Health 1.0h. . .Geez, This Is a Mess

Stoltz
Craig Stoltz is a web consultant working in the health 2.0 space. He
has previously served as the health editor of the Washington Post and
editorial director of Revolution Health. He blogs at Web 2.0 … Oh
really? We’d like to congratulate Craig for being named to Time’s list of the top twenty five bloggers in the country this
week.

A family member just had surgery, but don’t worry, this isn’t about that.

I want to share just one observation from the experience:  Between
the decision to have surgery and the moment scalpel touched flesh, the
patient’s medical history was taken four times. None of these documents
contains identical information.

Medical History 1. At the specialist’s office, forms were filled out
in the waiting room, then completed and annotated during the in-office
consult. The primary care physician’s record was not provided or asked
for. We didn’t have the records from previous episodes of the medical
issue in question–this all came up suddenly, and. . .we couldn’t find
them.

But the hospital said they’d faxed the latest ER report, didn’t they? Can’t find it here.

Medical History 2. The day before surgery, a hospital prep nurse
called and created a new medical history by phone. My wife was there,
so she was able to correct and change some details. One of these
details was. . .the correct name of the earlier diagnosis, at least as
far as my wife could remember. I had it wrong the first time. My bad.

Medical History 3. The day of the surgery, a nurse came by and, with
the phone-interview medical history in hand, went through the whole
thing again. We remembered things a bit more clearly this time. The
patient was there too, and remembered some things differently–some
adamantly (no, he didn’t have to rest in bed that time, and he knows it
felt funny for two weeks, not two days). And let’s see, he was 6 years
old the first time (not 4!) and this happened two times in the last
month, not three.

Medical History 4. After the nurse left, a physician’s assistant
rolled in a black cart bearing on old Dell PC with a splatter-shield of
yellowed plastic. Then she asked all the same questions. While she had
the handwritten documents previously created, she essentially glanced
at them occasionally and mostly typed in what we told her. (“No
allergies? “Yes, seasonal allergies, and he takes Allegra–not
Singulair, right honey? He took the Allegra yesterday, not today,
right?.”) Life being what it is, and brains being what they are, we
changed a few more details again (no, that was three times, but it
happened once the month before too). After she was done, she. .
.printed out the report, put it on top of the now-thick file.

I’ll spare you more details. But today there is a “medical record”
of my family member’s experiences containing some accurate data,
multiple unresolved contradictions and a whole bunch of best
recollections. The last report, the one that got printed out, is mostly
accurate, I think.

I work in the world of Health 2.0, one dedicated to building
communities, leveraging collective wisdom, connecting people with data,
enabling virtual care, creating actionable visualizations, yada yada
yada.

Frankly, until the medical “system” can create an accurate patient
record–in sharable, electronic form–I have to wonder about the value
of the more advanced stuff so many of us are working on. It’s like
trying to attach a rocket to a car with no wheels.

I know the whole EMR thing is being worked on–I know some people
who are working on it, and godspeed to them, I say. Microsoft and
Google too, whose PHRs may provide some stopgap until the
“stakeholders” in the healthcare delivery system can get their hands
out of each others’ pockets long enough to build the fairly simple
thing we all know we need.

It’s almost too obvious to say: The prerequisite for 2.0 is Health 1.0. We haven’t passed the first course yet.

— by Craig Stoltz

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