George Bernard Shaw said America and England were two countries “separated by a common language.” Medical comanagement often feels the same. Professionals in different fields speak the same language but don’t always communicate well or heed each other’s judgment. And the electronic health records intended to bridge such gaps sometimes only make them more intractable.
Earlier this month, a Texas hospital let the first US patient with Ebola walk out the door instead of being quarantined. The intake nurse recorded that the patient had recently traveled to Africa, but because the hospital’s EHR nursing workflow and physician workflow are separate, that detail didn’t show up in the chart the ER physician saw. Same patient record, different views—and a vital piece of information slipped through the cracks.
Headlines like “Electronic-Record Gap Allowed Ebola Patient to Leave Hospital” (Bloomberg News, Oct. 4) don’t do much to build confidence in our patchwork EHR system. They only reinforce the stories that we all have of our own frustrations in navigating the health care system. Here’s mine.
The Case of the Extraneous X-Ray
Earlier this year, during SECO, I hurt my shoulder in the hotel gym. My GP diagnosed tendonitis and recommended a course of physical therapy. I went to PT about 20 times over three months. After every single visit, the place sent me a paper record of the encounter, even when I didn’t have an outstanding balance to pay. Just an FYI.
When the therapy didn’t seem to be helping, I went back to the GP. “How did it go at PT?” she asked. Had she seen the physical therapist’s records, I inquired? No. Hmm, maybe that would have been better than my subjective report. Anyway, she ordered an X-ray and referred me to an orthopedic specialist.
I took off from work and went to the radiology lab my doctor recommended. The only thing that X-ray revealed was how bad my doctors are at sharing records. Trying to get the report from radiology to the orthopedist highlighted how much work remains to be done in EHR.
I called the specialist’s office to see if they could pull up the results from the radiology lab. Nope, different system. (Remember, my GP recommended both the lab and the specialist.) Next, I called the GP and asked if they can send the results to the orthopedist before my exam. “What’s the fax number?” the receptionist asked. Beats me, I thought. You made the referral, shouldn’t you have it or know how to get it? And is a fax really the best way to share radiology images?
“Well,” the receptionist said, “maybe you can come by and pick it up before your appointment.” Really, the patient as carrier pigeon? In 2014? Confidence waning, I felt I’d better have a physical copy in my hands, so I did stop by the GP’s office for the much-vaunted X-ray results. I got no actual images, just a two-sentence description of a radiologist’s interpretation, with no contact info for more detail or to obtain copies of the film. I brought this essentially useless bit of health care data to the specialist—who promptly ignored it and ordered a new X-ray. She too had received no record of my interactions with the GP or the physical therapist.
• I got PT records I didn’t want.
• Two doctors didn’t get records they might have wanted.
• I was tasked with hand delivering results of a test a generalist ordered but a specialist didn’t want.
• Time and resources were wasted.
Mind the Gap
With this issue’s series on surgical comanagement plus an excellent article on avoiding EHR pitfalls, we detail many ways to bridge potential gaps like these in your practice.
Optometry is often touted—rightfully so—as a potential game changer in the delivery of care to cataract patients, whose ranks grow every year while ophthalmologists’ do not. Plus, refractive outcomes are more vital to these patients than ever, and who knows more about refraction than optometrists?
So, keep up on surgical topics and make the effort to connect with your surgeons. And push through those EHR hurdles to unlock its true collaborative potential. My doctors didn’t—maybe I’ll just sleep in at next year’s SECO instead of hitting the gym—but aim higher for your own patients and practice.