Who should track health care information? (Part V. Travelers)

It is February and cold.  Oh how I long to go to Mexico. It would be warm and maybe the achyness in my bones would go away.  I just finished two challenging semesters of Spanish at my local college.  I never took Spanish in high school so this was quite the ordeal at my age. I have  been reflecting on how much time and effort I spent and yet I still feel that there is so much to learn.  The same can be true of the area of healthcare and medicine.  Most people do not really understand medicine.  Medicine is so complex and that is why we all rely on the experts (the doctor) but what about when we travel? How do they know all of our health information?  That is just it, they do not have a record on us or an electronic health record (EHR) I have only been out of the country a few times and most of the time I travel via car and see the sights along the way.  One particular time, I took a cruise with my husband out of the country.  It was our first time. He was not feeling well before we took off.  He had a scratchy throat, achy but was not runny a fever. He thought about stopping by a minor emergency center before boarding but he decided against it.  On day two of our trip he was very sick and needed something for his fever.  He went to visit the ship doctor and was told he had strep throat. The weird part of all this was how unprepared we both were for all of this.

Everyone needs to track their health care information even those that travel for recreation, business, missionary work or athletics.  Stay with me as I continue to blog on this important subject. You can also follow me on twitter.  Please check out my website at positiveresourceconsulting.com

Who should track health care information? (Part IV Sports players)

I live in Oklahoma so I love to watch sports.  I love football and basketball and baseball or you name it.  Oklahoma is proud of our sports teams.  We are so proud of the NBA team the Thunder.  We love our college teams as well.  I have met others that have come from others states to visit or live here and at first they make fun of us and our love of ball.  The love of the game is year round and we are die-hard fans for our teams and players.  We watch the news and follow the team and players throughout the season. We keep up with them when they are hurt or sick. Oklahoma’s do not only watch and enjoy professional ball we are also engaged in developing our youth.  We love to see our young people develop skills that will help them later in life.  I love how it helps their self-confidence and helps them with team building.

It is not unusual in Oklahoma to see a man around March of every year have a group of boys on the field teaching them the techniques of baseball. The games are very physical there is no doubting that.  Even though the professional organizations are trying to make things safer for our players, accidents happen.  My son played ball from the age of 5 all the way though high school so I know that accidents can happen.  Back then when he was in ball all the parents did was fill out a questionnaire on each young boy about their health.  The coach would take the information with the team to each game in case there was an emergency of some kind.   Most of the time it was parents who took the child to the doctor or the hospital.  I can remember one time back in 1996 when my son was playing ball (he was a catcher) and he tried to catch the ball coming in from 3rd base and he missed it.  He had his helmet off and the ball popped him straight in the eye.  He had a concussion and a black eye for over a week.  My ex husband and I took off towards him.  My ex husband took him to the emergency room and I was right with them.  We both had to give the hospital all the information about his health, immunizations, past and present health information so that they could treat him.  This was back before the electronic health record.  I am not sure if having the electronic health record would have mattered anyway.  He played in town and out-of-town for tournaments.  He loved his ball.  I loved watching him play but more than that I loved keeping him safe.

All players or the players parents need to keep track of their health care information and keep it handy in case of emergency.  This is true especially when traveling. I think about the parents that do not attend the games and that rely on the coaching staff to take care of their child.   This is very sad.  I think it is the parents job to be there at the games and practices.  Tracking health care information can be easily condensed and stored in a glove box of your vehicle.  Take the time now to write down vital health care information and keep it with you.  Tracking health care information is everyone”s responsibility even those that play sports.

Who should track health care information? (Part III Caregivers)

Again the answer is everyone needs to track their health care information. This post is about caregivers. Caregivers are every where today, yet they are amongst a silent group.  If you were to listen for just a few minutes while at the hair salon or tire shop while going about your daily business you would probably hear someone talking about caring for someone else. Caregivers need to track health care information for the person they’re taking care of.  Some of the most common things to track are medications, previous diagnosis that are chronic or continuous. Others things to keep track of is past hospitalizations dates and medical reports. I looked at a cancer forum this morning and I read about a lady that lost her mom to colon cancer.  She was sharing her journey about the final days of her mom’s life.  It was very descriptive and powerful.  You could tell that she was speaking from her heart.  She wanted to share her experience because there is not that much information about the final phase of life on the internet. She explained that when her mom’s physician was explaining things to them about the final days that he really sounded more like he was giving a pep talk. The lady went on to report that each time they had test done to show the progress of the cancer they usually got a verbal report.  She decided to ask for written reports so that she could look things up for herself on the computer.  It wasn’t because she didn’t trust the physician it was more like she could not remember everything that was said.  She also did not understand everything that was being said either. She went on to say that she wished she had done that earlier because her research would have prompted more test or even a different course of treatment for her mom.
Caretakers have such a difficult challenge and that is with communication with healthcare providers.  The key to good quality health care is open communication.  The more you know the more you can research on your own and then ask questions to figure out the best care for your loved one. So keep tracking health care information, asking questions and loving the ones that are close to you.  I hope you have enjoyed this post and will continue to follow.

Who should keep track of health care information? ( Part II -Seniors)

Yesterday I answered that question with everyone.  Yes, everyone should track their health care information and today I would like to address the need for seniors to track their own health information.  My parents are finding this to be so true.  They are lucky in the sense that they are free to go to what ever health care provider they choose.  They can even choose their own hospital.  This winter they both had pneumonia and they both ended up in the hospital.  My step dad was in a hospital on the north side of town while my mom decided to go to a hospital on the south part of town.  They both upon admitting had to share with the clinicians their health care information.  They shared their medications, past history and current symptoms.  My step dad stayed in the same health care network that he had always been going to.  My mother however went to a different hospital in a different network.  The paper work still took about the same amount of  time at both places even though it was mainly verification needed for my dad while my mom had to start from scratch. My step dad has an electronic health record within his network so information is shared with his health care providers on a portal before and afterwards.  My mom does not have that advantage.  This is really a solid reason to keep track of your health care information.  Oh sure most seniors keep track of their medications and some seniors will come in to the physicians office with all their medications written down on a sheet of notebook paper but the health care tracking goes beyond that.   More on this topic later.

Don’t get me wrong they both received great care from their perspective hospitals but so much responsibility still lies with the patient.  The patient still needs to follow the orders of the doctor and relate this information to the doctor that they see after the hospitalization if they are not in a network.  Another thing to think about is who is going to remember this information about the hospital stay let’s say six months down the road?  Who is going to remember the date, the medication that worked etc? I hope the patient is documenting everything.  Sorry to say but so much is still left up to the patient when it comes to tracking health care information. Seniors start now with tracking your own health care information.  Ask for your records. It is your right.

Who should track health care information?

The answer is simple, Everyone!  The first person that comes to mind is Pregnant woman.   I will blog about pregnant women first and why they should track their health information.  I will follow up with others that need to capture their health care information at a later time.   To start off, I loved being pregnant and I wanted to write down everything about my baby, all the miles stones, etc. but what I realize now looking back is that I wished I would have written down more about myself while I was pregnant.  This was not a common practice back then.

Today everything seems to be about taking selfies while pregnant and I think that is great do not get me wrong but I wonder though is that picture really going to tell them a great deal 10, 20 years from now?  I think a journal along with their medical records would tell a better story.  I wish I would have used a journal during my pregnancy.  I wished I had written down during my pregnancy about the foods that I ate.  I wished I would have captured what I weighed at each stage of pregnancy.  I would like to know what made me sick and also how many times did I visit the doctor?  I wished I could remember what did the doctor say about my baby’s weight, etc. Capturing health care information from your health care provider is so important.  Health care information can be more than a memory book but a life saver.  Women need to ask for a copy of their health records if they are not automatically given to them.  Some things that can be tracked are like your own nutritional progress, weight and blood pressure.  Track your complications or any hospital visits.  Better quality care is the main reason for doing this.  By tracking your own health care you can reduce or eliminate duplicate tests.

I know there are a great deal of women out there that cannot conceive so it makes it that much more important to capture their health care information. This is especially true since we all live in a mobile society.   People move.  Doctors retire. etc.   I also think about women that have a complicated pregnancy and I wonder are they keeping track of their health care information?  Yes, it is true your health care provider(s) has your records but they do not keep them forever.   Most states allow them to keep records on adults for 10 years.   Everyone should track/monitor their health care information.  Pregnant women can get a jump start on the game and begin tracking your health along with your babies health.

Ebola and Measles Tracking

It is challenging enough for the patient to track their own health care information but you would expect that the World Health Organization and Center for Disease Control would have their acts together.  I watched in awe last year when we had the Ebola outbreak that touched the United States.  I could not believe all the scrabbling up at the top with these organizations on who was responsible for reporting.  The agencies involved were all pointing figures at who develops the guidelines for how to handle the exposure.  Well folks Ebola is still being monitored and thank goodness but where is the information going and what are they doing with it?  Yes, the hospital emergency rooms are still asking the patients if they have been to Africa especially if they come in with a fever.  Who is responsible for the information after that?

I just read an article that was dated September  2014 about Ebola and Global Health Governance.  The author stated it was time for the reckoning.  It was written by David P Fidler, Associate Fellow, Centre on Global Health Security.  He went on to say in this article that the suffering inflicted by the Ebola outbreak—and the ineffective reactions to it—reveals a massive failure of global health governance. – See more at: http://www.chathamhouse.org/expert/comment/15811#sthash.nhPUxK39.dpuf.   After that I took a look at the World Health Organizations website and it clearly states that WHO is reforming to be better equipped to address the increasingly complex challenges of the health of populations in the 21st century. From persisting problems to new and emerging public health threats, WHO needs to be flexible enough to respond to this evolving environment. I also found it interesting that they are submitting a paper on the topic of Ebola a year later.  The websites mentions that one year after the first Ebola cases started to surface in Guinea, WHO is publishing this series of 14 papers that take an in-depth look at West Africa’s first epidemic of Ebola virus disease.  Well folks I guess sometimes you have to study the past to prepare for the future.  As a person interested in tracking health care information I can clearly see that more works needs to be done in this area.

 

Most of everyone has heard about the Measles Outbreak by now. According to the CDC website, the United States experienced a record number of measles cases during 2014, with 644 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

In summary the take that I have on these two outbreaks is that health care tracking starts with the patient and then next the health care provider, after that health care providers are supposed to be reporting it according to their state law but my goodness we need to fix this relay of information because by the time it gets to the top the information can get lost in translation.  (This reminds me of the game that I use to play as a child whereby I told the person next to me something and then they repeated to the next person, etc, etc until the final person had to state what they heard and most of the time it was incorrect) Health care information is more in important than that.  Our health is more important than that.

 

Empowering the patient

I think all patients should monitor their own health care. Do you keep track of your medical records and what is inside them? I do. Why because I feel I know myself better than anyone. It is not that I do not trust but I feel that I need to know what is going on with regards to my  medicine, treatment and options. I would go as far as to say that if you have a chronic problem or serious disease you need to be 100% involved in your healthcare.

I just now re-read my thoughts from when I wrote this post.  I guess at the time I was in a hurry.  I could write for days on this topic.  I have been reviewing some applications (apps) on my iphone and I have noticed while we are making great strides in the area of tracking health information we still have a long way to go.  I have also noticed that when you Google the subject, electronic health records (EHR),a great deal of products pop up.  Some of them new and some of them are old and have been around a long time.  I have used the electronic health record from a coder/biller stand point to an auditors viewpoint.  I have even used many products from a patient perspective.  I have read and studied so many of them as a registered health information technician (RHIT) but I still find them lacking with a very important component.  The patient vantage point is still missing.  It is a critical link to fixing a broken health care system.  I have noticed that for the most part it is still up to the patient to track their health care.  Oh sure, the hospitals and now most clinics and doctors office have an electronic health record but it is for them (health care providers.  They can track everything from your where you are at in the hospital to your medicine to your urine output but still there is a gap that must be filled.   The gap is between the patient and the health care provider.  More education needs to continue and the patient needs to speak up and ask more questions.  The physician and all health care providers need to learn how to communicate with their patients better.   Why do I feel so passionate about this topic because I see it playing out right before my eyes as I go in and out through the health care system.

Here is what I see.  This is just an everyday occurrence, medical errors that is.  I see the patient entering through the ER and then the health care provider decides to admit the patient because they are very ill.  (Ok some serious tracking going on now).  The hospital knows where the patient is at all times and inside the electronic record is all of the patients information from the medication they are given, vital signs to what the patient ate or didn’t eat while in the hospital.  But information in is information out in a lot of cases.  Or like the old saying, “Garbage in is Garbage out.”

Let’s start with a scenario and let’s tale a closer look at where the communication starts.  It starts with the patient.  The patient comes in through the ER or doctors office and starts by sharing with the physician or hospital staff information about their health.  The patient shares information from a financial stand point as well as from a medical stand point.  The patient discloses this information so that he/she can seek quality treatment.  In this scenario, the patient is asked what are you here for today?  A very common question.  The patient describes his/her symptoms and shares what medication they are on all the while the clinician is taking notes.  They usually document it in their computer or electronic health record (EHR).  The patient goes on to tell the provider about their past history and all the surgeries that they have had.  Some physicians have you fill out a questionnaire ahead to save time.  The fact is that communication can even break down before this point if the receptionist is allowed to write down what you are coming in for and the health care provider doesn’t ask the right questions.  Lets say that you describe to the nurse symptoms of a sore throat, sinus headache and drainage running down the back of your throat.  The receptionist makes an error and writes, UTI, which is the abbreviation for Urinary Track Infection.  Next the patient (you) sees the nurse and he/she takes your vitals and ask why are you being seen and you describe the symptoms and he/she then sends you to the lab for a specimen.  The lab asked for you to urinate in a cup.   Most patients would do this.

Now lets change the story to what actually happened to me. At his point with cup in hand for the specimen I went back to the nurse and asked why was I asked to urinate in a cup and she told me they needed it since I was coming for symptoms of a urinary track infection.  I explained, no I wasn’t that I had symptoms of a sinus infection which is usually abbreviated as URI which stands for an Upper Respiratory Infection.  Now, I am not an old person so you cannot blame this on the elderly and I am not an uneducated person so you can not blame it on that.  This was clearly an error of communication that started with a receptionist that did not know what he/she was doing or bad hand writing etc.  The point is the communication is lacking and errors are being made with or without an electronic health record (EHR) and the patient pays the price, the patients insurance company pays the price and ultimately the patient is the one that suffers.

Medical errors happen every day in America.   According to Fierce Health Care Journal, In 2013 it was thought that medical errors leading to death are much higher than previously thought, and may be as high as 400,000 deaths a year, according to a new study in the Journal of Patient Safety.  The new study reveals that each year preventable adverse events (PAEs) lead to the death of 210,000-400,000 patients who seek care at a hospital. Those figures would make medical errors the third leading cause of death behind heart disease and cancer, according to Centers for Disease Control and Prevention statistics.

Is there an app for that?

It amazes me the amount of apps or (applications) that are available for phones these days.  I recently heard on the news that only 40 % of Americans still use a land line.  So the use of a cell phone as a standard means of communication is in full swing for most of us. So with that many people using cell phones it is no wonder that more people are demanding apps for tracking things that are important to them. If you are dieting, there is an app to track your progress, if you want to track your exercise routine there is an app for that.  Too bad there is not one app that does it all for tracking health care information or personal health information. I would like to see an app that tracks all my medical information and stores it all in one place.  There are many barriers to this project but slowly the barriers of capturing, storing and sharing health care information are deminishing as new technology becomes available.

Customer Service

I went to the doctor the other day for a check up.  The doctors visit went great it was just the confusion with scheduling and getting the appointment that was a hassle.   The doctor that I see is a specialist.  I told her of the scheduling issue when she was examining me.  I told her that I had to cancel the last appointment due to the snow/ice but I had a terrible time getting back into see her.  She told me she knew of the problem and wondered if I took names and notes of who I spoke with and I told her I did.  She wants the names of the people who are in her scheduling office.  The weird part was that when I left the doctor she told me she wanted to see me back in two months and if I had trouble with scheduling let her know. She is booked out for a year in advance.  She told her assistant to go with me to scheduling to make sure I got back in within two months.  The lady went with me and the lady at the front receptionist counter in scheduling was busy.  The doctors assistant told her to make sure that I got an appointment in two months.   The lady finally got to me and told me the doctor was booked and I reminded her that I needed an appointment in two months.  One lady went to go ask why??? and the other lady at the counter acted like she did not want to get involved.  She kept saying we are booked and I will put you on the wait list.  The one lady tried to make a few phone calls to someone who could override the appointment but she could not get an answer.  The one lady came back and said I cannot find anyone to help me.  I will put you on the wait list and someone will call you.   She told me, “You can go now and we will call you”.  Well do you think I will get an appointment in two months.  No one has called me yet.

Barriers to EHR continues

I see every day the barriers of the electronic health record (EHR) that face the health care community.  Tablets are fancy gadgets but I am so concerned that the text is so small and so hard to read.  Errors are made.  Implementation is slow going and a daunted task.   The conversion of the workflow and the training are so critical and yet it is easily misunderstood to how important it is.  Proper training is needed and yet we rely on salespeople to guide the process, a train the trainer approach.  The colleges of today and our educational system is failing us since there is not enough grants to offset offering new and upcoming programs for technicians to be trained on the electronic health record.   Our backs are against the wall, so many of my friends have lost jobs since the government is regulating everything and the physicians are not coming on board like they anticipated.  Let’s face it the real reason for the loss of jobs is the grant money ended.  We are all waiting on the next funded project.  Yes, the electronic health record is here to stay but the barriers are bigger now than ever.