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

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

Comments

[Mark Scrimshire]

THe health care industry is so concerned with control they make it difficult to innovate. THere is so much to be learned from the web.

I address this issue on my blog on the subject of data portability and the healthcare challenge.

http://ekive.blogspot.com/2008/04/health-20-healthcare-and-data.html

[jim jaffe]

why does the system have responsibility for creating a comprehensive record. in the financial world? I have accounts scattered about. when it is tax time or I want to refinance, I have to pull the relevant information together, which isn't a terribly heavy lift because I start with Quicken. Of course, I could keep comparable medical records, but I don't. Unsure why.

I'm somewhat confused why many of us avoid financial services companies that offer such one-stop shopping, but then complain that the option isn't available in medicine (tho, isn't it if we select a closed-panel HMO?)