Good news: my local hospital has the fanciest, newest, coolest computer system (costing major bucks, of course) and now is routinely sending me \”transition of care\” documents on my patients.
Bad news: they are horrible.
Seriously, we get several of these documents per day and often can\’t figure out what the document is about. On the bright side, sometimes after taking 10-20 minutes of looking through the 12-14 page document, we do actually gain some useful information.
Here\’s an example of what we get:
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Search as I may, I see no primary diagnosis, nor have I ever seen a \”diamond\” next to a problem on the list. Searching for diamonds makes me feel like a treasure hunter, though. Perhaps they could make this a reality TV show on Lifetime: \”Doctor Diamond Hunters.\”
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I am, however, informed about the patient\’s cognitive status, whether they can see and hear, can take a bath, and if they are still smoking weed. Reading these documents makes me see the merits of moving to Colorado.
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I am also given a very skinny print-out of a test that he had run. I am not sure what an \”Inflammator Y cell\” is. There is no explanation of who ordered the test or the circumstances surrounding it being run, nor am I certain if it was run during this mysterious encounter, but I do (scrolling through 3 pages) learn what was found on a test that has been run.
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This is followed by the very useful assessments of the nurse, reassuring me that the patient was given food supplements, was instructed to report pain, and that his bed rails were up (thank goodness) and the wheels were locked (presumably to prevent patient bed races in the hallways).
Often we get bonus information at the end of this transition of care document.
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Patient instructions! I am not certain exactly why we are sent this information, but it\’s been a cornucopia of learning for me and my nurses. We\’ve been trying the acupressure point so much that we haven\’t gotten work done! I\’m sure my patients all read these documents voraciously.
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At the end they are given follow-up instructions. I love the advice: \”Your doctor may want to schedule more tests. You may be referred to a specialist. Be sure to keep all appointments. Have tests and exams done regularly as directed by your doctor.\” My patients love it when I give vague and unhelpful advice! We might want to do all of those things! We might want to throw a party!
They did, however, leave one thing off the list of things I may do: \”your doctor may be confused as to how there could be 18 pages in a 15 page document.\”
So why am I being so mean? Why am I so snarky about the hospital\’s attempt to communicate with me? Surely it is better than the total lack of information I had grown so accustomed to.
Here\’s the problem: they are not doing this so I can give better care for my patients. That is painfully obvious when these documents are viewed. They are nearly entirely unhelpful. The purpose of these documents is, instead, to document that they have performed a vital function of the \”ACO\” (accountable care organization): performed transition of care to the PCP. Hospitals are rewarded for doing this kind of thing, as they are presumed to be giving better care when they involve the PCP in the process.
This would be true, if not for the fact that they sent me 18 (of 15) pages of computer vomit. My job is to include this vomit in my computer system for posterity, confusing future generations of people who look at these records.
This brings me back to my belief that computerizing an idiotic system does not help anyone; rather, it simply allows idiocy to be performed with much greater efficiency, at a greater volume, and dissipating it to more unsuspecting victims.
This is what you get when care is about checking boxes or submitting codes. You get information that is useful only for the sender, not the receiver. You get information that spews out, not caring how it is received or if it is at all useful. The sad thing is that this is the rule, not the exception for medical records: they are not primarily for care. They are to prove that boxes were checked and codes were submitted so that the folks with the money will \”reward\” this good behavior.
It\’s terrible. It\’s tragic. It cost the hospital a bus-load of money and it\’s not going to fix anything.
Yes and yes. Great points; as a trainer of Epic proportions, I also have to tell people that marking something as "reviewed" contributes to "meaningful use."
Box-checking in meaningful use, anyone? Epic only cares about their own revenue stream, then a bit about the revenue stream(s) of their customers. Patient care? Not so much. But that’s true of much EHR tech, since actual patients weren’t involved in its creation. Very few actual point of care clinicians, either …
Sad for me to consider how I was once a huge apologist for EMR and even gave a talk at the CDC regarding "Meaningful Use." Technology totally got derailed and now is harming good care.
So you’re the one who is responsible for this mess! Now at least I know who to blame…
😉
Acupressure… awesome. So you have to keep all of this in their file I imagine? You can’t just prune out what isn’t really relevant?
Yes, we could sort this trash, but it takes less time just to dump it into the record. I actually believe that letting patients see their records would go a long way in fixing them. This is an embarrassment, but it’s OK because we medical professionals are used to it.
EPIC excels at generating what I call "computer emesis": multiple screens (or printed pages) of information that is so poorly organized and/or so extraneous that it is worthless. The signal-to-noise ratio is very poor for absolutely every aspect of the program. It is a doctor’s nightmare, and I am sure EPIC is responsible for driving more than a few into retirement.
Just want to mention that if you are a student and are given a homework assignment to write a report on some historical event, and you produce a paper of little to no value, with minimal effort, thought, planning, or quality, that’s your fault, not Microsoft’s just because you happened to write it with MS Word. The fault lies with the hospital. There is no reason for reports to look like that. There is no reason for all the information to be useless to you. Plenty of hospitals produce much better quality results. And no, this is not about Epic. Regardless of vendor, the ability to produce quality is there. If you implement something to satisfy some regulation, follow trends, etc, without putting much thought or effort into it, then ANY/EVERY system is not going to solve your real problems, which have nothing to do with the EMR system you choose to use… That’s a simple fact people love to overlook. Blame the vendor, blame the government, blame some regulatory body…. yeah go take a look in the mirror, there’s your problem.
Nope, Charlie. I can’t agree with this. The analogy is if the professor/teacher would give only A’s to people who do crappy work (the government rewards these horrendous documents and penalizes hospitals that don’t do this kind of thing). If the hospital focused on sending me truly useful information, they would in general earn MUCH less than they do for producing this drivel. The EMR system is designed to quickly and efficiently produce this nonsense so that hospitals earn much more money, which is why hospitals are willing to make Epic an incredibly profitable company. Now, I agree that Epic is not the primary one to blame in this; the government/payors who pay much for this crap that makes Epic rich is clearly the one to blame.
This is what you need as it’s EMR angostic and no HIE required either. Watch the videos and I’ll save the tech talk here as what you need to see is the Common UI at each end and this functions like a phone call live when needed and connection dead when done. EMRs need an API and there just so happens to be an EPIC API. This is new engineering that collaborates records from both or one point on the fly too, hospital to hospital, to MD, etc. It’s a server install that sits on any EMR and could even connect the DOD and VA.
http://ducknetweb.blogspot.com/2014/07/zoeticx-clarity-server-middleware-hie.html
Here’s another link with doctor talking about it as well.
http://ducknetweb.blogspot.com/2014/09/zoeticxehr-agnostic-clarity-healthcare.html
This platform with an API written for the EMR solves interoperability and is out there today.
FWIW, these documents don’t have to be this long and contain pages of useless info. Get on the horn with the sending organizations’ leadership and work with them to make it better – Epic is very configurable (as are other EMRs), thus eliminating the pages upon pages of administrative info is entirely possible…and frankly, I’m guessing, a pretty quick fix.
Ha! "Quick fix" and "Epic" are two words that do not go together. Further, there are so many things that "University Hospital" above is trying to fix in Epic, that one family doctor calling the hospital VPMA with a gripe about overly long Transition of Care documents will likely be met with laughter. They are desperately trying to figure out how to make scanning work properly, or get the doctors to select the right flu shot so they get paid for the vaccine. The hospital doctors are probably clamoring for dozens of fixes to reduce the horribly inefficient user interface that Epic has. While I agree this is a problem, it is a tiny one compared to the glaring issues that doctors are faced with when they have Epic or some other enterprise EMR. That’s how bad things are.
So sorry to see the doctors also get this volume of paper, because this is exactly what I get as a patient. The nonsense CYA instructions overshadow anything of real medical significance to me. I am looking at all my EHRs as part of a patient project and am shocked, dismayed, disgusted about the lack of real usable information in the hundreds of pages I have reviewed. Even finding an ICD number is scarce. I try to remind myself this is something new and we are going through the pains of rethinking medical record delivery and patient access, but it is especially discouraging to know that our physicians are getting the same crap. EPIC fail doesn’t begin to describe what this EHR monopoly has done to our medical records.