What is “meaningful” about exchanging information in health care?
Patient Lily Johnson lies in her hospital bed, waiting for Dr. Barlow to write her discharge orders. She is tired. Hospitals are exhausting places where it’s nearly impossible to get a good night’s sleep. Activity swirls around her but none of it seems meaningful to her. She thought she was going home today. Dr. Barlow had come in on his morning rounds and told her she could go home. But although she calls out to the nurses who pass by her door, she can’t get any definitive time. So she waits.
Meanwhile, Dr. Barlow thought he had processed his discharge instructions in a timely way. He has paged the nurse on her floor but has not received an answer back. It’s not unusual for him to be in the dark about his patients’ discharges. He rarely hears back when they have finally been sent home, and he is not alone in this. He read recently that only 11% of primary care doctors feel they get timely information about their patients, and only 26% of primary care physicians are contacted once their patients are discharged. He is exasperated. In addition to the inconvenience for Lily Johnson, the delay is costing the hospital an extra day as well.
There is a lot of talk these days about the “meaningful use” of electronic health records (EHRs) and better communication among health care providers. But meaningful to whom? The doctor? The patient? The nurses on the floor? There is much more to “meaningful use” than just collecting and transferring data among providers. The potential for improved efficiency and quality of care will be particularly good news for patients. For example, Stage 2 of the Meaningful Use guidelines will spur the exchange of patient data, not only among providers but between patients and their doctors. Stage 2 actually requires that at least 5% of patients have access to secure messaging with their providers.
Will all these regulations be truly meaningful to patients or just a nuisance to physicians? So far, we know that patients who currently already have access to their physicians via text or email report high satisfaction with that form of communication and wish their physicians contacted them more. In fact, over half of respondents in a recent survey said that emails or text messages from their providers could have helped them avoid a past health problem. Do doctors feel the same way?
One of the benefits of the federal HITECH (Health Information Technology for Economic and Clinical Health) Act is that it requires doctors and hospitals to get on the electronic communication track, because there are financial incentives for doing so. And the Affordable Care Act is pushing the reimbursement aspect of electronic communication even further. But what does this mean in practical terms for providers and patients? Although the number of primary care doctors using electronic health records is going up – 69% in 2012 vs. 46% in 2009, 71% of physicians in one survey cited lack of interoperability among providers as a major barrier.
What would health care look like if providers, in addition to sharing patient data via the EHR, could more easily and quickly talk to each other, no matter if they are in the hospital, their office or at home? Take the case of maternity care. When a woman comes into the hospital in labor, nurses monitor her progress, sometimes with a fetal monitor and more often through occasional physical exams. If there is a question about the patient’s progress, the nurse has to find a phone to page the doctor. Sometimes it takes awhile for the nurse to get a response. But what if a nurse could text the doctor with constant updated information about the rate of dilation, blood pressure, other vital signs? What if the doctor could text back questions or comments regarding the status of the patient to make more informed decisions? Secure text messaging among providers could not only save time for the nurses and doctors but provide the patient with higher quality care.
Another case where better communication could improve care and save time, is the emergency room. The ER doctor may examine a patient who has had a heart attack but be unsure about whether a catheterization is necessary. The usual process is for the ER doctor to consider paging the cardiologist on call, but if it’s in the middle of the night when the catheterization lab is closed, the ER doctor might hesitate to page the doctor and potentially wake up the family. What happens now is that when the ER doctor does decide to page the cardiologist, he or she must wait for a call back and then try to explain the condition of the patient and hope that the information is clear. However, if a physician could text that cardiologist on call, perhaps even attach a copy of the EKG to the text, the cardiologist could make more informed decisions about whether or when to come into the hospital. The longer the wait when catheterization is necessary, the more potential for damage to the heart tissue, so the patient would benefit from a quick and accurate response as well.
The true meaning of better data and communication lies well beyond the bureaucratic requirements of a federal law. It’s not just about mere data exchange – it’s about the ability of doctors and other providers to talk to each other quickly when they need to, nurses to check on what the aides are doing to the patient in room 21, radiologists to send a picture to a specialist and get an informed response. Could Lily Johnson have been discharged more quickly and efficiently if Dr. Barlow had been able to securely text the nurses on the floor and receive confirmation that the discharge had been processed? That would have been a meaningful use of information for both the patient and the hospital staff.