Friday, July 24, 2009

More Expensive Medical Care & Duplication of Testing...

So I spoke about the poor integration of information systems in medicine...and here's even more. The technology is out there to convert radiology imaging and other ultrasound imaging into an electronic format. Some hospitals have that capability. You no longer have to get a copy of an x-ray and stick it on a view box, rather it's transmitted to a computer terminal and you view it on a screen. Systems can be very sophisticated where you can essentially connect via secured Internet sites with encrypted information) to view these studies in your office or even in your home called teleradiography.

The biggest issue however, is if you are not a part of a hospital (meaning you don't have privileges as a physicians) you do not have access to the information. There is a total lack of integration. There is also a concern that somehow, people will get sensitive health care related information, and inappropriately disseminate it. Where this is true with any electronic data, there are enough mechanisms in place to assure security.

Let me give you an example of how ridiculous this is for the EM physician. Mr. A presents to the ED at Hospital B with a chief complaint of chronic headaches for the last few months on a Friday at 6 p.m. He states he was called by his doctor, physician C, who had ordered an MRI of his head and was told that he has an abnormality and needs to go to the hospital - perhaps a brain tumor and he has had the MRI at hospital D's outpatient department. You call physician C, but physician E, a covering doctor, does not know anything about the patient or the results and cannot get in touch with physician C. You call hospital B, only to find that they cannot give you the information because the MRI department is closed. It closed at 5 pm. So, what are stuck doing - you can either repeat the MRI, which is an extremely expensive test and not easy to get even in your hospital at 6 p.m. or you perform a CT scan of the head (less expensive but still expensive and has a small risk for radiation exposure). Hours later you get the results of the CT scan - a brain tumor, you still need the results of the MRI but that can wait tonight since you have a diagnosis and the patient needs to be admitted to the hospital for a biopsy and treatment.

And you ask, why did the patient not go to hospital D's ED after the call...the answer, "because your hospital has a better reputation" but I lived closure to hospital D to get the MRI and it was easier....Of my God, not easier for the poor physician working in Hospital B's ED trying to care for the poor patient (who by the way, will ultimately probably die within a year despite chemotherapy, radiation, and surgery) all further expensive care with a low yield for survival.

Again, do you really think that physicians enjoy working this way?

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