Sunday, August 25, 2013

Most wired?

Now that I am a "civilian," I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, rad techs, lab techs and the like.  On that front, I remain tremendously impressed.  Indeed, I am even more impressed that they can offer such fine care now that I get to witness the logistical "systems" in place to do the humdrum things that are required to provide service, work flows whose design not only makes things harder for patients but also for providers.  Examples:

I contact my PCP who recommends that I see a specialist.  The PCP is on the patient information portal, but the specialist is not.  This means that I cannot use the portal to set up an appointment.  Can I do it by email? No, I am told.  I must call the specialist's office.  This results in several back and forth telephone calls, using up the precious time of both the patient and the desk clerk.  An opportunity to benefit from the asynchronous nature of email or other electronic scheduling is lost.

I need to have an image made before seeing the specialist.  His office tries to enter the order for the image, but the system kicks it out because my insurance company does not have the name of my PCP in its records.  The person entering the order does not have the authority or ability to inform the insurance company of this piece of data, although it is known to her.  Instead, the specialist's office has to contact me, and then I have to contact the insurance company, and then I have to call the office back and tell them that I have done so, and then the order can be entered.

Then, because electronic scheduling does not exist, I have to call the radiology department to get an appointment for the scan.  Here's the first bit of good news.  The scan and the radiologist's reading is inserted into my electronic medical record so the specialist has access to it before my appointment. Indeed, I have access to the report, too, through the patient portal (oddly, in that the specialist does not participate in the patient portal.)

But my PCP and the specialist recommend that I see yet another specialist.  I search for his information and find that he uses the patient portal.  I go to my page in the patient portal and attempt to add him as one of my doctors so I can make an appointment electronically, but the following message appears saying that I must have an initial appointment with him before I can do so: 

Ah, Catch-22!

There is no email available for him, so I am left to call his clinic and make an appointment.

By the way, this occurs in a physician practice organization that regularly receives awards for being part of one of the "most wired" health care institutions in the country. And, truly, it deserves that honor compared to many others, but the kind of lacunae I describe above are indicative that the standard against which such awards are granted is low compared to what you would expect in many other industries.

Oh, also, the Press Ganey survey I received after the appointment with the first specialist had no questions related to any of these problems.


Ileana Balcu said...


Just... thank you so much for this...

We patients are in a catch 22, not only for dealing with the system you described in this post, but also for not having a place where to describe and complain about this kind of issues. It's unfair to complain to doctors and nurses and front office staff and there's not much they can do either.

You can't really have patient engagement until the effort to become engaged is not as big as you describe, even in a most wired system... can you imagine the systems most patients deal with - the non-wired ones.

Paul Levy said...

Exactly. I don't want to take more time from front office folks and providers by complaining to them about a system they cannot change. They are victims as well.

Barry Carol said...

Perhaps if all of the providers you are trying to deal with are part of the same large multi-specialty group practice, you could complain to the practice manager or even the CEO and suggest they do a root cause analysis of the problem(s) and try to fix them.

On the plus side, the fact that the system is so screwed up with respect to the issues you described, there appears to be plenty of room for progress not only in saving time for both patients and providers but for bending the medical cost growth curve as well.

Paul Levy said...

I like the "glass half full" sentiment of your second paragraph, Barry!

On the first point,I think I did just complain to the management . . .

Anonymous said...

Yours is another in a spate of posts by medical insiders experiencing the 'system' as a patient for the first time. (And thank you for adopting my practice of putting 'system' in quotes, for it surely is not a true system).
Perhaps such encounters should be required of all medical residents and administrator trainees. For instance, why do members of the same practice group practice in such a non-standard manner? And if there is such wonderful IT expertise available, why are they all not required to use it?
The answer can be found in all of the stories I've read recently: the medical profession and hospital industry have set things up to please themselves, not their customers - who happen to be a sick, captive audience. This is the height of narcissism.

nonlocal MD

Neville Sarkari MD, FACP said...

It is, in most places, designed with the providers in mind, not the patients.

MightyCaseyMedia said...

Welcome to the Kafka-ville that is being a patient in the 21st century healthcare system. Which is partying like it's 1975. At the rate of change currently in effect, we might get to the internet by 2030.

Seriously, though, thanks for pointing out the fact that patient engagement IS. NOT. POSSIBLE. within the existing system because patients collapse, exhausted, before they can get to the finish line of any single transaction. Much less navigating all the way through tx for a complex health issue.

The common perception in health folk is that healthcare is something that happens "over there" to "sick people" - not to them. The punch line there can turn into a punch to the head the instant they or someone they care for gets sick ... because healthcare is 24/7/365, and involves every choice we make. What we eat, how we move, even how we think - because the action in our craniums has an impact on our health, too. Ask any person who's dealt with clinical depression about that.

Keep bringing this up, Paul. Patients are waiting for the healthcare "system" to catch up with us in our 21st century lives.

First order of business: REAL healthcare reform, not the health PAYMENT reform currently masquerading as healthcare reform. Breaking the chain that ties group insurance access to employment = Job 1.