Viewpoint
A Patient’s View of Health IT
By Michael L. Millenson
As I drove with my teenage son to the hospital emergency room, there was good news and bad news. The bad news was that Daniel was slumped in the passenger seat, moaning periodically from an intense headache caused by viral meningitis.
The good news was that we were on our way to a hospital with cutting-edge health information technology systems that we’d get to see up-close and personal. As excited as this made me as a health care insider, I decided it might not be the best time to share my excitement with my son.
I wasn’t quite so upbeat six days later when Daniel walked weakly, but painlessly, out of the hospital. As a consultant and researcher, I remained as strongly persuaded as ever that properly implemented IT can dramatically improve care. As the parent of a patient, however, the electronic health record (EHR) experience left me as flat as the gleaming, high-resolution monitors that populated the patient rooms and nurses’ stations.
Unfortunately, the ways in which this EHR improved care were largely invisible to patients, while the processes left unchanged or made worse were very visible—even if they were clinically less important.
Disconnect Between EHR, Patient
Take our arrival at the ED. Because Daniel previously had been a patient at this hospital, his insurance and demographic information was in the computer, making check-in quick and hassle-free. What he’ll remember more clearly, though, is lying on the waiting-room carpet because it hurt too much to sit up, and no beds were available. My intervention got us into a patient consultation room where he scrunched onto a minisofa and lay in the dark. A triage nurse quickly visited, and I assured Daniel that if his condition had been dangerous, not just uncomfortable, he would have received swift attention. Given the throbbing of his swollen brain lining, he did not fully appreciate the difference.
Although Daniel’s lab tests over the years had been performed at this hospital, the results, including blood type, did not immediately show up on the EHR. Nor was his pediatrician connected electronically; communication throughout Daniel’s stay was by telephone.
When Daniel was admitted to the pediatric unit, I knew as a health care insider that his medication orders would be transmitted accurately, legibly and with important safety checks built in.
What I saw as a parent, however, was that the actual administration of therapy was delayed until the ED record could be processed by the admitting office and then cleared for access by the floor nurse. That nurse assured me that if Daniel’s condition had been critical, rather than just very painful, this process would have been handled more quickly. But with his eyes closed in pain, he once again failed to appreciate this distinction. Had there been a paper chart, it would have traveled with him on the gurney, and he might have received his medications immediately.
Two days later, when Daniel was transferred to an adult floor to free up a pediatric bed, access to his chart again had to be electronically authorized—presumably for privacy reasons—in a process that took longer than his physical transfer. The room in pediatrics had a small, old television set and a fading Muppets poster, while the freshly refurbished adult room had a large flat-screen television, a DVD player and modern art. Daniel, though, was in no mood to notice the difference in his surroundings, given his much greater interest in the prompt administration of pain-killing and nausea-reducing medications.
Interestingly, this Most Wired hospital did not yet bar code its medications. And when my wife insisted to a nurse that a pain medication was to be administered “PRN”—and that one drug should be delayed because it caused nausea that led to Daniel not eating—the nurse wrongly overruled her and Daniel. Had there been a paper record, my wife might have pointed out the doctor’s notation on the chart. The EHR, of course, was only accessible to the nurse, even without HIPAA restrictions on the parents of a teenager.
Daniel eventually recovered, thanks to generally good care and good caring, not to mention the natural curative powers of youth. His discharge was as administratively smooth and quick as his admission, and he even got to take home his balloons.
Patients are Stakeholders, Too
One obvious lesson of this story is the need to remember that computers are only tools. If we don’t give them data (such as lab results) or enable them to communicate quickly (during patient transfers, for example), they won’t. If a human overrules the technology (in giving a drug, for example), most systems in most circumstances can do little more than warn and record.
The second lesson concerns the stakeholders that health IT serves. I wondered whether the hospital’s leadership believed that delays in EHR access were the only way to address privacy concerns and whether their confidence that glitches would evaporate in the event of a true emergency was justified. It seemed like IT implementation ignored the patient’s viewpoint in favor of those of the more vocal stakeholders—nurses, physicians and administrative staff.
I wondered something else, too. Unlike some high-tech devices, EHRs don’t necessarily dazzle patients with obvious benefits. Yet news articles singing the praises of EHRs as a solution to health care cost and quality woes are popping up almost every week in local and national publications. We risk disappointing the public and endangering support for IT funding if we don’t point out to patients the ways in which care is being made safer, more evidence-based and more caring through thoughtful IT implementation in their community.
Ultimately, what is now an IT evolution must turn into a true IT revolution. When it does, I think patients like Daniel will be the first to fully appreciate the difference.
Michael L. Millenson is an author, consultant and visiting scholar at Northwestern University’s Kellogg School of Management in Evanston, Ill. This article first appeared in the Nov. 17 2005 issue of Most Wired OnLine.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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