Archive for November, 2010

Healthcare Productivity – Valuing Patients’ Time

November 22nd, 2010

I write this as I sit on hold for now going on 1:05:50 hours trying to schedule an MRI at Georgetown Hospital.  Yes, I named names. I usually don’t.  But the list of offenses against patientdom by Georgetown now runs so long my head might pop off. They clearly do not value patients time. If I did not need to be seen by an academic medical center, specifically, one with a transplant center, I would be so out of here.

There is much abuzz for the past few months on how HIT can improve hospital workflow and healthcare practitioner productivity. Never once have I heard anyone speak about trying to improve patient productivity. But I guess no one ever considered that my time and those of other patients is valuable.

Let’s consider just this one test.

1.       I was mailed one slip of paper a week after I spoke with my physician– a universal test requisition form. No instructions on how to schedule, when to schedule, where to go, preparation instructions, anything.

2.        I had to call my doctor’s office and request this practical information. On hold only 3 minutes that time.

3.       I call to schedule an appointment. So far this is 1:14:26 and counting.

4.       Assuming I get an appointment (big assumption), I know I need to allow extra time to park because the current parking is woefully inadequate.

(note as I was wrapping up I was finally connected 1:28:44 – no apology. 1st dates/times given were incorrect because of the type of test I need. Then offered 12/21 date – forget egg nog, pass the contrast. So my test ordered 10/29/10 will not be done until 1/10/11. And I have to get renal function tests beforehand – I know what they are for, but no explanation was offered)

5.       There is the wait for the test, usually no relationship to actual appointment time.

6.       I have never yet gotten non –ER lab or other test results back in less than 2 weeks.  Often I have to be proactive about tracking them down with my doctor.

7.       Then I guess we start all over again for whatever treatment is necessary.

By my calculations this will take at least 8 hours of my time not counting the meditation time it will take to recover from the frustration. A full work day’s worth of effort for just one test. Multiply this by millions of patients. Can our economy afford this?

What if:

1.       My doctor’s office (at this same institution mind you) scheduled the appointment for me or could point me to online scheduling options.

2.       Directions, instructions, etc were available online and downloadable.

3.       Any prerequisite tests would be ordered automatically or at least an alert sent up to my doctor that she needs to write an order.

4.       MRI results were available promptly and accessible through a patient portal.

5.       A follow up call or visit was automatically requested/scheduled prompted by the MRI results.

If I hung up I would be labeled a non-compliant patient, not following up on my doctor’s instructions, a bad patient.  What responsibility does the institution have to make healthcare work?

1:39:45 hours

What Patients Want From HIT

November 8th, 2010

I am privileged to have been invited to speak at two conferences this week to lend the patient perspective to panels on the future of health information technology. Kudos to each meeting planner and moderator who prevailed upon their colleagues to include a patient as an active participant in the thoughtleadership and agenda setting that occurs during these meetings, shaping the perspective of attendees across stakeholder segments and planting the seeds of what will bloom into policy and regulation in public and private sectors.

In preparation, I’d love to share my initial thoughts with you, Dear Reader, and ask for your suggestions for my remarks.

I see the essential question as: What do patients want from HIT? (EMRs, EHRs, PHRs)

My answer has seven principles:

1. Comprehensiveness

2. Accuracy

3. Priority

4. Safety

5. Efficiency

6. Privacy

7. Quality

Comprehensiveness: An electronic medical record should aggregate all my information across time, specialties, and institutions/practices. A record that does not hold my historical records from all my doctors no matter where I was treated can be misleading to the point of peril.

Accuracy: The information must be correct to be useful. And please make sure my record only holds conditions, lab results, notes, and images that actually belong to me.

Priority: My ideal EMR would highlight the important information in my record for my physician, organizing and alerting her to key issues, new results, missing information. Simply distinguishing between conditions successfully treated in the past from ongoing conditions would be a step up from some current offerings.

Safety: I was thrilled to see the new barcode scanners at my local hospital reducing potential medical errors by checking patient identification bracelets against each medication before administration. Checking for drug interactions, allergies, avoiding overdosing are all important abilities for HIT solutions.

Efficiency: I could spend all night listing ways that the average physician office can be less disorganized. Tops on my wish list are the functionality to send lab results, e-prescribe, schedule appointments, send reminders, instructions for procedures, and orders for bloodwork.  I’m sure many of you would have guessed that my most pressing desire would be to be able to contact my doctor by email. While that would be nice, I am so much more interested in my doctors emailing and coordinating my care with each other before they get around to talking with me.

Privacy: There is a spectrum of comfort level with sharing and release of even seemingly innocuous personal health information. In general I believe that most patients would like to have systems that facilitate appropriate sharing of information for purposes of treatment, more individual or consented release of information (even deidentified) for research purposes, and are concerned about discrimination in employment and other settings if information is made public.

Quality: HIT contributions to quality are predicated on everything listed above. One additional significant way that EMRs  can improve quality of healthcare delivered is to accelerate the translation of new science, guidelines, or regulatory information to healthcare practitioners.

As a patient, a decidedly non-techie patient, unless you involve me throughout development of health information systems and keep a laser focus on the practicalities of care and research your vast expenditures of time and resources may all be for naught. You can build it, but I may not come. Thanks for finally asking what is meaningful use to me.

The 6th Annual World Healthcare Innovation and Technology Congress

Preconference to the American Academy of Nursing’s 37th Annual Meeting and Conference Transforming Nursing through Informatics and technology: Implications for Practice, Education & Policy.

Consumers v Patients

November 1st, 2010

Although often use interchangeably, there are distinctive differences between consumers and patients in the context of healthcare.  Much is made of what to call those of us actively engaged in pursuing and receiving medical care from health professionals and this post does not intend to settle that issue, but after reviewing countless new conferences, pieces of legislation or regulation, coalitions, job titles, and  grant opportunities,  I’ve discerned a shift towards using consumers as the catch-all term to describe what are actually segments with different experiences, needs, views, and behaviors within the healthcare system.  Too often I see the few seats at the table begrudgingly opened to non-physician or non-academician or non-corporate  parties are filled by labor unions, general consumer groups, and organizations whose average members may not have visited a doctor in years. Organizers, though, feel satisfied in checking off the patient representation box.

Consumers, in my personal dictionary, are members of the general public. Consumers may be perfectly healthy (or think they are) with little contact, or desire to be in contact with the medical system.  The term consumer is also associated with rational nonurgent cost and feature comparison activities demonstrated in other industries with more transparent information sharing.

Patients, acute patients for the purposes of this post, are people with some illness or injury necessitating an interaction with the healthcare system.  They are not electively consuming goods or resources, but trying to secure the more effective treatment with the least amount of pain, time, and cost (if there is a choice or information). Their experience with clinical settings and information may be short-lived and soon forgotten.  If there was no error or incidence involved patients may return to their lives without having been significantly shaped or changed.

Patient Warriors, those patients with chronic diseases, diseases that are potentially terminal or that leave life-changing and to whatever degree life-defining marks (visible or invisible), offer something fundamentally different to the conversation.  Experience over 2 decades with 3 conditions at 4 institutions with 5(to the nth power) physicians, nurses, fellows, medical students, and techs is quantitatively and qualitatively richer than that of an acute patient or a consumer.  Their cost calculations are too often, should I buy food or medicine? should I bankrupt my family or save my life? should I pay these medical bills or my mortgage?

There is a great need from a population health perspective to reach all three segments but the approaches and expectations of each should be varied.  Moreover, than cannot be substituted for one another for research, policymaking, or other purposes.

Consider these questions:

Do consumers want access to their personal health records?

What role do patients want to play as part of their healthcare team?

Can patients be experts?

What is the consumer perspective on comparative effectiveness research?

These questions are almost meaningless as asked.  Consumers may not care one whit about access to a personal health record, but it may mean life and death to a patient warrior.  Patients (subject to individual preference and temperament) may want to be informed while a Patient Warrior may want to be perceived as a full partner or have endured for so long they just want the key decisions while they maintain a positive mindset.  Patients may not be interested in becoming an expert. Patient warriors (often E-patients) may spend hundreds or thousands of hours reading, attending medical conferences, questioning other patients and physicians.  Consumers may consider comparative effectiveness research as commonsensical as having Consumer Reports for other products and look forward to cost-savings.  A patient or patient warrior may be skeptical that a personalized treatment option may be made inaccessible to them.

Extent of interaction with the healthcare system and impact of health issues on someone’s life are the defining factors in determining these population segments.  If we really are to solve the myriad of challenges affecting healthcare we can’t afford to be lazy in our language or our thinking about ensuring that all stakeholders are truly considered and engaged appropriately.