Over the last fortnight I have been to three doctor’s visits at different practices. In each case I was required to recite my (complex) medical history to a nurse before confirming the data with a provider.

Being a mathematical type I timed each incident.

  • Nurse and Doctor one took fifteen minutes.
  • Assistant and Doctor two took eight minutes.
  • Nurse and Doctor three took twenty minutes.

That’s an average of fourteen and a third minutes. In each case my medications list had changed by one new drug, and there was a small amount of information that I had to update the clinical team about.

For those that are interested, approximately forty percent of the time was allocated to the physician and sixty percent to the one or more med techs or nurses who took the preliminary list.

A sample size of three, and a patient with complex conditions is certainly not statistically significant, but I’m still amazed at what percentage of my appointment was spent reconciling base data that my physicians probably should have communicated to each other prior to my arrival.

In theory my time spent in these activities could have been reduced by my use of a personal health record (PHR), but this didn’t appear to be the case. To make the staff’s lives easier I had thoughtfully brought my cell phone and pulled up the CareSync care summary screen which I keep up to date after every appointment.

I think the extra information made the process slower. I suspect they’d have been happy with “yes, everything is the same except for the new med”, but they got the full state of things and they had to check it all.

It’s a good thing they did. Every single provider had at least one error in their system relating to drug, dose or administration time — even though they had typed the same data in using my phone’s care summary screen not two weeks before. I had not changed any other med and am certain the error was not on my part.

I guess I’m happy that they found the errors that had been so studiously made on the last visit. Quality is better than speed after all, and with some of my meds incorrect dosage could easily have me visiting the ED or worse. But surely three different offices can’t all make different errors at each visit?

Apparently they can.

What would be ideal is if my doctor’s had spoken to each other about the case changes, or at least had the ability to accept an updated summary from the one person who actually manages their own continuity of care — me. Of course, in today’s meaningful use world not one of them can do anything useful with that data. It’s considered patient contributed and lumped in with the number of steps I collect on my iPhone each day.

021015_CS_Careplan_header

My PHR does allow me to fax or send my care summary in via direct to each Dr’s office in turn, but they have no internal workflow to deal with the inbound data so there’s little point in doing so. The data would just get lost in the shuffle, or worse yet be left out on a desk for all to see while they worked out what to do with it.

I think my PHR has the possibility to be the real brokerage point for my health data that I manage and keep up to date. My doctor’s offices just have copies of this data, and as we’ve seen they are often out of date or just plain inaccurate. Everything I need to know; diagnosis, medications, past procedures, and my general care plan is in my PHR, and I would claim that regardless of how my Dr’s office thinks their EMR has the truth, my PHR contains the gold data.

My hope for 2016 is that we can get this data into the EMR in a pre-reconciliation screen, and then very quickly automatically match items so my doctors are not wasting half their time on reconciliation activities.

That would be meaningful use.

http://www.smunson.com/portfolio/projects/lifelogs/cscw2016-lifelog-collaboration.pdf

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