An Eye Opening Reminder

Posted January 9, 2009 by Lygeia Ricciardi 

Every day in my work I think about personal health records and other information tools that empower patients… even so, it helps to bring it all back to reality every so often.

On Tuesday I got the call from the daycare. “Your daughter is sick and you need to pick her up immediately. Looks like pinkeye.”

Uh oh. Well, at least it wasn’t anything too serious—from a health perspective, anyway. But in terms of disrupting my life balance (and hers), it’s been pretty significant. Three and a half days later, her eye is still swollen, she’s out of school, and I’m way behind in just about everything at work.

The Reality

My husband was out of state when the daycare call came in, so I had to abruptly dash out of a meeting and make a plan. Understandably, daycare doesn’t want contagious kids to stay. And pinkeye is highly contagious, so a child can’t even return without a signed note from a doctor saying she’s under treatment.

Immediately I picked up my daughter and called the doctor’s office, and told them it was pinkeye (I’ve seen it, unfortunately, several times before). As I suspected, they wouldn’t make a diagnosis or call in a prescription without an office visit. But they were about to close for the day. Despite pelting rain, a miserable child, crazy traffic, and nearly impossible parking—I abandoned my car and took cab—I made it (just barely) to the doctor’s office.

The doctor took one quick look. “Yep. It’s pinkeye. I’ll write you a prescription for X.” I remembered that in the past my daughter had tried some medicines for pinkeye that hadn’t worked, while others had. I asked the doctor to check her health record for them. He rifled through a large stack of papers, but didn’t find any useful information. So he went ahead and wrote a prescription for X.

As we left the office I remembered that the medication that had been most effective against pinkeye had been prescribed by a clinic in Wisconsin when we were on vacation there a year or more ago. What was it called? I didn’t know, and even if I had, there’s no guarantee that it would have been effective in this instance. Still, it would’ve been good to review the whole picture with the doctor.

Today, Friday, my daughter is still out of school with no visible improvement. Despite the medication, her eye is pink and her mood is black. After a full day of phone tag, the doctor has called in for me a different prescription….

Imaginary Future Scenario

Some illness is unavoidable, but managing this one could’ve been a lot easier with the right tools. For example:

• Remote diagnosis—either by video or through the camera on my cell phone. Would’ve been great to skip the mad dash in the rain to the doctor’s office. 

• E-prescribing—not to mention that extra trip to the pharmacy….                                

• An EHR at my doctor’s office that would help him easily call up my daughter’s history of eye infections—and, ideally, integrate information from that clinic in Wisconsin. 

• A PHR that helps me to track my daughter’s response to particular medications: which worked, which didn’t, how long they took, other environmental factors, etc.

• Email exchange with my doctor. We could’ve saved several hours of phone tag and gotten the new medication started earlier. 

My story (fortunately) is pretty low on drama. No lives were lost or saved because the right information was (or wasn’t) available at the right time. But it’s the kind of story about inefficient and inconvenient health information sharing that is playing itself out in countless homes and families across the country, today and every day, sometimes with much more significant consequences.

I’m reminded by this episode not only that the US health system is in drastic need of reform, but also that that reform has to be comprehensive. Yes, a PHR alone would have gone some of the way to make this scenario better—but what we really need is PHRs that are integrated the broader healthcare system. 

Comments

[Deborah Leyva]

Lygeia, well written, totally on point and I agree with your analysis. The ability to have a "comprehensive" health record is essential to improving care. End of sentence.

But then, there are those who think that EHRs can harm or cost lives. This claim was from a post that stirred me into a rant.. I emphatically believe it is NOT the technology that is error prone, it is the lack of knowledge of the people using it that creates the potential for error. That said, there's a steep learning curve for new technology when you have barely used a computer so education is essential - as a 1st step.

I wrote about it on my blog (http://www.myhealthtechblog.com). See if you agree. I would be interested in your thoughts.

[Project HealthDesign]

Hi Deborah –

I totally agree with you. Health information technology is just a set of tools. Like any other tool (a hammer, a car, you name it) it is inherently neither good nor bad.

Yes – it holds tremendous potential to improve health, and may, as I believe, be a prerequisite of a better health system – but IF and only if it is used well. That means choosing the tools that are designed to best accomplish specific tasks, and setting up policies around their use. In addition, an important issue you highlight in your post is education.

So often people assess the costs of health IT in terms of buying hardware and software. Sure, that’s essential, but another significant and sometimes hidden cost is helping people learn to reengineer workflow and use health IT effectively.
The only thing worse than not using health IT using it poorly….

[Melissa]

I couldn't agree more with the both of you. (Unfortunately, I could not access Deborah's link to review her post). I am an IT Consultant (part time) and have had experience working as a contracted technology coordinator at a private urgent care clinic. WHAT A MESS is all I can say when it comes to training. You hit the nail on the head when you said people assess the costs of IT in terms of software and hardware. Training is a complete afterthought and many are resistant to it. I have personal and quite gut- wrenching experiences with this exact thing. Let's just say, private practice, all Chiefs and no Indians when it came to executing training procedures and protocols. No one wanted to listen to the IT Technician (me) who installed and configured the entire infrastructure. It was more about, ok, you've installed software and hardware, thanks, your work is done here, we'll take it from here. How hard can it be? We don't need to be spoonfed, we're medical professionals, we can figure it out and make up our own rules. Needless to say, an entire section of digital patient records had been deleted and no one could be held accountable. Major fail there, but it could have easily been avoided and protected had protocols been followed. Anyhow, that's MY rant on it. I KNOW this technology can succeed, but not without the right training and protocols adhered to put in place and made accountable along with measurable goals for ongoing improvement instead of degradation!