notes for your doctor and they respond back to you (it sends a message to any email address you enter). Any prescriptions the doctor gives you are printed on a laser printer so the pharmacist has no problem reading them. What makes this even more surprising is that Geisinger is in north central and north east PA, not some big city.
There is not a high level of appreciation there. And it is universal - not a country related thing. <p>Ultimately though, it would be good to have phone calls answered by a bank of dedicated staff, 3 hours of each shift spent by medical staff emailing and otherwise advising relatives of problems. The downside to this is that most hospitals are flat out balancing their budgets as it is in just the medical services. <p>As it stands, to improve the services to Hotel quality service would result in one certainly - your bill (or your insurance bill) escalating dramatically.
The space shuttle blew up. My System i does have problems, even though it is supposed to be the most stable platform. We are all experiencing the inadequacy of mankind. Sometimes we get good experiences and sometimes bad ones. I try to stick with the good when I find them. <p>Some hospitals are good, some are bad. My personal rule is to stay away from any hospital unless you are forced to be admitted.
I think most of us would agree that hospitals are not fun places. As I was reading this article I, like it seems jorphi was, started thinking that the medical staff probably don't really care if they get a patient's hourly history online somewhere for the family. They just want to keep moving and do as much work as they can on the patients. So, how about the idea of having hospitals have some type of patient representative assigned to every patient. That hospital staff person would constantly keep track of what was going on with that patient. They would update a hospital database, send emails, make phone calls, or whatever it took to keep family and friends informed. <BR>
There is no perfect system (except for the ones I develop) but something does need to be done about this.
This reply could become long and difficult to follow, so I am going to try to be brief. Sorry for your irritating exposure to hospital(s). <p>The medical profession is no interested in sharing information with patients or patients family. In my experience(3 children, sibling died of AIDS, loss of other friends and family), doctors are more focused on what they can do to resolve the problems than telling you what they have seen. <p>Nurses are more interested in making sure as much info as possible is available to the next shift. If the information never leaves the floor,they are not bothered one way or another. <p>Add to that the aituation that doctors and nurses in general practice or hospitals are in short supply, and you see the lack of opportunity for sufficient reporting/dialogue. <p>So, currently we have an information flow problem. Add to that the situation that IT departments seem more involved in managing their software rather than asking 'How can we make this information more useful?' and you see how the problem compounds. <p>I would love to create a series of package 'connectors' to help this information move along, but, I see the frenzy in the hospitals and wonder when you could get a few minutes of the doctor and nurse time to perform a decent analysis and design. <p>I used to use a doctor that was very busy, and had walls of folders per patient (this was in the mid 1990s). I asked the office manager if there was a possibility of scanning those charts/notes into a data base for electronic retention. The angry glare I received answered my question...I did not receive a spoken response. I think if the doctor had been present at the time, he would not have condoned the response. As you can see the office staff as well as the health care professionals do not seem to have the time to invest in the capture,organization, dissemination of medical information. <p>HIPAA is just another poorly thought out government intrusion. It is an obstacle that I suspect will discourage more people from seeking health care.
My wife and I have had the same experience. She has been recieving treatment at a large prestigous teaching hospital but their information processing is a bad joke. Mistakes in scheduling and ordering wrong or incomplete tests are commonplace events. We joke that everywhere in the hospital there are pamphlets with a picture of a smiling nurse asking "How are we doing?" and requesting one to fill in a questionaire. We think they are on the same par as "Your call is important to us".
My mom has been in and out of the hospital over the last two years. Her last time was for 3+ weeks and she was moved with the same hospital 3 times. She had 4 different doctors working on four different conditions. Do you think any one of these highly trained and paid professionals could spend 10 minutes together with us explaining what was going on. I even had to get the copy of my mom's power of attorney for health care out and show the hospital that I was entitled to her medical condition. Oh they already had a copy on file, but that information was never transferred to the floor she was on. The need to "protect" the privacy of the patient has replaced common sense and courtesy. Heaven forbid you are ever in a postion where someone is asking for life saving procedure to be done, and NO one has bothered to keep you up to date as to all that has been done for your loved one.
My dad has had several lengthy hospital stays over the last few years. If anything, hospital-patient communication seems to be getting worse! And heaven forbid that the multiple doctors on the case should be able to communicate with ease and efficiency.
This is a discussion about <B>Is Health IT Sick?</b>.<p align='center'><a href=http://www.mcpressonline.com/mc?1@232.1KNKfHX1eQT.17@.6b507b1a>Click here for the article</a>.</p>