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The Follow-up Visit

by John Moore | October 03, 2009

QuixoteThis week I had two follow-up appointments from on my trip to ER last Sunday.  The first was to the trauma orthopedist at Brigham & Women’s.  Upon entering the office, was handed the infamous clipboard with five pages of forms to fill-out, all the usual stuff, most of it just a repeat of the information I provided verbally on Sunday.  Filling out these forms with a broken wrist was anything but enjoyable.  By the time I got to page three, I was about ready to heave the clipboard across the room in frustration.

Now why can Brigham & Women’s not take the information provided on Sunday and provide me a pre-populated form where all I need to fill-out is the missing info, likely half of what I filled out?  Better yet, why not do a simple data request to my PCP asking them to provide the majority of this information? And as for privacy, security and consent to exchange such data, can’t see that being much of a problem as the forms I did fill out had me check off a box to release the PHI created in this encounter to the insurance company.  I understand why the insurance company wants this info, but I and likely most others are more comfortable having doctors sharing our PHI, then sharing it with an insurer.  So again, why can a major player in the Boston Hospital scene, (Brighams’s is part of the Partners’ network whose IT is led by the widely quoted CIO, John Glaser) not get my PHI from my PCP to help populate a clipboard form?

My second appointment was on the following day, this time at Faulkner, which is part of the Brigham’s network.  This appointment was to remove the stitches.  Can you guess what I was greeted with upon signing in?  Yup, another clipboard asking many of the same questions all over again.  At least this time, the office was not busy and the receptionist offered to help me fill out the form. But why have the form in the first place? Does not Brigham’s share my clipboard entered data provided earlier that week to its affiliated hospitals?  Is it any wonder why I avoid hospitals like the plague?

Oh to have a time when prior to a visit a hospital, clinic, etc. asks you if you have an online account with PHI readily available that you consent for them to access for say a small window of time e.g., 24hrs to automatically populate the clipboard form.  Oh the time when after an appointment, the hospital, clinic, whatever asks you, electronically via email, if you have an online, personally control account for managing your records that they can automatically send your records to.  This time is coming, but ever so slowly.

As I age and am more or less forced to interact with this dysfunctional system more often, all I can do is just fight a little harder, make my voice a little louder and shake more cages demanding change.  It may be a Quixotic venture, but I know I am not alone in making this push.  But we need far more than myself and other healthcare digerati to make this happen (I’ll see many next week at the Health 2.0 event in San Francisco and CTIA in San Diego). We need broad, widespread consumer engagement to get this system off the dime and institute the changes needed to better serve its customers.

Maybe it’s the Health Internet, maybe it’s healthcare reform, maybe it’s employers, I’m really not sure where and when the consumer will finally get engage.  Maybe, just maybe it will be something as simple as stories like the one above that consumers contrast with their experiences interacting with other service industries and finally say they have had enough and start walking, engaging (taking business to) those providers who indeed provide a higher level of service and ultimately a more pleasurable experience.

A very funny and somewhat disconcerting piece, If Air Travel Worked Like Healthcare is alarmingly close to the mark of what we must deal with today.

7 responses to “The Follow-up Visit”

  1. I hear those frustration and see it all the time. It may be the individual doctor’s office with participation too.

    I think we have missed a point here with PHRs too, we need to focus on seniors to be the message carriers. I say this as I did a little experiment with my 85 year old mother and HealthVault. She went in to her primary care physician, used his computer and pulled up her records and said she could share some of this with him, he about hit floor, couldn’t believe he was seeing what was there, and to have an 85 year old woman/patient show him:)

    At least with a PHR there’s an option to share without having to do the clipboard thing over and over.

    Granted I have helped and coached Mom so she’s maybe more advanced than most seniors, but even with senior groups I have spoken to, before online PHRs were even around, many of them had the usb drive with their records as some local fire departments provided this service.

    I just gave a talk a couple weeks ago to a small group of doctors on web 2.0 and none of them were even aware of the software much less the term web 2.0 and none of them had seen or heard of Healthvault or Google Health. I sometimes even forget myself that when I am on the internet with all the brilliant folks that contribute, that there’s a real world out there where this knowledge doesn’t even exist, sad.

    Back on topic with the EMR element too, again it might just be the level of participation at the doctor’s office. If we could at least get physicians to accept the information from a PHR versus the clipboard, we would perhaps be making some real progress. It’s a long road to the world of education in healthcare with bringing the benefits of technology to use to benefit all.

    This is one of my real peeves with there being a far cry of NOT enough communication and training available for both patients and doctors all over. Many hospitals don’t get behind it either, as in one facility where I have done some work, the CEO of the hospital runs for the hills when he sees me using my tablet pc for an example as he might have to be exposed to some new technology and he fears it; there is no level of curiosity and trying to find a way to tap into that is key for any kind of change to take place I think. Anyway, that’s my few thoughts here.

  2. Charles says:

    What I don’t like about Google health, and Healthvault, is that there are too many places to try to connect to. Doctors and patients need a single place, a single logon, to get all this done. Here’s an example… PHR and RHIO all in one. (doctors upload there EMR data via PHR into a Hybrid database system, and can they view items from other facilities. Also provides secure messaging. This is how Healthcare Information needs to go…


  3. James says:

    Frustrating – BWH, and all other Partners institutions and at least many of the affiliated PCP offices have access to the Partners EHR app, known as LMR. I wonder why they can’t just look there for demographics and history.

    Also, for the record, Halamka is CIO of BIDMC, which is most emphatically not a Partners hospital…


  4. Jeff Brandt says:

    I attended a PHR meeting at OHSU (Oregon Health Science Univ) several weeks ago and one of the speaker brought this same problem up and the escalating loss of confidence that the patient and family has the more times the same questions are requested. The tech people know that it is possible to link these records and are frustrated when encountering these low tech solutions. The non tech patients and family just think that the health facility is just incompetent.

    Credibility is earned and once lost is hard to regain.

    Jeff Brandt

  5. John says:

    You are correct that this is indeed a major undertaking that will require a significant amount of education of both consumers and providers. While I share your thoughts about senior citizens being one avenue, my experience to date with seniors has been a mixed bag, especially when I compare it with people in y age bracket and even more so for those in their 20s & 30s. These digital natives will talk with their wallets and go to those that provide a higher level of service engagement. Serious disruption on the horizon for those physicians, clinics and hospitals that do not begin building their operations around more effective and efficient deployment of IT.

    RHIOs and HIEs can certainly play a pivotal role at a regional level, but these services will only provide a portal view for the consumer into their PHI. Hardly ideal as there is no control for the consumer. Also, being regional in nature, they can not create a longitudinal record, say for example “snow-birds” that live in the Northeast during the warm months and down South in the winter. HIEs/RHIOs at best will be just a stop along the way to creating a full longitudinal record. In the previous post on the Health Internet, this model, if successful could ease the process of data collection for a consumer that wishes to compile their own PHI in a Google Health, HealthVault or other such personally controlled platform for PHI.

    Thanks for the catch on Halamka’s true employer, have made correction inserting the Partners CIO, who also is an uber-HIT guy now on sabbatical at ONC helping to formulate the plan for executing on the ARRA HITECH Act stimulus.

  6. […] Article John Moore, Chilmark Research, 3 October 2009 SHARETHIS.addEntry({ title: "The Follow-up Visit", url: "http://articles.icmcc.org/2009/10/04/the-follow-up-visit/" }); […]

  7. Thank you John, I find the best way to motivate and get that element of curiosity engaged is to show my own participation as so many still seem to think that PHRs in particular “are for those guys over there” and of course that is seen all the way up to Congress too, no participation and everyone seems to forget this is for everyone.

    I use my mother a bit too as just due to age she has a lot more medications, history, you name it than what I can show, of course with her permission. Actually I’m darn proud of her with the strides that she has made and as mentioned her PCP is one of those still in the dark ages. PHRs are really not something you put out there and wait for them to come as it might be a long time. The failing pilot PHR program in Arizona for Medicare, perfect example.


    We have no mentors to say it bluntly, one of my coins over at the Medical Quack “Magpie Healthcare” with a lot of talk and little participation:)


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