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Even I'm a Loser

August 25, 2009
by daphne
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You think I’d know better. I mean, I’m a senior editor here who writes about electronic medical records all day long. But when I needed to find a new doc, I got dinged just like any newbie.

I moved a year ago and though I liked my GYN, her office was too far from my new place. I wanted a new one close to our Healthcare Informatics offices here on Fifth Avenue in New York City. I thought I had found it: six blocks away from our offices, hard by Union Square, is a giant, bustling ambulatory pavilion connected with one of our local academic medical centers.

That’s what I wanted — a place where I could get it all: labs, X rays, mamos, sonos, the whole nine yards, all in one place without schlepping all over town. With a shared (I thought) medical record. So I did my due diligence, checked out the docs, found out who was board certified, where and when they got diplomas, and even looked up the opinion blogs. I found a doc who fit all my criteria. Then I made my appointment.

And was dismayed when the registrar, followed by the doctor, did everything on paper, then handed me a whole sheaf of referral papers for mammograms, and others for dermatology (I had a funny-looking mole). And told me to get copies of all my old mammos. When I asked her about an EMR, she said, “Oh yeah, that. We’re supposed to get something called eClinicalWorks, we’ve been talking about it forever. I have a meeting this week.” She looked, by the way, much less than enthused. She told me to call the other doctors and make appointments for everything.

Well, here it is, a month later. I couldn’t bring myself to deal with the draconian phone system. All I wanted was, when I left, for all those appointments to have been made, my mammos requested, and my record accessible to the other docs. Which it SO was not. I would have had to do the entire paperwork all over again in each office.

I gave up, and never got the primary preventive care I needed. I still haven’t.

Me and a few million others in this country.

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Comments

Hi Daphne and Gwen!

You post and comment make me smile and frown at the same time. I am smiling because I am a Razorback and am proud of how progressive Fayetteville has become. I am frowning because I currently wear 3 "cancer bracelets" for my mother, my sister-in-law and one of my best friends that are all currently (successfully!) fighting cancer.

We can not allow our loved ones to become so discouraged by the lack of consumerism in their Healthcare communities (like Manhattan) that they don't get the screenings appropriate for their age and heredity.

We have to keep blogging, grandstanding and whistle blowing until all communities have the same situation that exists in Fayetteville and my current home of Wellesley, MA.

There is plenty of room on this soapbox! Come on up!

Best Wishes!
Joe Lavelle, National Practice Leader
Health Provider Consulting Services
Santa Rosa Consulting

Joe, you raise an important point about what the doctor sees in the EMR. I spent last week talking to CIOs about just that--customizing the EMR so the doc/specialist only sees what's relevant in order to keep them from being overwhelmed with alerts and too much information. Your daughter's example shows how difficult it is deciding what that level of relevance is.

Daphne,

Let me tell you about my experience yesterday here in the metropolis known as Fayetteville, Arkansas. I was scheduled for my annual checkup day - I go to an Internal Medicine guy for the overall once over, a female GYN for the girl stuff, and a Dermatologist to make sure that the sins of my youth as a sun-lover growing up in Florida with a bottle of baby oil and iodine haven't caught up with me. All of these doctors are in separate offices across town, but are linked through the same EHR.

Never once did I have to carry a piece of paper, a mammography film, or a even an appt. reminder card with me (I opted for email reminders). They all had my records in front of them - the doctors I saw at the end of the day even had my results from the beginning of the day - it was flawless, and amazing, and the way it's supposed to be. Nothing was repeated, or misinterpreted, or missed because it was all right there.

It is possible! Sure, Walmart, Tyson Chicken, and the Razorbacks are all based here, so I can see why we'd get superior healthcare compared to what they can offer you in NYC. Maybe you should move - beautiful Ozark mountains, low cost of living, and my Derm is a hunk. :)

G.

Joe, you have a huge point... "even when we do have enterprise-wide EHRs, from using them to provide integrated and coordinated care."

I call this "Meaningful Use" of clinical data contained in an electronic health record. After all, aren't we seeking to achieve improved health outcomes? Better coordination between providers and facilities? Preventive care vs. the *high cost* of curative care?

I agree, the "EHR of the Future" isn't "just around the corner," but we can take a few steps, turn left, and we just might find it.

Actually, I'm writing a series of posts at http://www.myhealthtechblog.com on this topic:
Step 1: The Value of the Internet for Improving Healthcare
Step 2: Online Healthcare Information
Step 3: The Internet and Access to Quality Healthcare Information
Step 4: (in progress) The "e-bilities" for electronic health records - Usability, Readability, Accessibility

Thanks everybody. I'd move to Arkansas but I can't live without NY pizza.
Seriously, I think it was so much worse for me because Gwen's model is the one I write about all the time, the one everything we do is about, and the one I've come to think I deserve. I think I will vote with my pocketbook and find another academic medical center here that does offer that model, even if it's more than a few blocks away. At this point, I feel like I can't settle for anything else.

Daphne:

Great post! You are NOT a loser. The healthcare system in this country is (so) badly broken in so many ways. There are some that believe the stimulus $$ will change all of that. I am a very optimistic person - BUT - I think the $$ allocated to HCIT is a good thing. However, I think it is merely a down payment to fix a system that is very (very) broken. Just my opinion. I'm just saying.

You don't know how lucky you are! At least you have doctors. My old medical group (in Florida) switched my insurance to Humana. They are such bad payers that there is not a single provider or hospital that is "in network" within 50 miles (I live in Sun Valley). I'll say the sytem is Broken!

This is a great thread... I'm smiling and shaking my head at the same time. Makes me wonder: When is the economic model in healthcare going to mature to the point that money talks? When will places like Daphne's go out of business because they are so draconian while places like Gwen's take off like a business bullet because they are efficient, thorough, and patient friendly? I can't figure it out. I keep hoping, but traditional Adam Smith economics don't seem to apply.

Maybe Daphne's clinic needs to hire Dr. Dreamy from Gwen's place, and they can be as draconian as they want to be. It works for the beer and shaving cream markets. )

It's amazing, isn't it? We write about health IT and speak to people with systems that are fully automated and integrated, then when it's time for us to go to the doctor, it's like we stepped back in time.

It's so easy to forget that the percentage of health systems that are truly electronic is actually really low. Hopefully ARRA HITECH will change that, but I think it's going to take a long, long time.

But in the meantime, get yourself to a doctor!

You're no loser!

- The "poor man's" PHR -

I've been scanning the paper documents from my own care, and that of my children and dad, into my computer. The paper is automagically OCR'd. When I need last year's lipids, or a consultant's report, PSA, etc, I use Google local search or Spotlight and I retrieve my PHR pretty much instantaneously. My backup procedure is automatic (Time Machine).

Since I cannot get all of my care through one provider or a linked set of providers, the only EHR I'll see any time soon is the one I maintain for myself.

- Even When There is an EHR -

My daughter's ambulatory care is maintained at a large, multi-facility implementation of GE's Centricity (aka MedicaLogic). Each doctor, however, only seems to see the problems and notes for their specialty. That might not be how it's designed, built, or implemented. But in practice, the doc last week only saw a piece of my daughter's record within that organization. I was in the exam room and saw what he saw.

When it comes to eight year olds, pretty much any medical service/organ system can impact growth (height and weight), including endocrine, with hormones like grown hormone, GI nutrition/malabsorption, orthopedic, psych or neuro. Not all of which are relevant in her case. Some are though I brought it up in dialogue, even though the record should have presented the whole patient.

My point is, we're along way, even when we do have enterprise-wide EHRs, from using them to provide integrated and coordinated care.

daphne

Twitter @Daphne Lsawrence

Daphne Lawrence is senior associate editor at Healthcare Informatics magazine, covering the...