This week is one of those “you can’t make this stuff up” kind of weeks. It’s been filled with plenty of hard work, a fair amount of organizational dysfunction, and some pretty cliché observations.
Despite the challenges, I’m working with some genuinely nice people who seem to want to be successful and that makes all the difference. I’d rather work with people who know they have issues and want to try to be better than with people that think that everything is just fine when it’s not.
The practice I’m working with provides a fair amount of cash-based services (mostly cosmetic) and we dealt with some complaints about the lack of support for those workflows by their EHR vendor. It’s been interesting trying to explain why vendors have been spending all their time and energy on MU-related features and functions when the providers don’t care about being meaningfully used.
We did get some quick documentation templates done for a couple of their most common procedures, so that was a big win. One of the partners was so happy with the new workflow that he offered to give me some complimentary services. I wasn’t sure whether I should be excited about that or offended that he obviously thinks I need some work.
The physicians also have traditional primary care patient panels, but it feels more like a sideline rather than their focus. They’re trying to get in step with current primary care trends, but it’s a hard sell when you can make more money smoothing wrinkles, lightening dark spots, and making irksome leg veins go away.
Since they’re in a building on the hospital campus, several of the physicians hit the physician lounge for lunch every day even though they don’t admit their own patients. They’ve been taking me with them and it’s been enlightening to see what some of their peers think about the state of healthcare IT since I haven’t done much work in this part of the country.
I almost spit my sweet tea across the table when one physician said that since he was going to switch EHR vendors in the spring, he was going to go ahead and apply for a MU hardship exemption. He’s got connectivity issues with his current “lousy” system and has decided to just stop charting electronically. I’m not sure that qualifies as an extreme and/or uncontrollable circumstance, but he’s welcome to try. The vendor in question has tens of thousands of physicians who have successfully attested, so it’s an interesting position to take.
The practice is one of the first I’ve been in recently that still has pharmaceutical representatives call on the physicians. Most of the reps I’ve encountered over the years are hard-working and spend a lot of time dealing with cranky physicians as they haul samples from their company cars (used to be a lot of Ford Taurus-equivalent sedans, but now I’m seeing a fair number of minivans). The highlight of the week was the sales rep that pulled up in a new Maserati that cost more than my first house. He turned out to be EHR vendor’s regional sales exec. I guess he’s not hurting for business.
While I was fielding agenda changes from the client (who apparently thought of 20 other projects for me to work on during the time I was en route), I got a couple of emails from family members. My grandfather had a bone marrow biopsy last week and was told the results would be available in eight days. He dutifully called the office at the end of the eighth day after hearing nothing, only to be told that the physician would be out of town until October 29 and no one else in the office could give him results.
He sent his primary care doc a message through his patient portal trying to get the results, but was asking me for advice (as were his wife and my aunt). I thought it would be better to try to get in touch with the hematologist’s partners, who would presumably have access to his chart and would know what question the bone marrow biopsy was to answer or what condition was to be confirmed or ruled out. Even if he could see the results in the hospital system, I didn’t think this particular primary care physician would be likely to give them since he wasn’t the ordering physician.
I suggested that they call the hematologist’s office again and ask what the physician’s coverage arrangements are while he is out of town, and if they were told there aren’t any, that they mention the words “patient abandonment” and see what happens. This isn’t a question of a patient misunderstanding how he was to get the results – his discharge instructions clearly said to call for results in eight days. As a physician, I’m horrified at this kind of a process failure and the stress and worry it’s causing the patient and his entire family.
A couple of hours, later the PCP responded, basically saying he doesn’t know much about interpreting bone marrow results but that it “doesn’t look that bad.” That’s not exactly a vote of confidence for a worried patient. I saw the screenshot of the secure message and he definitely could benefit from a little coaching on how he explains things to patients. We’re still waiting to hear back from the hematologist’s office, who said their office manager would be calling to explain the cross coverage arrangements. Like I said, you can’t make this stuff up.
Turning my attention back to the client’s workflow issues, we identified several more commonly-seen conditions where the EHR didn’t fully meet their needs. I headed back to the hotel to get some additional custom templates built before selecting my next dining adventure. Several readers have commented or emailed about their BBQ preferences. The Carolinas are leading Texas two to one and I’ve received some suggestions I can’t wait to try. Tomorrow I’m finishing the day with a tour of the local Bass Pro, which promises to be something to behold.
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