Follow Up

Earlier this week I rather hesitantly put up a blog with two posts sharing my informatics research/patient perspective on healthcare technology and patient-centered care. Reactions were very positive and I’m now connected to many new interesting, intelligent and nice people. I have a collection of other posts in the works, but I decided to follow up in way that expands on my two previous posts.

In, Hey Doc, Where did you get that app I shared my experience and ideas on how innovative exam room technology can support patient education and shared decision making. By contrast my post, The Patient is the Messenger, Not the Message presented a very frustrating experience I repeatedly encounter in managing the insurance centered workflow in my follow up care (guess which post received more tweets?).

The follow up workflow is indeed cumbersome, frustrating and confusing, but once I get through all that and see my specialist I can’t ask for better care. At my most recent follow up visit, just a few weeks ago, I experienced another example of how the otherwise disruptive exam room computer can support patient education via enhanced physician-patient interaction. However, this experience had nothing to do with innovative technology like DrawMD. Instead it showed how a dedicated physician can go beyond the limitations of technology that was never designed to be used with patients. 

Here is what happened. I arrived at my cancer specialist’s clinic with my image study CD. The CD was loaded into the hospital PACS system and I was taken to the exam room where I immediately noticed an imposing new presence. In the corner of the exam room was a fancy wheeled stand with a new computer. It was obvious my specialist’s office was now live with a new electronic medical record (EMR) (of course the computer was in a corner facing away from me, the patient).

Computer Cart

Uh oh, look what’s in the exam room this time. Will I be competing for my doctor’s attention?

My specialist came in and, as usual, we started our visit by talking about healthcare technology (he knows about my job). Like every doctor I know, at work or in my own care, we talked about how the EMR fails to support physicians and is distracting to what is most important – communicating with patients. He demonstrated a few examples of how the new EMR imposes documentation tasks that have no benefit to him, me or even the hospital from what I could tell.

After our EMR shop-talk session we proceeded to discuss my care. He pulled up my image study on the computer. He mentioned something on the study and I was suddenly concerned, yet had no idea what it really meant. What happened next was, I think, pretty amazing. First, he wheeled the cart around so I could see the computer (patient-centered care innovation via 5,500 year old technology – the wheel). Then he picked up the phone and called the head of radiology. What followed was essentially a radiology consult with me in attendance. With the radiologist located in another part of the hospital they each pulled up, reviewed and discussed not only my current image study, but almost all of my past image studies (MRI, CT, x-rays…) including the CT scan from my initial diagnosis over two years ago. As you can imagine most of the discussion was way above my head, but I was included in the conversation. After about ten minutes of this three-way conversation (okay, two and a half), my concern was addressed – it was nothing to be concerned about. If I had just donated enough money to build a new wing of the hospital I’m not sure I would have received more time and attention.

My doctor is a top researcher and guideline author on my condition, innovator of robotic surgery techniques and the head of surgery at a major hospital (another potential blog topic is how the healthcare system did absolutely nothing to connect me with him and that I found him by pure dumb luck). He’s a pretty easy going guy, but I have the distinct impression that everyone in the hospital responds to his requests. However, he is just as responsive and accessible to his patients. For example, he answers all my emails, even when I ask for help in finding similar specialists for friends or family on the other side of the country. Given all this, some might argue his position and responsiveness designate him as an above average outlier. I know plenty of other very dedicated and responsive physicians, but I’d like to go beyond all that and make the more productive argument that this type of positive experience can inform the design of better patient-physicians experiences for everyone.

By design, I mean much more than computer carts or the screen layout and workflow of the EMR. Of course these systems can be designed to be more efficient, usable and supportive of patient-clinician interaction, but the computer is just one component of the experience. According to Wikipedia Service Design is defined as , “…the activity of planning and organizing people, infrastructure, communication and material components of a service in order to improve its quality and the interaction between service provider and customers…” Okay, now replace service provider with healthcare provider and customer with patient (or consumer) and you have the basic outline for creating a healthcare system that can routinely (vs the exception) provide the kind of patient-satisfying, effective, highly interactive, information rich, technology supported, collaborative, patient-centered communication interaction experience I had last month.

I’ve helped design a number of complex healthcare applications and in every case the biggest challenge isn’t technology or usability, it’s process, culture, business, time, competing priorities and other issues that arise from complex human systems. Fortunately I met someone to help me think about this in a new way. For almost three years I have had the pleasure of corresponding with Peter Jones, a very thoughtful and intelligent academic, researcher and author dedicated to educating everyone and anyone on service design in healthcare. If you want to learn more about his ideas and work, read his book, Design for Care: Innovating Healthcare Experience.

One thought on “Follow Up

  1. Linda Williams

    Interesting story on NPR about physicians using scribes to interact with the EHR so that they can stay focused on the patient.

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