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When it Comes to Meaningful Use, Are We Forgetting to Sweat the Small Stuff?

June 7, 2010
by Gwen Darling
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Patient follow-up is being lost in the midst of all this healthcare IT upheaval

As one of Healthcare Informatics “Career” bloggers, I usually write about Healthcare IT workforce and career development topics, and leave the more technical, in-the-trenches type of subjects to my blogging colleagues who are experts in these areas. But as a patient I certainly have an opinion about what I’d like to see as the end result of this electronic healthcare revolution we find ourselves in the very heart of, and something occurred last week that made me stop and wonder, are we forgetting to sweat the small stuff?

A bit of background first. I’ve frequently blogged/bragged about our fantastic healthcare system here in Fayetteville, Arkansas. Thanks to the fact that the University of Arkansas is here and Walmart headquarters is just up the road, we’ve got the benefits of small college town living with big city amenities – including a state-of-the-art digitally savvy and connected physician network.

 

Here in our idyllic setting in the Ozarks, as patients we can schedule appointments online (complete with emailed reminders), fill out all those pesky pre-visit forms electronically, and request prescription refills with the simple click of a mouse. Sweet. Since there are over 70 physicians and providers in the independent network including family medicine, pediatricians, internal medicine and specialists, and each physician has instant access to a patient’s comprehensive record, gone are the days (as long as you stay in the network ) of schlepping a manila X-ray envelope across town, or trying to list for one doctor the dosages prescribed by another, or the really annoying and time consuming process of filling out a medical history every time a new physician comes into the picture (and the older I get, the more annoying and difficult this becomes)!

Okay. So I’ve set the stage for our story. Last week, I accompanied my oldest daughter Sam to her “girl stuff” doctor’s appointment. We made the appointment online, it was confirmed via email, and since all forms were filled out electronically beforehand, all we had to do was sign in and help ourselves to free lattes while we watched “Regis and Kelly” on the 52-inch plasma. (If you are going to attempt to make a “girl stuff” visit pleasant, this is definitely the way to do it). She was called in on time, the doctor had her records and lab work, and in 30 minutes we bid him a happy farewell, and headed to the check-out desk. Sam needed a follow-up appointment, which we really wanted to get out of the way before the summer got rolling, but the earliest opening they had available was in four weeks (damn those free lattes). So, I did what any mother who doesn’t want a “girl stuff” appointment hanging over her teenage daughter’s head would do, I asked for Sam to be put on the cancellation list. Here’s where it got interesting. Guess what the woman behind the Jetsons-esque contemporary desk, with the oh-so-cool touch screen appointment software on the sliver-thin flat screen computer monitor, sitting right next to the wireless copier/fax/printer/flux capacitor did next? She fished around for a pen, scribbled Sam’s name and phone number on a pink Post-It note, and stuck her to the corner of her state-of-the-art flat screen, joining multiple other pink stickies that I can only imagine contained the names and numbers of other anxious patients. Are you kidding me? As I felt Sam’s “OMG don’t embarrass me, Mom” grip tightening on my arm, I leaned in and said hopefully, “Do you input those sticky note names later in the day?” “No, our software doesn’t have a place for us to do that,” she said. “I’ve got a good memory, though, and will call you if something comes available.”

No she won’t. And no she hasn’t. And it’s not her fault. Even Sam, who at her age really doesn’t care or want to understand exactly what it is I do for a living, understood the irony and idiocy of the situation as she pointed out, “Even our hair salon has software that can do that.”

I’m still bullish about our healthcare system here in Small Town, U.S.A. But again, what happened last week certainly makes me wonder - on our way to “meaningful” use, are we forgetting to sweat the small stuff, and worse yet, is the patient the “small stuff?”

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Comments

Thanks for the comments, Gentlemen!

Joe, I think the term they use at the hair salon is "customer service." Of course, they rely on generous tips to stay in business - maybe that's a model hospitals should consider!

Frank, Great insight - I will ask for a patient survey as soon as we secure the ever-elusive follow-up visit. It'll be interesting to see if they direct me to an online survey or hand me a clipboard!

G.

Gwen,
Interesting post. Is there a term at the hair salon for the "call me if there's an earlier cancellation" list?

I agree with you that the small stuff isn't small. My dad (he's fine now) was hospitalized two months ago for symptoms related to his blood pressure being out of control. They did a lot of good and needed stuff for him while he was an in-patient. What they didn't do was address his blood pressure control, lack of which put him in the hospital. Was that an oversight? Was it deliberate because of other diagnostic or therapeutic factors? All bets are on the former.

It's at best a 50 / 50 proposition that Meaningful Use will impact this kind of small stuff. It was never easy to deliver world-class service. As you skillfully point out, our expectations are clearly being driven up by other consumer services that are demonstrating what is possible and apparently practical in other industries.

Gwen,
Great post...and it underlines the classic difference between a best of breed system and a HIS major vendor system. I know of several major players in the HIS /PO world that have scheduling systems that are nothing more than the old appt book on the screen. Yet without even trying I can think of three best of breed solutions that can easily do what you asked. So why would a hospital install such a limited system?
Because that's what came with the other clinical systems or financial system...and who really cares if the scheduling department has all the tools they need? The CIO or CFO would say to the department..."hey lets deal with one vendor its chealper and easier for us (C types) so if you can 'live with their 'yugo' solution don't worry we'll get by".

My advise is fill out a patient survey and let'em have it. Soon hospitals will be rated on patient satisfaction and under Medicare P4P will get dinged on payments if they don't get good scores. Remind them of that.

Gwen Darling

CEO, HealthcareITCentral.com

Gwen Darling

@HealthcareITJob

www.HealthcareITCentral.com

Gwen Darling serves as an online HIT matchmaker, bringing together qualified Healthcare IT...