Posted in August 2014

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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Learning and Teaching about Crisis Management

I enjoy my time at MIT in the summer lecturing and learning about disaster recovery and crisis communication. This morning I am on deck but first we are getting an introduction to the course and all the great students here at the course. Sold out crowd with people from twenty countries.

Right now, we are about to learn the Basics of Crisis Management and Business Continuity from Dr. Steve Goldman.
There are no hard and fast rules. Common sense should prevail. It is an art and not a science. Thus, you must adapt this and all such information to your specific needs and organization.

Before you have an emergency/crisis/incident you can determine who what where how and why but don’t know when.

With proper planning you can survive. Think about your management unit, implement your emergency response, assemble you crisis management team and assist your business units to resume, recover and restore business operations.

Management in companies is expected to be prepared to respond to a crisis. Management needs to provide leadership throughout the crisis. They should also take appropriate actions to resolve the crisis through teamwork.

You should communicate with all affected stakeholders and deal with the human side of a crisis.

Remember back to the Tylenol crisis in 1982. 19% of J&J profit was from Tylenol. Seven people died. A VP was appointed to manage the crisis. The first thing they did was to go public, alert FBI, and recalled the drug. Set up call centers and rewards. They got 30,000 calls. They even destroyed products they knew were safe. !00 million in tables gone. They then implemented a tamper proof lid. A competitive advantage was therefore obtained by Tylenol over time as other companies had to implement the same lids. To this day, they have found out who poisoned the Tylenol. The FBI approached J&J and said please don’t recall what is on shelves because they wanted more people to get the laced capsules so they could obtain more evidence. J&J understandably demurred.

Software plans are advantageous because they are easy to access (assuming your plants or IT system doesn’t go down or isn’t impacted by the crisis). Plans are easier to access for most employees if they just get 2 or 3 pages of instructions.

In addition to combating the crisis, you must continue and restart your key business operations. In your planning, don’t forget to account for you busiest time of the year. (IE, April for the IRS). During all your response, always be communicating.

After the disaster, mitigate your risks, conduct your Business Impact Assessment and Risk Assessment. IT and business must be linked and work together. IT must be able to not only restore the applications but also the DATA.

Bring PR people in early as well. Respond quickly. Your company’s image will be determined by tour communications staff. Your response is the story much of the time.

A crisis is company’s defining moment. Define yours right because you may never get another chance.