Poor Coordination of Care – Who is in charge?

23% of sick Americans felt  “no one doctor understood or kept track of all the different aspects of their medical issues.”  At present there is only one solution.  The patient needs to keep a notebook of information about their health.  This should include an up to date health history, medications, allergies,copies of significant tests, x-ray reports and lab tests.  After office visits ask for copies of results and after hospitalizations ask for copies of the discharge summary for the notebook.  The impediments to sharing of information are tremendous:

  • No nation-wide patient identification number
  • No common way to store health information
  • No way to search all sources of health data
  • Patients moving or changing doctors or changing health systems
  • Name changes, identity theft, undocumented aliens
  • Poor communication to and from a primary care providers
  • Lack of pharmacy integration into databases
  • Strict privacy rules
  • Separation of outpatient and inpatient providers

Nobody knows who to trust with their health information.  If such a trusted place for information could be found then American’s health information could be electronically stored there with access controlled by the patient.  This probably will not happen soon so patients should:

  • keep a health information notebook
  • get a primary care provider
  • try to stay in a health system that has a good information system
  • support the idea of trusted regional or statewide health information systems

Health care mergers and acquisitions are increasing but the merging of information systems sometimes does not follow.  Perhaps such joining of health care systems should have legal requirements to merge the patient data systems as well.

Despite the dim hope of information sharing on a large scale there are things providers can do.

  • Give patients copies of important medical information either on paper or electronically
  • Always send information to the patient’s designated primary care provider.
  • Always give the patient an updated list of medications they should be taking, not just the medications prescribed that day.
  • Encourage the patient to bring the medication list to every health care encounter.
  • Make it clear to the patient who is in charge at all times.  Hand-off of care means a positive, certain, provider to provider communication and not just a whisper in the wind.
  • Make it easy for other providers to contact you.

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