Monday, February 08, 2010

Medical advancements?

As I sat in my doctor's office and my local hospital, it struck me how manual these operations still are.

In my doctor's office, the only computer to be seen is on the receptionist's desk. If there is one in the doctor's office, I wouldn't know, as she doesn't normally take patients in there. She wrote me a manual order for urine testing, on a pad of pre-printed forms on which she can also request blood work. She also wrote me a couple of prescriptions, mostly legible compared to a lot of doctors (though I still can't make out some of her writing). My doctor writes her comments and notes on loose leaf in my chart. From what I can tell, my chart is just a pile of notes and reports that aren't really organized in any fashion other than chronologically, in that the most recent test result is likely on top. The real kicker is the fact that she waits for snail mail for test results, which usually takes 2 weeks from the lab to my doctor's desk. If it was an emergency, she may call the hospital for a verbal report.

I stopped by one of my local hospitals to drop off my urine sample. I pressed the button on the ticket machine to get a thermal-printed number, and waited for my turn to sit at a desk (some desks are not private) and my number to appear on a digital display. I answered a bunch of questions for the registration process (where I'm going, what for, who ordered the tests, and verified my contact info was still accurate). Then I proceed over to specimen collection to obtain labels for my urine samples. The clerk took my paper order from my doctor, entered some info, checked that I had registered in the lobby, and printed laser labels for me to attach to the bottles. I dropped the samples in a Rubbermaid bin which sits out in front of the counter, free for anyone to contaminate.

On a previous visit to one of the two hospitals in my city, I was really surprised to find that their computer information systems are not linked. I have a provincially-issued Medicare number, which I thought meant that there was a central database of my information that could be accessed by any hospital in the province (wrong!) or at the very least, hospitals in my immediate region (still wrong!). What I discovered was that each hospital has its own information store on me... I still can't believe that is true in 2010.

The hospitals in my region recently switched to an "appointment-only" system for bloodwork. We do not have privately-run blood labs like my husband had in SoCal; all bloodwork must be done at a hospital or designated satellite location. Under the new system, you must call for an appointment at a specific location. While waiting for my urine sample labels, I noticed that the appointment system is a series of large binders full of paper forms, with appointments written in pencil. Seriously. One binder for each hospital/satellite location and one person answering the phone, penciling in appointments.

That day's visit to the hospital yielded some more puzzling administrative questions. This hospital is very large, and serves our city as well as our region. In some cases, people are transferred here from other parts of the province for specialized care. While I do agree that finding your way around can be challenging if you are new, I am not sure this is the best way to handle things.

Wayfinding kiosks?!?! My heart goes out to the senior citizens, who simply want to ask a real human being where the x-ray department is. Do you get the feeling that soon, there will be reduced hours for the human at the info desk, and possibly its elimination?

In my mind, I visualize something so totally different than what we currently have:

I would be able to make a doctor's appointment for a non-emergency issue that would be sooner than 6 weeks away. When I go to my doctor's office, she would have a PC in every exam room. On this PC, she could call up my chart, search for similar complaints, perhaps cross-reference my symptoms. She could call up test results from a centralized database which is shared among the medical community for the province. In this database, test results would be summarized with a flag for "follow-up needed" so that those results could be addressed first. If she needs me to go get bloodwork or drop off a urine sample, she would ask me which hospital I'd prefer to use, and then submit a request with all of the appropriate tests. This request would reside in the database, and would be accessed by the specimen collection desk at the hospital. I would go straight to the specimen collection desk (why would I need to register for a sample drop-off?), they'd pull up my doctor's request and pertinent info, and away I go.

If I needed to register at the hospital, kiosks would be available for non-complex registrations. I would walk up to one, swipe my medicare card, reconfirm my info, specify where I was going, etc. This is one area where I think human interaction isn't necessarily needed, especially for patients who make frequent/routine visits to clinics or labs. This is where I think spending money on kiosks would actually do some good. I am, however, a strong believer in having humans available to help those who do not want to use a kiosk system. You shouldn't force technology on those who are timid, just because you think it is easy. You also shouldn't cause a giant bottleneck by not using technology.

For prescriptions, my doctor would have completed a request via the PC in the exam room, asking at the time which pharmacy I would like to use. I assume here that the system is simple enough for the doctor to click options and hit send faster than writing everything out on a pad of paper, and linked with the existing notes she is making on my electronic chart anyway (as she's charting the Rx, it also creates the Rx). If the doctor does not have enough time, it could be a two-step process. The doctor fills out the Rx portion and approves using a PIN/password. The receptionist could then fill out the pharmacy and do the actual transmission. There would also be a box for "fill now" or "fill later", so that when I went to the pharmacy, the Rx was ready for pickup (or on file for later).

Bloodwork appointments should be available to request online. I would log in to a secure site, do a lookup for what is available, and compare different locations for availability. I could take a moment to compare that to my personal calendar, instead of making someone on the other end of the phone wait while I make sure I'm available at the time they give me, as opposed to the time I choose.

Most of what I see in the medical profession is done with the attitude that the profession's time is more valuable than the patient. I think it's time to prioritize the patient's time for a change, and let me get through my medical processes a bit faster. I may still have to wait a while for an x-ray or a CAT scan, but life would be a lot simpler if I could drop off a urine sample in less than an hour.


Liza said...

Perhaps SoCal is ahead of the mechanisms of providing medical care, but the computers also distract the practioner from actually examining the patient. For my recent knee exam, the doctor looked at the x-rays on the laptop, typed in some data as he told me there is nothing wrong, and dismissed me.

I ended up feeling that it's time for the doctors to step back and realize that there is a patient in the exam room, not just electronics.

Perhaps someone can develop a system that balances the patient with the process? I think that if we handed these problems over to companies such as Microsoft or Google, we'd probably start to see improvement in both patient care and processing!

Hope everything is okay, but you won't know that for another month, right??

John said...

I worked for QSI for just over 5 years, from 95-99, and we had both a medical and a dental system that, in essence, did everything you have asked for here. It was designed to work with all the new HIPPA requirements being passed and to safely and accurately store, access, and send patient data everywhere.

It is too bad that medicine is one of the slowest and most resistant to change of any organization, as they still have not linked that data or created the hubs needed to balance the patient and the technology, and it is over 10 years since I left that company.

Cyn said...

hmmm most of what you would like is already here in Nova Scotia. :) Our drs are not able to order prescriptions via the health internet thingy though, but I suspect that's coming soon.

And the whole bloodwork thing? Really? That's insane. Here it's possible pretty much any Tuesday or Thursday to drop by pretty much any large clinic or drug store and have your blood drawn and sent to the lab! We are, however, not allowed to have our blood drawn at the main hospital blood clinic though - that's only for inpatients. Thank goodness women downtown can use the IWK, but men are pretty much SOL and have to come out to the west end or suffer the uckies of the VG. Still though... that whole appointment system is entirely ridiculous!