How does Doc A know what Doc B is prescribing?
So I’m in one of those tiny, big-practice medical examining rooms, waiting for the doctor. They used to keep copies of the Physicians Desk Reference in these rooms, which were fun to read, but I imagine that’s gone all digital. So I scan e-mail on my BlackBerry, get bored with that, then pick up and examine the football-sized model of the human digestive system. In real life, it covers a lot of yardage, if not exactly a straight line.
Result of the visit is, I have to take a pill every day. No biggie, I’ll add it to the statutory Lipitor. And the fish oil. And baby aspirin. And multi-vitamim. I’m no spring chicken.
For most of the world, there is no electronic medical record. This particular specialist has an iPhone and a notebook PC on a rollabout stand. The laptop seems to be connected to a WiFi network, but the doctor has several pages of written notes. Regardless, whatever he knows is unknown to my primary care physician P.C.P.). That practice, in yet another fancy building in Bethesda, Maryland is something like Jiffy Lube — it simulates personal care. But they know your body in the same way the grease monkey at Jiffy Lube knows your car. He’s seeing 50 cars on his shift. Not like the mechanic you grew up with who, when you were filling up, would call out, “Hey, let me know when you want to bring it in for those ball joints.” Heck, a checkup today, they don’t even unbutton your shirt to listen to your heart. You could be speckled with melanoma and your P.C.P. would never know.
Anyhow, basically sound as I am, it occurs to me that the P.C.P. ought to be aware that I have acquired a new pill habit that won’t otherwise show up on his records. The two practices don’t communicate. They would if some sort of EMR infrastructure existed in a meaningful way. But automated medical offices are stovepipes, lacking automated cross communication. The specialist wants two or three tests added to the next time the P.C.P. does my semi-annual blood workup. So I have a scribbled-on piece of paper to carry in the next time they draw blood. How’s that for sneakerware? This isn’t rural West Virginia, but a hub in one of the densest, most affluent suburbs in the hemisphere. The three miles between the two practices are clotted with doctors and facilities including the National Institutes of Health and the Walter Reed National Military Medical Center and a big hospital with a helipad on the roof.
When I call the primary care place, I finally reach a somebody who agrees to take a message for the P.C.P. Yet I sense a blend of irritation and puzzlement in her voice. Like, “Why is this turkey calling us to tell us about a prescription from some other place?” The next time I go I’m going to test to see whether he is aware of the information. The incident brought out in sharp relieve, if only in a routine situation, the efficiency and better quality that and electronic medical records infrastructure could bring.
Yet I can see why — despite a two and a half year program of the federal government trying to bribe medical practices into adopting EMRs for “meaningful use”– so few practices have it. It’s mainly that they are too busy.