I'm Back!
Among the many emails waiting for me was a note RE a recent publication in the Archives of Internal Medicine (not available unless you pay $). Summary key findings:
1. 75% of primary care docs have problems obtaining patient info (test results, records, etc.) when they need them. Many years ago, my daughter had open heart surgery at the Univ. of VA, and the surgeon ordered a chest xray on the way to the operating room. He knew they could never find the one taken the day before, and it was simpler just to take another one. Well, that is more efficient than delaying the OR, but . . . .
Key finding #2. Fewer than half send patients reminders about preventive or follow-up care. My dentist does that! Even the Goodyear dealer where I buy tires for my car sends notices when it's time to rebalance. Guess these docs aren't hungry enough for the business. Or maybe they aren't accustomed to accepting responsibility for their patient's care--a common feeling. About five years ago, we instituted a monitoring program to evaluate our offices with respect to how many women had had mammograms. "That's not my job!" was a common response. "We put notices on the bulletin board. That's enough!" On the other side is a friend who tells patients, "You can tell me 'no', but you can't ignore me. I'll be back."
Finding #3. Less than 25% use electronic medical records. Note that both the above problems could be solved by EHRs. Money is commonly cited, but I think it is mostly aversion to change. The author (Audet A.J) thought doctors required "technical assistance." Probably an age-related phenomenon, but doubt it is a major impediment.
Comments
It continues to amaze me how little technology has been allowed into the healthcare field when it comes to medical support yet there are amazing advances that occur in the areas of clinical technology. Recently two young children in Tucson were "saved" from having to have a heart transplant when they were placed on a heart assist device which allowed their tiny heart to essentially rest and heal. The main purpose for the placement on the assist device was to "tide them over until a donor heart could be found" but after three weeks on the assist device, their hearts improved so much that they were taken off the transplant list and a few weeks later were taken off the assist device. They are both doing fine now.
Then there is the other side of the story. I would encourage readers to read the latest HealthGrades report. Here is the hot link - http://www.healthgrades.com/media/dms/pdf/PatientSafetyInAmericanHospitalsStudy2006.pdf . It essentially states that healthcare has not improved since the IOM report came out.
What must we do to improve healthcare? FDA has now required that all pharmaceuticals have unique barcodes which sets up the capability for a fully computerized medication administration system. However, JCAHO rescinded their requirement for hospitals to implement computerized medication administration systems at the behest of the AHA. One would think that the one area of hospital care that is responsible for the vast majority of preventable deaths would jump at a system that has proven to dramatically reduce medical errors.
Posted by: John Harrison, RN, MHSA | April 17, 2006 04:04 PM