Having the patient's health information when you need it, wherever you are, can be very helpful… or perhaps a huge pain.
This thought occurred to me as I was hunkered down behind a boulder, out of the wind on Froze to Death Plateau, on day 2 of a trip to climb Montana’s Granite Peak (12,807 feet). My second day without Internet access, atop the highest point in the Big Sky state. What was I going to do?
Unfortunately, I spent some of my time (while trying to stay warm) thinking about what I would be doing if I had Internet access. I would likely be using my EHR, filling scripts, addressing patient cases, and reviewing labs, images and consult reports. Having my entire office with me, wherever I might be, is very convenient. I like the option, while traveling, of logging on and whittling down the work that will invariably be waiting for me upon my return. Re-entry to the office is much easier if I do.
I keep up with the office while I am at meetings. (I particularly enjoy listening to lectures about how to choose and use an electronic health record while I am actively exceeding their expectations in doing so!) I will, at times, log on and work on my in-box from the passenger seat while staff drives to one of our outreach clinics. This is better use of my time than spending extra hours addressing my in-box after clinic work. Anywhere I have cell coverage, I have my entire, mobile office.
Back to Granite Peak. The climbing guide tells me if I go to the top of those dark rocks over there I could get a cell signal. Good thing I didn't bring my computer—I might actually try it. Didn't bring a phone either. It is easy to become a slave to the technology and I am no exception. I should get away more often. But we do have plenty of cellular-free zones in Wyoming in which to lose oneself.
We also have great distances. Distances, drive times and mountain ranges conspire to create major barriers to health care access and telemedicine is an option to bridge theses geographic barriers. The solution I am most comfortable with is working remotely with a physician extender. With cloud-based health information technology (HIT), an audio-visual solution and remote access to PACS (picture archiving and communication system), I am able to review the data entered and saved by the extender, discuss the case with the patient and extender, review imaging in real-time and initiate or modify care. For me, having HIT that allows us me to access and work with the data is the most relevant factor for the quality of the encounter.
Ah yes, if I had Internet access on Granite Peak, I would be working from my mobile office. It's probably a good thing I don't. I think I will have some more hot tea and take a nap. We leave for the summit at 4 a.m. tomorrow.
Dr. Gee is an athenahealth client. He leads Frontier Neurosciences, based in Cody, Wyoming.