I would admit patients to the hospital and the first order of business is what I refer to as the game of 90 questions. Here I am with a computer in front of me as I take the patients information and ask when the last time was that you where in the hospital. Did you have your tetanus shot and if yes when? Have you have your flu shot and if yes then when? Have you had any surgeries and if yes what kind when and where? Do you have any allergies and what are they? Do you take any medications? How many and what for? Who's your next of kin and do they have power of attorney? Who's your insurance company? What's your address and phone number? Who is your primary health care provider? Do you have any metal in your body? Do have COPD or hypertension and if so what kind of medication are you taking and how much? What's your birthday? Are you diabetic and do you take insulin and if you do what kind and how much? I get about half way through the 90 questions and typically what happens is the patient says "I was just in the hospital" or "they just asked me all those questions in the emergency room don't you have it on your computer?" The answer for me is "well no in fact I do not." Then the doctor goes into see the patient and asks the same questions over again. Then the first thing the doctor asks the nurse is did you get a list of their medications and the answer more often than not is no. At this point the patient the nurse and the doctor are so frustrated that the tension in the air is thick. Now repeat this scenario time after time day after day and you can begin to understand why there is a shortage of nurses and doctors and now as if that where not enough lets throw in the fear of litigation just for fun. This is why the term burn out is used for the high rate of nurses and doctors leaving their practice. All because nobody can or will communicate with each other. The thought that kept coming at me was, come on people we have computers. Everyone else in the world is communicating with each other why isn't the medical community linked to this resource. This is just one of the information games played in the health care system.
There are several other such quagmires that are encountered with or I should say without healthcare information. The patient can't sign consent because they are not mentally capable or the patient is unconscious and can not sign consent for the surgery that they need and there is no next of kin or medical power of attorney (MPOA) available to sign for the patient. What do we do now resituate or not? Will I get sued if I do or will I get sued if I don't? Another barrier that causes a weak link in healthcare communications is the form authorizing providers to receive reports from other healthcare providers and facilities. Once and if you can get the form signed it must be sent to the facility that has the needed report or image. When the consent is signed the first barrier to treatment is down. At this point the consent is faxed and you have overcome the second barrier. Now barrier three someone at the receiving facility needs to find the fax. Then if and when they find the fax they have to locate the requested information and then hopefully they send it back ASAP. Then hopefully a person is looking and waiting for the fax to return so that the doctor can then read the report and make a decision on how to treat the patient. By this time the doctors fear of litigation forces him to repeat a test or procedure because he can not reasonably wait any longer before treating the patient. Thus duplication is created costing insurance companies and government agencies millions if not billions of dollars.
Not only is computer communication fragmented at the national level it is fragmented as well within each of the many medical facilities. There is no communication between doctors' offices and hospitals, or between hospital to hospital, pharmacy to doctor to physical therapy facilities to clinic, or clinic to hospital to insurance companies and etc. The medical community is ten to fifteen years behind the rest of the world. They need to catch up and catch up fast. This lack of communication is crippling healthcare and contributing in a large degree to the high costs of healthcare. I begin thinking that there has got to be a way to implement the ideal that was anticipated with the integration of the computer into the healthcare field. The fragmented system of communications after the installation of computers has not been effective in creating the smooth and integrated flow of information that it should have after their introduction into the hospitals. Paper consents are still filled out and signed and then faxed. Information is still difficult to obtain at best whether it is from the patient or by any other means. The communications environment of healthcare is still using many of the means it has employed since the nineteenth century. This antiquated system of communication can no longer keep pace with the needs of a twenty first century society. This breakdown in the communication process and the frustration it causes for healthcare workers and patients not to mention the wasted dollars is what inspired me to come up with the idea of MediCARD1, Inc. With the MediCARD1/VISA card consent is implied.
When the owner of the MediCARD1/VISA card gives their card to the health care provider in order to access their patients MediCARD1 PHR account on the MediCARD1 website consent is implied. This is secondary to the fact that the patient had to give his/her MediCARD1/VISA card to the provider in order for the provider to activate the account and access the patients PHR. This is done in the same way a someone would use a bank card at the bank or ATM with exactly the same security measures built into the card. With out the card and the pin number there is no possible way to access the account. This system is also used at the point of contact for the payment due at that time of service. This in conjunction with the HSA service provided for the client assures that all co-payments can and will be rendered at the time of service. Health insurance companies as well as government agencies such as Medicaid and Medicare can have the ability with the co-branded MediCARD1/VISA card to make payment at time of service without any additional steps other than to load the card with the patients covered amount. With the MediCARD1/VISA card the transaction is automated electronically and recorded immediately at the point of contact. This record is easily accessed by the agency, patient and or provider via the electronically automated MediCARD1/VISA processes. This process eliminates much of the back office billing with electronically automated billing codes at the point of service. This process reduces's the overall costs associated with the billing process and saves money for the government agencies as well as raise the income levels of health care providers that participate in this process. The health care provider will pull down a menu of billing codes from off of the web site and simply click on the appropriate code for the service provided. This transaction will automatically be recorded accounted and deducted at the point of service removing the back office processes. This in essence is a direct and singular activity that is actuated by the health care provider with instantaneous billing and payment as a result of the feature built into the system. This system will virtually eliminate the need for the back office entirely. This as well as the electronic audio recognition system built into the the system will replace financial burden of the dictationist from the providers services which will add another benefit raising the bottom line for health care providers. This service can be applied to physicians, nurses, therapist and any other health care provider that needs to record or chart notes.
In a future blog I will tell health providers how to make money with their EMR.