28% in the Sick in America Poll saw a health care professional who did not have all of the relevant medical information. Many patients think all health care providers are linked together by computers but this is absolutely not the case. The experience at an airport where a gate agent can look up your ticket and alternative flights — even from other airlines — is really spectacular. Unfortunately, American health care is not at that level of connectedness. If one doctor orders an x-ray the results go to that doctor. If the second doctor is in the same health system there is a chance the result will be in the system database. If the second doctor is elsewhere the doctor will not have the result unless the patient takes some action or has the result in a notebook. The situation is dangerous. The patient thinks the doctor has the information. The doctor does not have the information and orders duplicate tests or potentially unnecessary procedures.
- From the patient standpoint: keep a notebook of all significant tests and procedures and show it to any new providers. When making an appointment tell the scheduler about recent tests — there is a chance the office will endeavor to get the results. Admission to a hospital is frightening and is made worse by each new health care person ask the same questions over and over (suggesting poor communication between the admissions nurse, the hospitalist, the surgeon, the anesthesiologist, etc.) The questions get asked because the providers have not looked at the record or because the previous provider has not had time to enter the information. Really well organized hospitals minimize this repetition so choose your hospital accordingly.
- From the provider standpoint: Unless it is an emergency, try to have a staff member contact the patient before the visit and review any recent health care events. That staff member should check for data from those previous events and have the data available for review prior to the provider visit. Most outpatient providers have about 4 employees dedicated to them (nurses, schedulers, insurance filers, and record keepers). One of them should be tasked with collecting data for the visit. You might say the provider fee does not cover data tracking, but how silly does it sound to bill for saying we don’t have the needed information? When the patient is asked to come back for a second visit to review the missing data the patient may smile, but as the poll shows, they know poor organization when they see it. When seeing a patient in the hospital review the record before questioning the patient. It is reassuring to patients to have a provider review the information in the record with them and ask “is that correct?”
- From the American health care system standpoint: other countries do a better job of reducing health care data fragmentation. In England there is a system wide (NHS) computerized medical record. In France each patient has a smart card that contains the medical and billing record. Nobody knows for sure what the current cost of data fragmentation might be but it is certainly huge. Perpetuating an inefficient system wastes money and talent.