A (Real-World) Tale of 6 Practices and 5 EMRs

By Dr. Peter S. Tippett

August 29, 2018 — We’ve all been there. Someone in our family (or ourselves) has a medical concern so schedules a primary care visit, gets some images or lab tests, and perhaps learns that surgery is needed. What starts as a fairly simple process can quickly turn into a near-comedy of inefficiency. My own recent story is typical.  

My primary care provider (PCP) retired. Her practice uses EMR-1, but the surgeon down the hall who would do the outpatient procedure, uses EMR-2. Although I am healthy, with no history of hospitalizations and no chronic diseases, I needed a medical clearance, so scheduled a visit with my new PCP who uses EMR-3.  The surgery center where the procedure will be done uses EMR-4, and some of my relevant medical records are in EMR-5 at a nearby hospital. Despite being within a half-mile of each other (in most cases, within 20 yards), each provider FAXed my record to the other or sent it with me on paper, which the recipient scanned, renamed and saved into a non-searchable media file in their EMR and then manually re-entered pertinent data into the structured portion. 

  • None could share anything electronically.

  • None would login to any other’s portal.

  • None of the clerical or clinical staff had ever heard of Direct messaging (or anything else digital)

  • 1 facility could use FHIR (but not for referrals or care transitions)

  • And only 1 of 5 could access an HIE, which didn’t help without at least one of the other 4 (and which wouldn’t have helped anyway since the EKG, formal clearance, and other required items aren’t available via the HIE).

If any of these doctors had a question or needed a clarification, consult note, EKG, or lab value, they or their staff had to pick up the phone. They couldn’t text or email each other because no secure option was available at both ends to connect them. And no matter how good the EMR was at any of these facilities (two were using top-end EMR vendors with innovative add-ins for analytics, alerts, quality systems, predictive tools, and more), none could leverage the data from any of the other providers to add to the digital decision-making or make any of the jobs of the clinical or clerical staff easier. In the worst case, the inability to share items such as X-rays, could have resulted in duplicate tests or even procedure cancellation or delays, with implications for all parties involved.

I spoke with clerical staff at four of the five groups and they told me that their own computer, Fax and phone work involved for my simple case was typical and ranged from 25-55 minutes each—all of it just to exchange information needed to prepare for an outpatient surgical procedure. When I had the procedure done, the labs and EKG from a week prior were printed in Fax-fuzzy black and white on the anesthesiologist’s clipboard—who diligently scanned them into his own EMR -- the sixthone for my single case.  

Later that day, I went to an emergency room due to mild dehydration. They also used EMR-6 but only had basic anesthesia data for my case and no way to communicate with the surgical team. The ER (appropriately) did their own workup and labs and concluded to treat me with a simple IV.  Had the ER doctor or staff been able to text or securely message the surgical team, they would have been more informed about my case and known that a simple IV would be fine.  But no such communication was possible without a system that could work across different practice groups and organizations.  

Is it any wonder that referrals and transitions in care are among the biggest expenses and unsolved challenges in healthcare? The sharing of digital information is just too difficult for almost all providers and results in poor hand-off between providers, unnecessary paperwork, duplicate tests, and more time and frustration for everyone. And the results speak for themselves:

  • Only 46% of faxed referrals result in a scheduled visit[1]

  • Up to 50% of primary care physicians never know if their patient actually saw a specialist

  • 52% of specialty referrals are deemed unnecessary[2]

With careMESH, we facilitate digital referrals, secure text and email communications, and better patient transitions via secure exchange of digital medical records, between any providers in any locations, across the US.  And perhaps best of all, any provider can start today, even if the recipient of the information you want to share doesn’t know we exist. 

I invite you to learn how careMESHcan take my above experience and make it all digital. We have exceptional knowledge workers in the healthcare industry and had any of the six medical groups in my story asked for a rating of their service, I would have given every one of them a 5 out of 5.  They were all excellent, professional, timely, dedicated people and teams.  So, let’s empower them to communicate.

Please email anytime, if you’d like to discuss.

 

Peter

 

[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594/

[2]https://www.science20.com/news_articles/happy_patients_half_of_doctors_provide_unnecessary_referrals_upon_request-163018

Catherine Thomas