The Connected Patient: What Happens When the Connection Fails?

The Connected Patient: What Happens When the Connection Fails?

I have often said I want my server in my closet so I am not dependent on the internet to see patients and deliver care. As a technology-driven practice, my patients are connected to my office via the patient portal. What happens to them when the internet goes down?

In the past, I have chosen to only pay for one internet provider since my EHR server lives in my office. Unfortunately, twice in the past month my internet service has gone down for an extended period of time. As connections between the outside world and my EHR have gotten more robust, my office has begun to depend on them. I’m going to have to enter the world of redundant internet connection, and I think we all should consider this approach….regardless of whether your EHR data is in the cloud or in your closet.

I often learn about loss of internet connectivity when my office phone starts ringing more than usual. Actually about 35% more (that’s a lot of phone calls!) My patients/families have begun to rely on electronic access to their medical information and to our office. So what are these extra phone calls about?

· I know you have medication dosing on your website for acetaminophen and I tried to look it up, but your website wouldn’t come up, so I’m calling for that information. By the way, can you tell me how much Johnny weighed the last time he was in because I usually look that up so I know how much to give him?

· I need a referral to go back to see the cardiologist. I usually request them online but I couldn’t get access.

· I need a copy of Sarah’s immunizations to register for school. I usually just print them off the portal, but I can’t log in. Can you mail it to me or do I have to pick it up?

· Dr. Kressly asked me to follow up with her regarding how Anna is doing on this new medication. I was going to message her through the portal as it isn’t urgent, but I can’t seem to get access. Can you have her call me back? (I’ll be out most of the day except between 1:30-2 and after 6 PM.)

· I’m calling to request a refill of my medication. I usually do that on-line but don’t have access.

· I know I have an appointment tomorrow, but lost my card. I was going to confirm the time on the website, but I can’t log on.

· I was going to pay my bill on-line, but it doesn’t seem to be working. Can I give you a credit card over the phone?

· Dr. Kressly said I could get a copy of my labs to take to the specialist. I’m going tomorrow, but I can’t see them. Do I have to come to the office now to get the copy?

Now let’s add what didn’t happen in the office without internet access:

· e-Prescribing capabilities gone: had to print out prescriptions for patients in the office and staff had to call in prescriptions (go through the prompts, wait on hold) to call in refills or swimmer’s ear prescriptions. Oh, any importing outside medications (to check on the dose of Flovent the allergist prescribed and the mom doesn’t know)…capability gone.

· Appointment confirmations: normally my staff can automatically confirm next week’s appointments in < 5 minutes through the patient message exchange. Phone calls one by one…took her over an hour for just one day’s appointments.

· Importing new patient immunization information: usually my nursing staff can query the state registry and import them into the EHR with a click of a button. Instead, we had to call the prior practice, wait on hold, then wait until they faxed us the immunization records. Took significant staff time and the patient waited in the office for an hour.

· Lab results…OH MY! Normally staff can import lab results from our hospital and most frequently used outside lab. The results are attached to the patient chart and easily visible to physicians to review. No internet. Can’t even look them up online. Staff had to call the lab and have them fax them to us, scan them into the EHR and attach them to the chart…laborious process. And then results? Normally, we post messages to the patients on their portal when labs are normal (negative throat cultures, etc.) and only call patients with positives. Three times more outgoing phone calls than usual.

For those of you who are utilizing all the automated features of an EHR integrated with a patient portal, you might be surprised to learn how dependent you and your patients have become on electronic connectivity. I’m going to make sure I have redundant internet service in the near future so this doesn’t happen again.

To those of you who are not utilizing all the available features of a fully connected EHR, including a patient portal and patient message exchange, you don’t have to wonder about the return on investment…it’s real and demonstrable.