Connected and Communicating: What’s Taking So Long?

Connected and Communicating: What’s Taking So Long?


I don’t know about you, but at least once a day I get frustrated by the inability to send and receive patient and physician communications the way they should be done. Maybe I’m restless because I see the incredible power of robust health information exchange and it’s not being used the way it should be.  Maybe I’m impatient because it seems like interoperability is taking forever to become a reality. Or maybe it’s because I put so much effort into creating a medical home for my practice but my medical home neighborhood isn’t on the same page.   It’s likely “all of the above”.


Why is this so hard?  For starters, a “information exchange” roadmap was slow to develop for vendors to follow. Even though there are published national standards, many organizations think they have unique needs and unique reasons to change those standards for their own internal use, and have chosen to “ignore the rules”.  


Doctors feel the need to ensure security between systems and entities–they want to develop a trusted relationship and connection and they’re just not there yet.  The industry is growing and changing at such an incredible pace that it’s dizzying, and some of this is out of our control. More attention needs to be paid to workflow, processes, and the people who interact with the technology. If the people who are entering data don’t understand the value of the technology, it will be hard to improve care.  


Why am I writing about this? A few weeks ago I had an incredibly frustrating experience and the lack of interoperability was mostly to blame. One of my patients was taken to a local emergency room for “alteration in mental status”. The parents were frightened and took her to the ER, but things snowballed when she got transferred to a tertiary institution. The only way I even knew she required emergent care was because I got a fax from the ER the next day. Our local ED asks every patient for the name of their PCP–a mandatory field in the EHR. When the note is completed in the system, it auto-generates a fax of the report to the PCP’s office.  Technology worked!


But then…silence. Until the parent called distraught about his child’s condition and diagnosis. The patient’s father had “assumed” that the medical staff at the tertiary care center was in communication with me, but that wasn’t the case. I had no idea what had happened after the ER visit. We had left a message on the family’s home phone after seeing the original ED report and asked the parents to call us with an update. But they hadn’t been home in 10 days.  No third party medical report and no communication with parents equals an uniformed PCP–me.


Here’s where technology (and the humans and their workflows) fell apart. At the tertiary care institution, the EHR field says “referred by” (which was filled in by hospital personnel as “community hospital ED”). There is no mandatory field for PCP. Should there be one? Absolutely! To no one’s surprise, I have had numerous communications with the hospital IT folks and executives about how this needs to be fixed, and I’m told it will be in an upcoming release.  Until then, I will remain woefully uninformed.


Technology aside, why didn’t my physician colleagues pick up the phone and call me? Did they think that this family was NOT going to need support from a trusted medical resource? I know, it was July. New residents, new fellows. But that was RIDICULOUS! You owe this child, their family, and your colleague the courtesy of picking up the phone and initiating a conversation about how we want to be updated and how often it should occur. Does this system have the ability to fax us progress notes and updates? Sure. But someone has to initiate the process.


I long for the day that no matter where a patient shows up, it is clear that I am the PCP and I can get automatically generated information via secure electronic messaging within my EHR, so I can import any pertinent updated clinical information. Faxing alone is not a solution.  How many times have you heard about faxes not transmitting correctly, or being lost in the great fax black hole?  Maybe I expect too much. However, I’m not apologizing for that. We need to strive for what is possible and then make it even better. I just hope reality comes sooner rather than later.