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All's Well in the End - Great Technology and Patient Experience

May 18, 2009
by Joe Bormel
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Too often, we hear horror stories about someone's healthcare experience. Although there's no way to balance that out (all healthcare delivery should be perfect), I thought I'd share my very positive experience from this past week.

It was time. Time for my first colonoscopy. I've performed many sigmoidoscopies and sent many patients for colonoscopies. I knew this would be radically different; this was me-as-patient. And colonoscopies are much more extensive studies. I really didn't know exactly what “experience” to expect. But, all went well.

The procedure was successful and no major badness was discovered. The people, Reece, Kate, Richard and Swan were very professional and kind, telling me what to expect and never leaving me.

I know that quite a few CIOs are responsible for biomedical engineering departments, so I'll focus mainly on the monitoring device. That was the only device I actually saw, by the way, I never saw the colonoscope. The monitoring device was about the size of a large shoe box. Connected to it was my blood pressure cuff, telemetry leads, a CO2 monitor and a pulse oximeter. I found this really remarkable - they were using general anesthesia.

The drug was Propofol. Highly recommended! They could and did, on a moments notice, put me to sleep and subsequently wake me up. While I was out, they could tell I was okay, even if I wasn't breathing! The anesthesia safety afforded by this technology over the last two decades has gone from about four sigma to seven sigma of process reliability. Or, in English, a thousand times lower death rate.

I had several procedures including general surgery in 1991. The technology experience now was distinctly more elegant. The device was much smaller, the sensors unobtrusive (the CO2 monitor was hidden in the nasal cannula, and the pulse-ox was tiny). There was no post-anesthesia headache, and the control is phenomenal.

I'll spare you the mundane details of the prep and the post-procedure bloating; all fairly harmless stuff.

All in all, the healthcare system performed very well and the overall experience was very positive. Good processes and technology can really be a pleasure.



Hi Joe, I'm so glad to hear your experience was a positive one! I feel like many of us only blog about negative experiences with doctors and hospitals, and I think it's important to highlight the good as well. Good for you for undergoing what I'm sure was a tough procedure and looking out for your long-term health. Glad to hear all is well!

Thanks for your comment, Kate.

There was another interesting twist. When I asked about the timing for follow-up, given my result, the answer was 'uncertain.' The technology is evolving rapidly, as is our understanding of who is at risk. The answer I got was, "Let's ask that question in five years." I've never seen a guideline that was written in light of translational medicine. By that I mean, aware of the fact that we want to move information from research to practice as soon as it is appropriate.

Related story:

Edward Demming, the industrial quality guru, was quoted as follows:

Member of audience after one of his talks: "Dr Demming, those are lovely shoes you are wearing. How much did they cost?"

Demming: I don't know, yet.

A few months after this post, Michael Jackson died inappropriate home use of Propofol was a factor. It was not being used for a Colonoscopy.

My delight from an IT perspective was the precision available for using this short-acting, IV drug, on an acute basis. There are other examples, but few are as minimally invasive and used on an out-patient basis.

To recap, a box the size of a handbag was attached to me via four connectors: 1) pulse ox, 2) co2 monitor, 3) precordial EKG leads, and 4) an automated blood pressure cuff. Within a heart beat or a breadth or perhaps as long as one minute, a problem would be detected, without the overhead of a monitored bed (ICU, ED). Phenomenal.

Is this disruptive technology? Could it be used as disruptive technology, or adapted to be such? The home monitoring world and recent enhanced focus on post-discharge monitoring (ie reduce re-admission through early detection) makes it clear that it could be. Similar advances in glucose monitoring has also changed the game.

Technologic precision with physiologic monitoring is advancing rapidly. Let's drive more experimentation into HCIT in 2010 to try to do the same!