Good news: my local hospital has the fanciest, newest, coolest computer system (costing major bucks, of course) and now is routinely sending me “transition of care” documents on my patients.
Bad news: they are horrible.
Seriously, we get several of these documents per day and often can't figure out what the document is about. On the bright side, sometimes after taking 10-20 minutes of looking through the 12-14 page document, we do actually gain some useful information.
Here's an example of what we get:
Search as I may, I see no primary diagnosis, nor have I ever seen a “diamond” next to a problem on the list. Searching for diamonds makes me feel like a treasure hunter, though. Perhaps they could make this a reality TV show on Lifetime: “Doctor Diamond Hunters.”
I am, however, informed about the patient's cognitive status, whether they can see and hear, can take a bath, and if they are still smoking weed. Reading these documents makes me see the merits of moving to Colorado.
I am also given a very skinny print-out of a test that he had run. I am not sure what an “Inflammator Y cell” is. There is no explanation of who ordered the test or the circumstances surrounding it being run, nor am I certain if it was run during this mysterious encounter, but I do (scrolling through 3 pages) learn what was found on a test that has been run.
This is followed by the very useful assessments of the nurse, reassuring me that the patient was given food supplements, was instructed to report pain, and that his bed rails were up (thank goodness) and the wheels were locked (presumably to prevent patient bed races in the hallways).
Often we get bonus information at the end of this transition of care document.
Patient instructions! I am not certain exactly why we are sent this information, but it's been a cornucopia of learning for me and my nurses. We've been trying the acupressure point so much that we haven't gotten work done! I'm sure my patients all read these documents voraciously.
At the end they are given follow-up instructions. I love the advice: “Your doctor may want to schedule more tests. You may be referred to a specialist. Be sure to keep all appointments. Have tests and exams done regularly as directed by your doctor.” My patients love it when I give vague and unhelpful advice! We might want to do all of those things! We might want to throw a party!
They did, however, leave one thing off the list of things I may do: “Your doctor may be confused as to how there could be 18 pages in a 15-page document.”
So why am I being so mean? Why am I so snarky about the hospital's attempt to communicate with me? Surely it is better than the total lack of information I had grown so accustomed to.
Here's the problem: they are not doing this so I can give better care for my patients. That is painfully obvious when these documents are viewed. They are nearly entirely unhelpful. The purpose of these documents is, instead, to document that they have performed a vital function of the “ACO” (accountable care organization): performed transition of care to the primary care physician. Hospitals are rewarded for doing this kind of thing, as they are presumed to be giving better care when they involve the primary care physician in the process.
This would be true, if not for the fact that they sent me 18 (of 15) pages of computer vomit. My job is to include this vomit in my computer system for posterity, confusing future generations of people who look at these records.
This brings me back to my belief that computerizing an idiotic system does not help anyone; rather, it simply allows idiocy to be performed with much greater efficiency, at a greater volume, and dissipating it to more unsuspecting victims.
This is what you get when care is about checking boxes or submitting codes. You get information that is useful only for the sender, not the receiver. You get information that spews out, not caring how it is received or if it is at all useful. The sad thing is that this is the rule, not the exception for medical records: they are not primarily for care. They are to prove that boxes were checked and codes were submitted so that the folks with the money will “reward” this good behavior.
It's terrible. It's tragic. It cost the hospital a bus-load of money and it's not going to fix anything.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.