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The Cloud – Fun Friday

Posted on August 31, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Leave it to the one and only Dr. Deborah C. Peel, MD from Patient Privacy Rights to share with me this humorous look at the cloud and how many of us treat the cloud. I’m sure nothing like this would ever happen in healthcare. However, it sure does offer an interesting perspective of the cloud. This is particularly true with individual patients. I hope you enjoy learning about the cloud from Kitty Flanagan.

Does NLP Deserve To Be The New Hotness In Healthcare?

Posted on August 30, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Lately, I’ve been seeing a lot more talk about the benefits of using natural language processing technology in healthcare. In fact, when I Googled the topic, I turned up a number of articles on the subject published over the last several weeks. Clearly, something is afoot here.

What’s driving the happy talk? One case in point is a new report from health IT industry analyst firm Chilmark Research laying out 12 possible use cases for NLP in healthcare.

According to Chilmark, some of the most compelling options include speech recognition, clinical documentation improvement, data mining research, computer-assisted coding and automated registry reporting. Its researchers also seem to be fans of clinical trial matching, prior authorization, clinical decision support and risk adjustment and hierarchical condition categories, approaches it labels “emerging.”

From what I can see, the highest profile application of NLP in healthcare is using it to dig through unstructured data and text. For example, a recent article describes how Intermountain Healthcare has begun identifying heart failure patients by reading data from 25 different free text documents stored in the EHR. Clearly, exercises like these can have an immediate impact on patient health.

However, stories like the above are actually pretty unusual. Yes, healthcare organizations have been working to use NLP to mine text for some time, and it seems like a very logical way to filter out critical information. But is there a reason that NLP use even for this purpose isn’t as widespread as one might think? According to one critic, the answer is yes.

In a recent piece, Dale Sanders, president of technology at HealthCatalyst, goes after the use of comparative data, predictive analytics and NLP in healthcare, arguing that their benefits to healthcare organizations have been oversold.

Sanders, who says he came to healthcare with a deep understanding of NLP and predictive analytics, contends that NLP has had ”essentially no impact” on healthcare. ”We’ve made incremental progress, but there are fundamental gaps in our industry’s data ecosystem– missing pieces of the data puzzle– that inherently limit what we can achieve with NLP,” Sanders argues.

He doesn’t seem to see this changing in the near future either. Given how much money has already been sunk in the existing generation of EMRs, vendors have no incentive to improve their capacity for indexing information, Sanders says.

“In today’s EMRs, we have little more than expensive word processors,” he writes. “I keep hoping that the Googles, Facebooks and Amazons of the world will quietly build a new generation EMR.” He’s not the only one, though that’s a topic for another article.

I wish I could say that I side with researchers like Chilmark that see a bright near-term future for NLP in healthcare. After all, part of why I love doing what I do is exploring and getting excited about emerging technologies with high potential for improving healthcare, and I’d be happy to wave the NLP flag too.

Unfortunately, my guess is that Sanders is right about the obstacles that stand in the way of widespread NLP use in our industry. Until we have a more robust way of categorizing healthcare data and text, searching through it for value can only go so far. In other words, it may be a little too soon to pitch NLP’s benefits to providers.

Report Says EHR Usability Tests Should Focus On Common Safety Threats

Posted on August 29, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The American Medical Association and health system operator MedStar Health have published a report laying out a set of proposals designed to improve EHR safety. The report, which is also backed by The Pew Charitable Trusts, looks at ways that use of EHR usability can fail to prevent or even lead to patient harm.

As readers will know, to meet certification criteria EHRs currently need to conform with EHR usability requirements established in 2015. Developers need to document how they meet clinician needs and conduct formal usability testing addressing clinicians’ efficiency, effectiveness and satisfaction in using the system.

Unfortunately, the current generation of certification standards don’t focus specifically on high-prevalence safety hazards, which may mean that the process doesn’t address how usable some important EHR features are, the report says. Plus, even the earlier versions didn’t do much in regards to usability.

Over time, of course, both EHR developers and providers have begun to take these issues more seriously, and as the paper points out, are moving beyond the minimum required to meet certification standards.

For example, developers have agreed to review safety incidents with patient safety officers and product users, along with sharing such information across healthcare facilities. Also, providers have taken their own steps in this direction, such as protecting EHR safety surveys or establishing safety teams tasked with identifying EHR-related problems. As we all know, however, there’s a lot more to be done.

To make more progress, the groups suggest, EHR developers need to design more rigorous, safety-focused test cases. While they already need to run such real-world-oriented test cases, which are required for certification, but these studies might not be looking for the right things, the report says.

To be truly useful, these test cases should represent the expected uses of the technology; should represent a clinically-oriented goal with clear measures of success and failure; test known areas of risk and efficiency; and address a defined audience.

The paper also includes a list of criteria developers and providers can use to boost EHR usability and safety across the system’s entire lifecycle. For providers, this includes establishing a culture of safety which will support EHR-based safety efforts; seeing that user needs and product capabilities are aligned; customizing and configuring the system to meet those needs; implementing and maintaining the EHR carefully; and training clinicians to use the product safely and effectively.

Not surprisingly, research on these topics is ongoing, but some providers are more engaged than others. I was interested to see that MedStar Health’s National Center for Human Factors  in Healthcare continues to work with the AMA on these issues. For example, about two years ago the partners released a joint framework designed to rank EHR usability. (The partners also use the framework to rank the usability of several widely-implemented systems, including that Allscripts and McKesson were doing the best job at the time. That was fun.)

I hope to see more work on the links between EHR usability and safety in the future, as well, of course, as feedback on how to address both. We simply don’t spend enough time on this subject.

Will Big Media Spoil HealthIT for the Little Guy? – #HITsm Chat Topic

Posted on August 28, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 8/31 at Noon ET (9 AM PT). This week’s chat will be hosted by ShereeseM, MS/MBA (@ShereesePubHlth) on the topic of “Will Big Media Spoil HealthIT for the Little Guy?“.

We’ve all witnessed big tech’s recent push into healthcare. Atul Gawande is in a deal with Amazon, JPMorgan Chase, and Berkshire Hathaway, and it looks like we might be seeing our EOBs being sent to us from Google fairly soon. Amazon’s hired 20,000 doctors. Ok, that was an Onion article, but illustrates the point.  And now comes big media into our little world. And in an industry that still resists change, healthcare technology is still small. But what would make media companies want to dabble in the healthcare IT space. Well, to understand the why, you must first understand the who.

The “who” is Comcast Corporation. Comcast, the big media company, best known for broadband solutions, is now making a play for healthcare technology. Comcast recently entered a joint venture with the Independence Healthcare Group, in which the two will build patient-centered digital platforms for Comcast’s 60 million plus customers. The collaboration looks to make the patient-provider communications seamless by allowing patients to view needed information and to-do lists prior to operations and other engagements. Time will tell if this is finally the project for Comcast, as their prior attempts to break into the market, initially partnering with Kaiser Permanente on a now defunct pregnancy app and later with a UC Davis partnership on health and nutrition videos, were both colossal failures.

The “who is also Cox Communications. Cox tried to make a statement in the healthcare IT space by partnering with Cleveland Clinic to develop Vivre Health, a home health product and service delivered by broadband. The venture failed and Cox eventually pulled out. But like Comcast, Cox believes they have now found their footing. They are banking on the value of remote patient monitoring and in 2015 they purchased Trapolla. The product is now in development.

Now that we know the who, let’s concentrate on the why. The easy answer is market share. The healthcare market is worth more than 3 trillion dollars, according to CMS estimates. It’s only intuitive that other industries would come calling. Media companies may see healthcare IT as an opportunity to capitalize on a growing industry while their own industry may be cooling off. Companies have to leverage their current capabilities to drive growth in others sectors. Media companies are in a unique position to do just this.

The interest in healthcare tech by big media may have a negative impact on smaller or independent brands. Based on broadband alone, smaller companies can’t compete on the scale of companies like Comcast and Cox Communications. Could the current interest in the market, which is growing, mark the end for smaller companies? Time will tell but what is certain is that nothing in healthcare comes quickly. Big media may find it hard disrupting in healthcare where the small guy may already have the lay of the land. And small or not, already vested players won’t sit idly by while big media giants come it and try to dim their flame.

Join us for this week’s #HITsm chat to discuss big media in healthcare. What will be the impact for good and/or bad? How will they fair? Is this a good choice for them?

Topics for this week’s #HITsm Chat:
T1: Does big media belong in healthIT? #HITsm

T2: Will big media make seismic gains and at what cost to smaller companies? #HITsm

T3: What sound contributions can media make to health IT? #HITsm

T4: How can smaller companies compete with big media in the health IT space? #HITsm

T5: Given; healthcare is like no other industry, due to regulations. Will the complexity of it discourage big media? #HITsm

Bonus: Big media and big tech, what problems in healthcare would you like to see them tackle? Price Transparency? Prescription drugs? The opioid crisis? #HITsm

Upcoming #HITsm Chat Schedule
9/7 – International Healthcare: Standards, Patients, and Personal Experiences
Hosted by Jessica Maxine Selby (@JessMSelby)

9/14 – TBD
Hosted by TBD

9/21 – Human Centered Design in Healthcare #PatientsMatter
Hosted by Jen Horonjeff (@jhoronjeff) from @Savvy_Coop

9/28 – How Does Interoperability Affect Technology Adoption in Healthcare?
Hosted by Niko Skievaski @niko_ski from @redox

10/5 – TBD
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Can Providers Survive If They Don’t Get Population Health Management Right?

Posted on August 27, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Most providers know that they won’t succeed with population health management unless they get some traction in a few important areas — and that if not, they could face disaster as their volume of value-based payment share grows. The thing is, getting PHM right is proving to be a mindboggling problem for many.

Let’s start with some numbers which give us at least one perspective on the situation.

According to a survey by Health Leaders Media, 87% of respondents said that improving their population health management chops was very important. Though the article summarizing the study doesn’t say this explicitly, we all know that they have to get smart about PHM if they want to have a prayer of prospering under value-based reimbursement.

However, it seems that the respondents aren’t making nearly as much PHM progress as they’d like. For example, just 38% of respondents told Health Leaders that they attributed 25% or more of their organization’s net revenue to risk-based pop health management activities, a share which has fallen two percent from last year’s results.

More than half (51%) said that their top barrier to successfully deploying or expanding pop health programs was up-front funding for care management, IT and infrastructure. They also said that engaging patients in their own care (45%) and getting meaningful data into providers’ hands (33%) weren’t proving to be easy tasks.

At this point it’s time for some discussion.

Obviously, providers grapple with competing priorities every time they try something new, but the internal conflicts are especially clear in this case.

On the one hand, it takes smart care management to make value-based contracts feasible. That could call for a time-consuming and expensive redesign of workflow and processes, patient education and outreach, hiring case managers and more.

Meanwhile, no PHM effort will blossom without the right IT support, and that could mean making some substantial investments, including custom-developed or third-party PHM software, integrating systems into a central data repository, sophisticated data analytics and a whole lot more.

Putting all of this in place is a huge challenge. Usually, providers lay the groundwork for a next-gen strategy in advance, then put infrastructure, people and processes into place over time. But that’s a little tough in this case. We’re talking about a huge problem here!

I get it that vendors began offering off-the-shelf PHM systems or add-on modules years ago, that one can hire consultants to change up workflow and that new staff should be on-board and trained by now. And obviously, no one can say that the advent of value-based care snuck up on them completely unannounced. (In fact, it’s gotten more attention than virtually any other healthcare issue I’ve tracked.) Shouldn’t that have done the trick?

Well, yes and no. Yes, in that in many cases, any decently-run organization will adapt if they see a trend coming at them years in advance. No, in that the shift to value-based payment is such a big shift that it could be decades before everyone can play effectively.

When you think about it, there are few things more disruptive to an organization than changing not just how much it’s paid but when and how along with what they have to do in return. Yes, I too am sick of hearing tech startups beat that term to death, but I think it applies in a fairly material sense this time around.

As readers will probably agree, health IT can certainly do something to ease the transition to value-based care. But HIT leaders won’t get the chance if their organization underestimates the scope of the overall problem.

Boss Humor – Fun Friday

Posted on August 24, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today we have two hilarious things. One is in the comic strip below and the other is in the tweet that shared this comic strip. No doubt one of the hardest thing in any job is getting the right people working for you. If you can do that as a boss, then you’re doing amazing things. If you’ve ever had a boss, then you’ll enjoy the Fun Friday humor below.


The Cultural Nuances of Communication

Posted on August 23, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s amazing some of the insights you can get from Twitter. This is especially true when someone puts together a series of tweets (most people call them a tweetstorm) that shares a story or insights on a specific topic. Today, I gained some new insight into the cultural nuances of communication in this Twitter thread:

Why we need more black men in medicine. I had a patient this week who came in with left leg weakness over the last week. Younger black guy in his 30s. Brain MRI clearly indicates multiple sclerosis. So we all go in during morning rounds to give my man his diagnosis.

He has a bit of blank stare as he listens to my attending try to explain what he has. He was told earlier he mightve had a stroke, and now we’re telling him he doesnt have a stroke. But he’s clearly processing what he does have and just says “nah” to having any questions.

So we’re running the patient list after rounding, and as we get to him my attending says somn like “idk if apathy is the word, seems like he doesnt care”. Laughs and so does the rest of the team. I’m sitting there like, this aint it. And yes, I was the only one.

So after running the list, I don’t even stick around with the team. I go straight back to dude’s room and the code switch was automatic. “Look mane, I know all that was a lot. Did you really get what the doc was sayin?” Mans looked at me with a face of relief.

Now I’m goin into detail on MS, how it’s different from a stroke, and what it means for him long term. The real validation came when he interrupted me early on and said “OH so it’s a BRAIN thing I got?” “Yes my man it’s a brain thing.”

And now my dude understands what he has, why we need the tests we need, and what the rest of his life might look like. All because I could recognize what everyone else seemed to miss, from a cultural perspective. He’s not apathetic. Folk just weren’t connecting with him.

I’m in the right field fam.

We definitely underestimate the nuances required to communicate effectively across cultures. It’s such an important nuance that’s often missed. As we start to automate more of our healthcare communication with chat bots and other AI empowered communication, I wonder if we’ll take some of these cultural nuances into account. That’s a really challenging problem, but something we should consider a lot more in our healthcare communication.

The Role of Technology in Chronic Disease Management – #HITsm Chat Topic

Posted on August 21, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 8/24 at Noon ET (9 AM PT). This week’s chat will be hosted by Colton Ortolf (@ColtonOrtolf) who blogs at tech prescribed on the topic of “The Role of Technology in Chronic Disease Management“.

Chronic disease is an incredibly broad term, but it can be simply defined as “a physical or mental health condition that lasts more than one year and causes functional restrictions or requires ongoing monitoring or treatment.” In all, 86% of $2 trillion in US healthcare expenditures each year are devoted to those with chronic illnesses.

If you aren’t sufficiently shaken by that statistic, here are a few more on the devastating impact of these diseases:

  • 60% of people have at least 1 chronic disease, while 12% have 5 or more
  • Chronic disease accounts for $0.96 of every Medicare dollar and $0.83 of every Medicaid dollar
  • Productivity losses from chronic illness will cost the US approximately $1T annually
  • Chronic diseases are responsible for 7 out of 10 deaths every year

Also, here are the top 10 chronic diseases by percentage of the US population they impact: Hypertension (58%), High Cholesterol (47%), Arthritis (31%), Coronary Artery Disease (29%), Diabetes (27%), Chronic Kidney Disease (18%), Heart Failure (14%), Depression (14%), Alzheimer’s / Dementia (11%), COPD (11%).

Now that we can all agree on the scale of this epidemic, we can begin to decipher how we should go about addressing it. Being a chronic disease sufferer is – at best – challenging and – at worst – completely debilitating. Drawers and cabinets are filled with complicated medications, doctor appointments cause missed work days, and daily pain can become unbearable. Along with the added mental and physical stress, we would assume that consumers would try to avoid these illnesses at all costs. However, much of the rise in chronic disease rates can be attributed to preventable patient behaviors: smoking, poor nutrition, and physical inactivity. Couple these behaviors with extended life expectancy, and a chronic disease is nearly guaranteed for your future.

Given the nature of these risk factors, it is clear that reducing costs and prevalence is reliant on our ability to predict and alter consumer behavior; and, many entities have undertaken efforts to do so in recent years. Population Health initiatives, often spearheaded by public institutions, seek to remove environmental risk factors and educate the public on how to make healthier choices. Providers and Health Plans launch coordinated behavior modification campaigns targeted at populations at risk of developing chronic illnesses. Care Management teams directed by trained specialists deploy a variety of tactics to help the sickest patients stay on track with their care plans. The people driving these efforts are nothing short of heroic, but we are also on the precipice of an opportunity to scale and optimize their efforts using cutting edge technology.

And that brings us to the focus of today’s chat. Scaled data management and analytics, proliferation of wearables and IoT sensors, and the dawn of artificial intelligence are among the many technologies that we expect to drastically improve the management of chronic diseases. We are already seeing impact through companies like Omada Health, which utilizes digital tracking technology and a wifi scale coupled with personalized coaching to combat diabetes. Google is even developing an AI that can recommend fitness and meal plans. Controlling the growth of these diseases is undoubtedly the biggest challenge and the most salient opportunity we have in the US healthcare system. As we progress towards a new age of fee for value, let’s explore the following questions to determine our greatest opportunities at the intersection of tech and chronic disease management.

Sources:

Here are the various topics and questions we’ll be discussing for this week’s #HITsm chat.

Topics for this week’s #HITsm Chat:
T1: How can technology help drive healthier behaviors in patients? #HITsm

T2: Given increasing focus on mental health conditions, how can technology play a role in supporting behavioral health patients? #HITsm

T3: What tools should we develop for caregivers to help optimize their efforts in managing chronic diseases? #HITsm

T4: What needs to change in industry structure (payment models, policy, health system focus, etc.) to better enable our fight against chronic diseases? #HITsm

T5: Do you think providers, payers, tech companies, or others are best positioned to have the biggest impact on chronic disease costs? #HITsm

Bonus: What are some examples of companies that are having a measurable impact in this space? #HITsm

Upcoming #HITsm Chat Schedule
8/31 – Will Big Media Spoil HealthIT for the Little Guy?
Hosted by ShereeseM, MS/MBA (@ShereesePubHlth)

9/7 – TBD
Hosted by Jessica Maxine Selby (@JessMSelby)

9/14 – TBD
Hosted by TBD

9/21 – Human Centered Design in Healthcare #PatientsMatter
Hosted by Jen Horonjeff (@jhoronjeff) from @Savvy_Coop

9/28 – How Does Interoperability Affect Technology Adoption in Healthcare?
Hosted by Niko Skievaski @niko_ski from @redox

10/5 – TBD
Hosted by TBD

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

A Caregiver’s Perspective on Patient Engagement

Posted on August 20, 2018 I Written By

The following is a guest blog post by Michael Archuleta, Founder and CEO of ArcSYS, where he shares his experience as a caregiver for his father trying to navigate the healthcare system.

My dad is 99 years old. Having moved him to Utah 6 months ago into a retirement home, our first step was to get an appointment with a new primary care physician. I brought along a list of his medications and watched the nurse tediously look up and enter each into the EHR. Dad and the doctor got along great on that first visit. She assured us that she could help manage his medications. There was nothing realistically that could be done to really improve quality of life. When you’re 99, you’re stuck.

Around the middle of March Dad noticed blood and clots in his urine. Off to the primary care provider we went. They took a sample of urine, tested it, and there was no sign of an infection. Maybe we should look up a specialist in urology. A referral was given and a few days later the urology practice contacted us to make an appointment. Dad declined.

He didn’t want to see another doctor. Period. But day by day, the blood was always present in the urine. He started to worry and finally relented to going to the urologist. Off to the new doctor. Oh, yes, I brought along the list of medications and watched another nurse go to the process of keying them in.

The next day, I got an email via Updox saying there was a message from Dad’s doctor. Updox?? Really?? That was pretty cool. After being on the front end where our EMR system (Red Planet) uploads everything, this was interesting to see how another EMR system was employing Updox. Sure enough, there was the urologist’s note that had been completed 3 hours after the appointment. But, as I read it, I couldn’t help feel a little disappointed. A boilerplate. Since I had been in the room, I knew what was asked. Some questions were never asked and obviously inferred. Maybe a minor point, but I knew it. Anyway, the recommendation was to get an ultrasound. Off to another provider!

Within one day another message alert came from Updox. On logging into the Updox account, there was the report from radiology. Good news, nothing out of the ordinary.

A week passed and it was back to the urologist for a cystoscopy. I was in the room with Dad while the doctor performed the procedure. “Want to see this tumor?” the doctor asked me. “Sure.” I replied. Through the scope I could see a dark mass on the wall of the bladder. The recommendation was to perform surgery to remove the mass and biopsy it.

Another alert came through within a day via Updox. Still the same boilerplate style with default answers. Oh well, if nothing else it was timely.

On May 21 the procedure was done at an outpatient surgical facility. This time I was lucky: No one had to enter the list of medications. From here, unfortunately, things started to go downhill. Dad was left with a catheter and a bag which became his (our) buddy for 10 days. The unfortunate thing was being confined to his room. He could (would) not walk to the dining room at the retirement facility for his meals. So the meals were brought to him each day in a white clam shell styrofoam container. One piece of good news was delivered via Updox, the biopsy was benign.

Once the catheter was removed, he could be mobile, but was too weak to walk. He languished in his room. I coaxed him to try walking. No result. Others in my family encouraged him with the same non-result. I finally took him back to the primary care doctor. One look at him, and she noticed that the spark of life had been extinguished. She took me aside and asked if she needed to play hard ball with him. “You bet” was my response. In a firm way she told Dad that if he didn’t start walking he was going to be dead in 3 months.

That was the trick. Dad was furious that a doctor would be so “unprofessional” as to say anything like that. As soon as we arrived at the retirement home he pushed his walker half way down the hallway just to prove he could walk just fine, thank you. (Mission accomplished.)

But when you’re 99, the body just doesn’t really get better. There was still blood and clots, but were told that would be expected. A couple of weeks later he calls me to say he was in excruciating pain and can’t pee. By the time I arrive the pain was so bad I need to get a hold of the paramedics. They show up in 5 minutes and whisk him to the ER.

Fortunately, the ER has his list of medications so I’m spared having to go through that process. The doctor on call briefly examined him and turned control over to the nurse. A few hours later we have our “friends” the catheter and bag and head home. At least he was committed to walking to the dining room.

A couple of weeks pass and I received a phone call from the paramedics who inform me that Dad had a fall on his way to breakfast. They are transporting him to the ER. He was diagnosed at the ER with a bladder infection and they are concerned about his cardiac functions. Lab results also indicate e. coli and sepsis. Since they don’t have an on-site cardiologist, he was transferred to another hospital and admitted. And, yes, we have to go through the whole list of medications there because they don’t have access to that information? Go figure.

He hated the hospital. There was no rest. Every hour someone was taking vitals, getting him up, doing this, doing that. He was desperate for sleep and rest. At discharge, the cardiologist gave me explicit verbal instructions to take him off his Furosemide. She also gave orders for home nursing and physical therapy.

Whew. He was back home but again too weak to walk to the dining room. The Updox report came through and the written instructions by the cardiologist tell him to continue all meds including Furosemide. Really? Did she forget what she told me. Did she not take her own notes? The nurse showed up at his apartment, took lots of notes, asked lots of questions and examined him. Hmm. Concerned about the swelling in his feet and ankles. It was bad. We confer and decided the Furosemide needed to be restarted. The nurse reached out to the PCP who concurred.

Over the next 3 weeks the swelling slowly receded. The nurse and physical therapist helped him but the improvement was ever so slow.

What I have experienced was a medical world of silos. Each health care provider focused on just what they do. The urologist was pleased with surgery and how well it turned out. But he didn’t have to deal with 3 months of bags, styrofoam meals, ER visits, depression and hospitalizations. None of the doctors conferred with each other about the best treatment. The number of times I filled out past medical histories was finger-numbing. The written documentation didn’t accurately match what took place or what was verbally instructed. The cardiologist was adamant about the meds which would be best for his heart. Within each silo the people were very kind, compassionate, caring and professional. But, the EHR systems just seemed to get in the way of real care. Yes, INDIVIDUALLY, everything was working, but PEOPLE and their SYSTEMS were not interacting to solve the problem.

On the up-side, not one out-of-pocket penny was spent by way of the Medicare Advantage plan. Insurance and billing performed flawlessly. A little over $65,000 was billed and $12,000 was paid.

Clearly, providing health care is not easy. Maybe things should have been done differently. This was a relatively simple issue, but there was no clear direction. Will any healthcare administrator ever be aware of this situation? Probably not. Will any insurance company ever study this case? Doubtful. In hindsight, it would have been just as easy for me to pass out copies of medications and histories and have people tape them to the wall. A few phone calls between providers would certainly have come up with a better solution. But here we are down the road and Dad is not a happy camper.

Is anybody listening?

Your Healthcare Strategy – Fun Friday

Posted on August 17, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday and we’re heading into one of the final weekends of summer. Of course, if you’re like me, it already feels like summer is over. Well, at least it does because my kids are back in school. When I go outside, it’s still extremely hot, so that still feels like summer, but I digress.

As we head into the weekend, I thought this Dilbert cartoon captured what I sometimes see in healthcare:

Have you had a boss like this? Have you seen this in healthcare? Share your experiences and stories in the comments or on social media.