Imagine this scenario: A CEO stands in front of the board at a crucial juncture in corporate history, and says:
Members of the board, as you can see from the financial statements before you, we have had a reasonably good year. What!? You don't have the financial statements in front of you? I have them here. I mean, I think I have them here. Where are they? Let me check with the staff.
We will find them. Then, we can make some decisions. We are pretty sure they are in the system. We are searching the files in the computer now. We have a great information management system!
We should be able to find the information soon, or perhaps reconvene tomorrow when we have the information so we can make some decisions.
How often does the CEO of a successful business not have the relevant company business and financial information? This just doesn’t happen. Yet physicians frequently must make critical decisions at the point of care without having all relevant patient medical information.
Just a minute ago, I saw a patient for progressive memory loss. Despite numerous requests, we had not received prior imaging, labs or records. While I always start a consult by interviewing and examining the patient, not determining what others thought, there comes a time when having the prior workups is necessary. So, we spent much of our time determining what had been done and where.
She apparently had a history of an elevated ESR (Erythrocyte Sedimentation Rate) and a temporal artery biopsy which “might have been normal.” Does she have temporal arteritis? Is she having strokes? With luck, we will be able to find the information and not be forced to needlessly repeat studies. A functional health information exchange would be valuable, wouldn't it?
Once we find the data, I will then need to review it all again, and determine the course of evaluation and treatment based on the most recent recommendations.
Needed: Functional Health Information Exchange
I asked my lawyer a question I thought was time-sensitive and critical. Not surprising, I did not receive a timely reply and was billed for “research and review time.” Again, in contrast, physicians are expected to have immediate, well-researched, and correct answers at the point of patient care, often in the absence of relevant supportive data.
Unfortunately, even a great information management system, an EHR, does not in and of itself improve the physician decision-making process, or the use of health information technology. An information storage and organizational system does not necessarily facilitate the process of Health Information Acquisition and Utilization (HIAU). Getting lost in drop-down descriptors and document searches, and trying to type, dictate, and enter orders does not help the physician at the point of care. I am not at all surprised by the continued dissatisfaction physicians have with electronic health record performance and that, according to KLAS Enterprises, “50% of experienced EHR users want to replace their systems ...” Replace them with what? Another expensive disappointment?
Wouldn't it be nice if technology would assist the physician in the HIAU process at the point of care? Having a functional health information exchange to find and collect digital patient data is a valuable step. Then by building intelligence into the decision-making process (including research support) to work with the physician at the point of care, we can make the process smoother and more effective for the physician. It may not be easy, but it must be done to achieve greater physician satisfaction. I'll go ahead and throw that out as a challenge to industry. More Disruption Please! Can any system focus on the physician and exceed expectations?
Dr. Gee is an athenahealth client. He leads Frontier Neurosciences, based in Cody, Wyoming