Recently, I had the misfortune of sustaining an injury while running. Due to the nature of my injury I visited a total of five providers in the span of one week. The events that unfolded provided the perfect opportunity to reflect on the state of health information interoperability six years after the passing of the HITECH Act.
If you’re concerned about my condition at this point in the story, allow me to allay your fears. I’m fine.
The Event: Two weeks ago, one beautiful Sunday morning, my wife and I took our dog to the nearby state park for a run. About midway, the smooth trail unexpectedly turned into a rocky, root-laden downhill mess. Eager to finish, I foolishly decided to let gravity carry me down the hill. Just as I heard my wife’s cautionary shouts to “SLOW DOWN,” I tripped. Flying headfirst, I reached out to try to catch myself in a vain attempt to minimize the injury that was surely coming. As I picked myself up, muttering a few choice words, I thought, “Whew! That was lucky!” With a minor scrape on my left knee and left hand, I thought, “Good to go!” Then, as I reached to pick up the dog leash, I noticed with alarm that my right little finger was bent nearly perpendicular to my hand.
Not feeling much pain, I figured my finger was just dislocated and the nearest walk-in clinic could perform a quick fix. It was just a pinky finger, after all.
Care provider #1: “Picture ID and insurance card, please,” asked the nice lady at the clinic’s registration desk. After struggling to pull my ID and insurance card from my wallet, I was then asked to fill out a few forms and to “Please sign, here, here and here and initial here and here.” Understandably, they don’t have my information since this was my first visit to the clinic. Though, it would’ve been really nice if they had been able to obtain my health record from my primary physician electronically.
After seeing the x-ray, the doctor told me that my finger was broken severely, and that there was nothing he could do to help me because he’s not an orthopedist. He urged me to go to the ER immediately. Before leaving, a foam splint was taped to my finger, and I was given a disc containing x-rays and a printout of the doctor’s notes. #HIE-FAIL
Care provider #2: After a brief stop for lunch and a change out of my sweaty gear, I went to the ER as recommended. Upon arrival, I was required to complete more forms, which asked for all of the same history I’d just given to the clinic an hour earlier. Filling in the forms this time around was rough, with a splint protruding an inch beyond the tip of my finger. I returned the form to the admitting nurse, mildly embarrassed by my third-grader handwriting.
Long story short, there was nothing the ER doctor could do for me either, besides schedule an appointment with their hand surgeon. I was then sent on my way with x-ray disc in hand. #HIE-FAIL
Care provider #3: The next day, at the hospital’s affiliated clinic, I was given a clipboard with some paper forms that asked me to provide the same demographic data and history that I had already provided twice the day before. Wait. What? Really? This clinic was owned by the hospital I visited the previous day. I thought, surely their health records must be integrated. Apparently not!
After struggling to complete this third set of forms, I was greeted by the hand surgeon. Having reviewed the x-rays, he explained that he would insert two wires into the bone to fuse the pieces together while the bone heals. What’s more, the surgery needed to be performed soon. Since he performs surgery at three hospitals, the next available appointment before he left for vacation was the following day at yet a different hospital. #HIE-FAIL
Care provider #4: The next day, I arrived at the surgical center. As at my three previous visits to three care facilities over the previous two days, I was handed a clipboard with almost identical forms asking for the same information. This was getting old!
After I awoke following surgery, feeling a little groggy with my hand and wrist almost completely encased in a cast, my wife drove me home where I struggled to stay productive for a week with one hand almost completely out-of-service. #HIE-FAIL
Care provider #5: One week later, I arrived at the hand surgeon’s office for a follow-up, fully expecting to complete the same forms as before. After spelling my name for the receptionist, she found my appointment and politely instructed me to take a seat and wait to be called in a few minutes. What? No forms to fill out? Woohoo! It seems that the hand surgeon’s office was able to magically get all the information they needed about me through some other means, which impressed me even more in my current state, as I now knew from experience that a hand surgeon’s patients aren’t in any condition to use a pen. # HIE SUCCESS
A Long Way to Go: The care that I received throughout the process was excellent. All of the staff members that I met along the way were pleasant, empathetic and professional. I have nothing but admiration for them and the work they do. However, one thing is clear. Six years after Congress passed the HITECH Act the healthcare industry still has a very long way to go to achieve health record interoperability.
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