Filed under Health Information Exchange

Experiencing Healthcare: Words You Don’t Want to Hear

HIPAA 2013

Julie Meadows-Keefe

Experiencing Healthcare: Words You Don’t Want to Hear

“We can’t do this procedure today.”

These are words you don’t want to hear after you sit in a waiting room for over one hour drinking cupfuls of glow-in-the-dark foul tasting Kool-Aid and watching front yard makeovers on HGTV.

These are words you don’t want to hear when you’re wearing one of those fashionable exam gowns with an IV needle in your arm and with that arm bent outside of a CT scanner after being told “don’t breathe” so a scout image can be taken to get the general geography of your abdomen and colon.

Yet these are the words I heard last week when I went for an abdominal CT with contrast to determine the etiology of some rather intense abdominal pain and nausea.

What the Heck Happened?

Why was this procedure terminated almost before it started?

What we had was a failure to communicate.

You see, the day before the attempt at CT, I had another diagnostic procedure done at another facility-a hospital here in my town. The hospital procedure the day before was a barium swallow. This, like the radioactive Kool-Aid, was also delightful. You first take a shot of bitter pop-rock-type crystals on your tongue and chase it with water. Then you drink a thick barium shake, followed by a thinner barium shake and x-rays are taken as the material eases down your digestive tract. Being an engaged patient, at one point I was watching the action on the screen. (Since there was no HGTV).

As I was leaving the hospital after the barium swallow I was exhorted several times to “drink copious amounts of water” to expedite the barium’s departure from my system. I was NOT told to “refrain from abdominal CT scans for the next few days.

One reason the hospital didn’t tell me that was because they didn’t know I had it scheduled for the next day. They didn’t ask and I didn’t tell. It didn’t occur to me.

So the next day I present myself at the imaging facility and they ask on the history form if I’ve had other tests and I write “barium swallow.” They didn’t ask me the date of the swallow and I didn’t tell. It didn’t occur to me. And, it didn’t occur to the facility to ask either, before treating me to the kool-aid.

And, most disturbingly, it did not occur to the doctor’s office that they should not have scheduled me for a CT the day after a barium swallow. The doctor’s office does not use electronic ordering and the nurse was literally calling the different facilities to get dates for the procedures and to hand me my written orders. She was very stressed with papers and charts stacked on her desk.

This problem probably would not have arisen had I been scheduled for both procedures at the hospital. However, cost most likely figured into the equation of where I was sent for the procedures. The imaging center did not have the equipment or staff for the barium swallow.

The imaging center was also not equipped to be able to communicate electronically with the hospital or my physician’s office.

And there was no system in place at the doctor’s office that would alert a scheduler that she shouldn’t schedule an abdominal CT the day after a barium swallow.

So after the IV was removed from my arm and I was dressed and ready to go, the technologist at the imaging center was able to show me the picture of my belly with all the barium. I swore that I had followed the edict to drink lots of water after the barium swallow. He advised me that even if I had consumed enough water to fill a small pool, the barium would still have interfered with the acuity of the CT.
Much Anger and Frustration Ensued

I left the imaging center furious at the time I had wasted. I began asking myself what purpose such a fruitless morning could serve in my life and then it occurred to me that it perfectly illustrated the need for Health Information Exchange which is something near and dear to my heart. When systems can’t communicate and when data is not integrated, time is wasted and resources are unnecessarily consumed. This leads to higher costs and inferior care. Also, the miscommunication with my studies didn’t lead to any life-threatening issues, which could occur in more complicated procedures and situations.

My experience with the CT also exemplified the virtues of an intuitive EHR which would have built in a way to alert a provider that tests shouldn’t be scheduled at certain intervals. Much like a pharmacist is alerted by an automated system when you have a potentially harmful drug interaction, an EHR with electronic ordering would have been reminded that the CT should have been done first.

Should I Have Just Gone to the ER?

As I was driving home from the CT that wasn’t, I also thought back to a night earlier in the week when I was up because of the pain. It was around 11:30 pm and I thought that I should just go to the ER and have it solved. I wasn’t sleeping anyway and when I checked the ER’s website it told me that the wait time was less than 10 minutes. Granted, the co-pay is hefty but the benefit was that I arguably could have gotten all the testing I needed at one time, in one location and with pain meds to boot. However, having worked in healthcare so long I know that ER overuse is a huge problem and that my pain was not a true emergency. So I self-rationed.

Why Write About It?

I had to write a blog post about this so I could say I got something beneficial from the experience. The benefit is that I saw the value in systems I spend a lot of time working with and thinking about and that I am passing the experience along so that it can benefit others and show an example of how precious and costly healthcare resources are wasted when providers can’t readily communicate with one another. Plus now I have a story to tell!

And, one piece of advice: if you just had a barium swallow yesterday, don’t drink the Kool-Aid today.

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Health Information Exchange Governance Valentine from Dr. Farzad!

Health Information Exchange Valentine

 

I listened in on this town hall this afternoon!

 

Happy Valentine’s day to me!

 

I did not expect Dr. Farzad Mostashari, the National Coordinator of ONC to wish me (and all participants) a happy Valentines day as he was flying on an airplane to a far-flung local.  He spoke quickly about how he “hearted” all the “listening” and open discussion going on involving health information exchange-especially around the issue of governance.  Since his plane was landing, he had to cut his remarks short so other ONC staff took the reins for a really robust and interactive webinar session on the issue.

A Rational & Non-Regulatory Approach to Health Information Exchange Governance

 

It was reassuring to hear the ONC staff verify that they are committed to a listening approach rather than a pure regulatory approach to health information exchange governance.   This is a real relief to those of us who are still wading through the HIPAA Omnibus Rules.  They emphasized that they are in a listening and “information collecting” mode at present and plan to continue this way.  The ONC has had other townhalls on this and other topics.

My opinion: The complexity and level of detail that would need to exist in regulations is overwhelming, and with Health Information Exchange being a fairly new creature, regulation is just not pratical at this time.  It would also chill implementation, adoption and participation!  Who wants to have to deal with even MORE regulations and the associated penalties and costs?

There were several main themes developed throughout this town hall meeting:

  1.  Information should securely and privately follow the patient.
  2.  Trust is key. Trust policies are HUGE.  Providers, organizations and patients need to trust in the exchange.
  3.  Meaningful patient relationships and engagement regarding use of HIE. (Like understanding what it IS!)
  4. How will patients be able to get their data?  There was an advocate on the call for patient mediated exchange.
  5.  Increasing interoperability is crucial.
  6. Costs need to decrease.follows patient and there is trust in the organizations that are handling the information.
  7. Adopting best practicies for exchange. 
  8. Whether HIE’s will agree to exchange information with one another or whether they will “hoard” the data, especially if there is a profit-based incentive for doing so.  There is currenly no requirement that this sharing occur.
  9. Crossing boundaries of current EHR vendors.
  10. Closing “digital divide” barriers to implementation and meaningful exchange.

The ONC  plans to monitor the exchange ecosystem and evaluate what activites are occuring and what problems or issues arise which may benefit from “national activity.”   The ONC is the entity to monitor and potentially come up with regulations if they were later required,

My opinion: If people can’t play nicely and fairly in the sandbox the ONC will be willing to regulate.  It seems like the equivalent to a mom hearing kids fighting outside over buckets and shovels and saying “Don’t MAKE me come out there!”

An aside…there does not seem to be a lot of love for EPIC.  They might the be the kid in the sandbox preventing others from digging in.  Just an undertone I got. (opinion)

HIPAA Components to Health Information Exchange Governance

Joy Pritts, the Nations Chief Privacy officer offered some comments on understanding how the new HIPAA Omnibus rules should be interpreted as they pertain to Health Information Exchange.  She suggested that by looking at the preamble to the final rule, one can find guidance about whether HIE’s will be considered business associates.  From my own reading, the analysis will depend on whether the HIE is “pushing” or “pulling” data.

Overall, the call was quite informative and a great way to spend Valentine’s Afternoon!

 

 

 

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