I read an interesting column about an octogenarian woman who lived by herself, despite multiple chronic conditions including congestive heart failure, arthritis, gout and glaucoma. Her health deteriorated rapidly last year and her primary caregiver, her daughter who lived two and a half hours away, was faced with putting her independent mother in an assisted-living facility.
In a nutshell, her decline followed taking a new medication that was prescribed to relieve excruciating pain - a result of built-up pressure behind one eye from her glaucoma. She became dehydrated, which precipitated her collapses around the house, lost her appetite and became confused. She was rushed to the hospital a handful of times and released. After the third visit to the hospital, a new doctor reviewed her medication list. Having had taken the new pill that the elderly woman had been prescribed - in his case to relieve altitude sickness - he understood that her symptoms were caused by the pill.
Once she was taken off the pill, she became herself again and the headaches returned. She opted for the alternative to the pill, which was surgery that would guarantee complete blindness in her bad eye. After her brush with the side effects of the pill, one blind eye was preferable.
The columnist made mention of the fact that he didn’t think having an EHR would have red flagged the problem. He said drug interaction alerts may come up but not "a bad reaction to a single drug." He blamed it on the doctors being too busy with too many patients to "connect the dots" of what ails their patients and a lack of caring on the part of primary care physicians.
There is truth to doctors having to see so many patients and patient care slipping through the cracks, but I'm not sure I agree with him about EHRs not making a difference. If the EMR or EHR system had an integrated evidence-based and experience-based clinical decision support solution, I suspect a red flag would have alerted the physician. If those symptoms are common side effects, the evidence would have been in the system.
Interoperability is part of the meaningful use criteria. Let me put in a plug for the value of health information exchange. If the ophthalmologist, the primary care physician and the local hospitals had EMR systems that were connected, they would all know that the patient had glaucoma, excruciating pain in one eye and is now taking a new medication, whose timing coincides with the bouts of dehydration and confusion.
I want to know how the physician who discovered the problem came across the medication list. Was it generated from an EHR or EMR system? Was it a paper record that was kept up by the provider, and if so, which provider? Or was it a list generated by the elderly woman's daughter? The reason I ask is that without that med list, the doctor wouldn't have connected the dots in the first place. An EHR and an EMR would have that medication list.
To his point about physicians being so busy and seeing so many patients, an EHR and EMR system has the potential to create a more efficient workflow, freeing up the physician to take care of the patient and connect the dots.
Lastly, I'm no physician, but wouldn't one of the first questions a physician asks upon presentation of the patient be: What's changed in this patient's life that may have created this problem?
Photo by Borya via Creative Commons license.
