John Moore, of Chilmark Research, graciously allowed me to use the the following post. I hope you find it as interesting as I did. If you are not farmilar with his work be sure to check it out.
Recently upon leaving my doctor’s office I was presented with a print-out of my visit summary. Knowing I worked it the HIT space my doctor proudly stated that this was one the ways that they planned to meet one of the menu objectives of Stage One meaningful use (MU). This is great I thought, until I began looking over that visit summary.
A significant portion of the summary listed the basics such as who I was, why I paid them a visit etc., all pretty boiler plate – nothing new. Then I turned the page to see the lab results of the routine blood-work – YIKES! nothing but acronyms, values and acceptable ranges. I think I was able to decipher about 10% of those lab results and I work in this industry! I can only imagine how difficult and mind-numbing these figures may appear to an “ordinary” patient/consumer.
So seeing some out of range values I began asking my doctor:
What does this acronym stand? Why is this out of range? Is this something I need to worry about?
Being the great doctor that he is, he took the time to explain my results (some of those out of range values are the result of meds) but also expressed a certain level of frustration stating: “I’m not a big fan of passing this information on to a patient for I worry that they won’t understand results such as these and then I need to take time out to walk the patient through their results which can be quite time consuming. Is this another contributor to physician burnout I wondered?
Now I am all for patient/consumer empowerment and do believe that providing patient’s access to their personal health information (PHI) as a critical component of such empowerment. But does providing a patient a visit summary really empower them or does it simply make them confused (as I was) and resigned or worse endanger?
Stage 2 meaningful use rules released last week state that an eligible physician or hospital will be required to:
Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
But what will that “patient-specific education resource” look like? Will it solve the problem I encountered?
I want more than a generic here is what these type of acronyms and values mean that litter the internet. I want personalization. I want a system that will take my lab results, my problem list, match it up with my meds, allergies etc. and provide me with personalized knowledge of what these results mean to me and my future health. I then want to be provided suggestions as to how to improve those values? This is what I see as true patient/consumer empowerment.
Unfortunately, what I have actually experienced as a result of this grand HITECH effort under Stage One falls far short of empowerment, if anything, it is closer to disempowerment.
Getting a bunch of data in a visit summary without putting it into context is not meaningful, it is meaningless.
My hope is that there are some novel, creative solutions now being developed that will leverage the new concept in Stage Two, the Base EHR, and provide a module that automatically digs into a patient’s PHI and presents the patient with an empowering visit summary. This is one of the ultimate intents of the HITECH Act, I now want to see it happen.
Mind The Gap 
Raw data is empowering. I have had instances where the raw data was misinterpreted by the treating physician, and I was able, with the help of information freely available on the internet, to reinterpret the data, and to realize that I needed to see a sub-specialist who would understand my particular problem. The sub-specialist interpreted the data as I did.
Raw data also enabled me to alert my doctor to a thyroid/pituitary problem that was overlooked.
Give me the raw data any day!
I like the raw data as well but as John Moore points out a little “context” to help me interpret what it means. Plus I probably wouldn’t remember to look up the information online by the time I got home.
Thanks for your comments!
Steve Wilkins
The same folks who wrote the EMR program wrote the patient ed materials…just saying might they want to engage an educator or better yet reduce the admin burden to the Doctor so that he has time to go over labs himself.
MU2 is just another distraction from taking care of patients that is merging in with the ALPHABET SOUP of acronyms that we have to deal with already
“I want more than a generic here is what these type of acronyms and values mean that litter the internet. I want personalization. I want a system that will take my lab results, my problem list, match it up with my meds, allergies etc. and provide me with personalized knowledge of what these results mean to me and my future health. I then want to be provided suggestions as to how to improve those values?”
Do you want that enough to pay for it, i.e., a one hour consultation that would not be covered by insurance?
Docs would like to practice that way, but the current system doesn’t allow that.
I ALWAYS have copies of lab tests, radiology reports, and specialist visits sent to my home address. The nurse at my GP’s office will explain my lab test results to me if I call and I expect an office call back if there is any reason for concern. Radiology reports are a bit more difficult to translate. I do my best on the internet or ask directly if I am scheduled for a return visit.
What I notice is that I am the one to catch errors and omissions in referral letters and appointment summaries and that these are not as rare as one might hope.
I find it fascinating that the ONC came up with the idea of a visit summary but then realized no EHR could do it ( not surprising considering EHRs are basically filing cabinets of free text documents.). So ONC then said that to qualify for the givaway of part of the $40,000,000,000 of taxpayer money, that the Visit Summary does not need to contain a summary of the visit…
Does anyone else find this ludicrous?
I too have been more than frustrated by the printouts offered by EMR’s. It turns out that only the most expensive and tech supported systems, such as EPIC at the local hospital have a viable solution.
I have been working with my EMR for the past several weeks trying to get them to modify an existing document or create a document that would be patient friendly as well as meet the criteria for attestation to Meaningful Use. While our EMR program is rather advanced and can do all kinds of neat tricks, it can not do this simple task! We can print a “Patient Summary” which IS actually a summary of the visit with comments and directions from the provider printed in the provider’s own words, as well as recommendation for next visit, but because it does not print “Allergies to Medications” this document does not meet the federal guidelines for MU! Really?!?! Instead, our clinic needs to print a multi-page document that does not provide the visit summary and is unfriendly to both the patient and to reception’s work flow. Sure, we could print both documents, but why! I was told that I could submit an Enhancement Request, but that it would not likely be actioned on. I have to think that Stage 2 is not going to fix this problem.