The number of facilities and provider practices with EMRs installed continues to rise – which is a good thing. I firmly believe in the work that Health IT is doing to improve care. But last week, I became the patient and was reminded, the hard way, that installation is only the first hurdle to clear if we truly want to make care safer and improve quality. What about those somewhat nebulous terms: care coordination and patient engagement? Please bear with me while I tell my story…
During a visit to my rheumatologist, we agreed that I needed to consult a hand surgeon about a cyst on finger. Darn, no hand surgeon in the same practice as my primary care provider (PCP) and rheumatologist so need to find another on my own. Go on to my health insurance to determine which hand surgeons are in-network since we all want the best reimbursement we can get. Log on, pick my coverage, and search—oops, no hand surgeons within a 50 mile radius of home. Wait, that can’t be right, I live in Dallas-Ft. Worth area, so there has to be one. Try multiple ways of search since I’m pretty tech-savvy. Finally give up, call insurance help desk, wait on hold for a while then a customer service agent tells me that in order to find an in-network hand surgeon, I need to sign on as a guest not a member. Darn, why didn’t I think of that….duh. Ok, now have a list but which one to choose? Luckily, I call a nurse friend who gives me a recommendation.
Go to my first appointment – fill out and sign all the paperwork, since they weren’t available as online forms. I’ve brought a hardcopy of my health history, meds list etc., since their system doesn’t talk to the one at my PCP & rheumatologist. But I refused to rewrite all information on “their” forms, which garners me a few frowns. After x-rays and exam, it is decided I need to have surgical intervention.
Luckily, I emailed my rheumatologist, who instructed me to stop one of my RA medications for a week before and a week after surgery. What would have happened if I hadn’t told her about the impending surgery? Not much coordination here, except by me as patient. I arrive for surgery at appointed time–oops, running about 1.5 hours behind. Pre-op RN: ‘Did you bring your med list?’ What….isn’t that information in your EMR? ‘No, we don’t share information with the provider’s EMR.’ And the providers’ office (which is 30 steps down the hall) didn’t provide it in preparation for my scheduled surgery? And you didn’t remind me in my pre-op call that you would need it?
All in all, the procedure went fine and I’m not upset with the overall care. However, I am recounting this story for a very specific reason – as a sharp reminder of how much further we have to go in using technology to positively impact the patient experience and the quality of care.
As an overall process for an outpatient surgical procedure, the fact that two different providers’ practices and the surgical center had installed EMRs made little to no difference to my perceived level of quality or safety. As the patient, I was still required to provide the same information multiple times and there was no portal for me to access either pre-or post-op instructions.
For those of us in HIT – our journey can’t end because we have installed an EMR. Our focus needs to turn to optimizing so that technology supports the healthcare process for patients and clinicians, instead of being just one more thing to deal with. And when you are the patient – it’s all about perception!