A snapshot of a doctor in his daily clinic:
Imagine a typical clinic day: You have a new patient in your clinic who was admitted recently to the observation unit at a local hospital for “high uncontrolled glucose levels” and discharged one week ago. Patient has not brought his discharge summary to your clinic and the hospital is not affiliated with your outside practice. The patient has poor medical insight but states that he has had “ton of usual medical problems” in the past. The patient states that he hasn’t seen a primary care physician in ages and he frequents urgent care centers or ERs when he needs refills of his medications. You quickly get a patient’s signature for a medical release form to be faxed over to the hospital and you ask the patient for the name of the pharmacy where he gets his medications.
Because the patient is new to your practice, you decide to order a basic metabolic panel, complete blood count, a fasting lipid panel, and HbA1c as no outpatient laboratory studies are found in LabCorp [or your local laboratory services provider]. The patient also adds that he has been experiencing productive cough with sputum on and off for the last 3 months after traveling to Southeast Asia. You are aware that the medical records from the hospital will take at least few hours to a day to come back and so, you order a chest x-ray PA/lateral given the concern for possible TB and an HIV test given the clinical history.
The next day, all the hospital results come through the fax and BMP/CBC is normal with HbA1c being 7.8. Also, the hospital had ordered CXR (PA/Lateral) which was unremarkable and also done an HIV test which was negative. The labs you ordered also come back with similar results. You look through the hospital discharge summary and find that the patient was admitted to another hospital 2 weeks before this one for similar clinical presentation for high blood glucose levels. Unfortunately, each hospital discharge has prescribed a different sulfonylurea and upon calling the patient, you find that patient has been taking 2 different sulfonylureas from 2 different pharmacies.
This fictional snapshot of a patient scenario is a reality that primary care doctors face every single day in which duplicating imaging and laboratory studies are done on a frequent basis. The problem is only compounded when patients have a multitude of different specialists who communicate via fax but order different dosages of medications for the patient or take out or add medications without the knowledge by the other doctors.
Unfortunately, our current methodology of such practices has contributed significantly to the rising costs of insurance premiums and creates about a loss of 20 billion dollars in health costs every year. This problem is even further exacerbated in areas of the population who lack healthcare insurance as these people utilize ERs for management of routine problems and refill of medications which can be readily handled by an outpatient clinic. If you add to this mix the patients who lack medical insight as our fictional patient above, it is not surprising that our national healthcare system is a challenging and a hot-button issue.
What is a solution that we can take as doctors? We can ask for an integrative Electronic Health Record [EHR] system in which all the hospitals and outpatient doctors’ offices are connected through one single system statewide. Currently, many states in the country have Health Information Exchanges set up in a local region of network hospitals which is allowing a safe exchange of patient data and reduction in repetitive studies especially CT-scans. A study published by Stanford Medicine in January of 2014 showed that in the states of Florida and California who were early-adopters of Health Information Exchanges, “patients were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get a duplicate ultrasound, and 67 percent less likely to have a repeated chest X-ray when both their emergency visits were at hospitals that shared information across a [health information exchange].”
The main argument against integrative EHR so far has been the costs of implementation and patient confidentiality. However, as physicians, our current hospital-limited EHRs can be accessed readily through phones, tablets, and laptops and it is up to us to have the ethical and legal responsibility to not openly access or share patient information outside of medical jurisdictions and indications. As for the financial implication of an EHR, it is important to compare the prospective costs of efficient healthcare delivery through the statewide exchange of patient information against our current norm and it is in plain sight that EHR would be a fiscally-responsible initiative.
If a vision of integrative EHR is realized across the nation with a focus on patient safety and confidentiality, we can truly achieve breakthroughs in cost savings and deliver healthcare in a timely manner without depending on a fax machine as the main tool of communication amongst providers. These are the real costs that are draining our healthcare system and need to be at the forefront of any discussion about healthcare. Politics and different bills spearheaded by legislative process won’t solve this issue whether it is Obamacare or Trumpcare but a meaningful implementation of technology will aid us in providing optimum care to our patients and easing the burden on our healthcare system.
