Our family has been dealing with the Healthcare Industrial Complex for the past week–my mother-in-law had an aortic aneurysm. She had major operations in 1998, 2006, and 2011 (all performed at the same hospital). I had been under the impression that hospitals were digitizing records and using technology to get more efficient and help save money. Taiwan has been using SmartCards for their health care system since 2001 (see PC Magazine). Why aren’t we?
We have one health care system in our area that runs probably 80% of the market. We dealt with two of their hospitals in the past week. On the positive side, the medical machines have clearly advanced, the surgical teams are top-notch, the ICU nurses are excellent, and the ER seems to function more efficiently overall.
On the negative side: they are still ill-equipped to deal with the hearing-impaired (see earlier post), they lack an effective communication strategy with patient families, communication between their own internal teams is intermittent, and their ability to access patient history in a clear, definitive way is non-existent. Target Pharmacy is more efficient at advising me I have a prescription refill via text message than the hospital letting us know my mother-in-law was picked up and transported to a different hospital (and headed directly into surgery).
I started to think of all the ways I personally used my technology (iPhone in my case) through this process so far, and I’d recommend it since health care isn’t proceeding as quickly as most of us assume it is:
- Used camera to take pictures of the monitor w/the constantly updated stats to send via text to family member out of town (blood pressure, pulse, etc.) *
- Instagram to share the photos of the experience itself
- Vine–to show a video of what it’s like in the ER at 1:00 AM on a weeknight.*
- iPhone Notes-log who we talked to at the hospital and what they said
- Evernote–her historical medical information including past surgery dates back to 1998, procedures, medications, and surgeons
- TurboScan to use the camera to scan critical documents as PDFs
- Facebook to update family on her condition
- Text messaging to update family on her condition
- Google: looked up the procedure TEVAR to find out what it meant and more detailed information than the hospital provided.
- Voice Memo (use to record the complicated information a surgeon tells you in the 40 seconds before they dash off to surgery)
Process Improvements Opportunities:
- Text alerts to family members as events occur. I know there are HIPPA regulations, but the patient could sign a form authorizing the updates. Because it’s difficult to get information, multiple family members bombard the nurses with calls or visits effectively cutting down the time the nurses spend with the patient.
- A healthcare SmartCard that tells them the full medical history, current medications, and allergies. Every team asks the same questions that you’ve already answered and should be in their computer system. They use a lot of bar codes, but that seems to be primarily related to medication and not patient data.
- Devise communication methods that health care teams share information. The nurse knows that blood should not be drawn from the arm that has the fistula, but the person who comes to draw the blood either doesn’t know or doesn’t look at the file. If the patient is sedated, they can’t tell the person not to use that arm.
- There almost needs to be a “general contractor” for a patient’s care – someone that is coordinating all of the moving parts related to that case.
I am grateful they were able to save her life and will always appreciate the science and training that made that possible. All of the surgical brilliance can quickly be undone by careless miscommunication or bad information supplied by someone who didn’t hear the question correctly. My sister-in-law sleeping in the hospital room with her seems to have been the only way to address this myriad of issues. There are so many opportunities for improvement here, it’s staggering.