This is Regina Holliday's husband's most basic - and important - health
information. It is on display at Pumpernickel's Deli in Washington,
DC.
Did I mention it is a mural? A permanent mural? It is the first of a series of public medical murals. Regina is making a point. This representation of a single page document is what she has been desperately needing for the last two months.
If this information had been available to her, her story would be less horrific. If the medical professionals who had been taking care of her husband had known this basic information, things would have turned out differently.
By differently, I mean better. Certainly a heck of a lot better for her husband, who had a distended bladder that went untreated until he was transferred to a different medical facility. It was documented in his EHR on several occasions, the most recent entry indicating his bladder was “dangerously” distended.
Why wasn't he treated at the first facility? Probably because this basic and critical information was buried in his “electronic health record.” It was, for all intents and purposes, inaccessible (except for billing purposes). To make matters worse, she was told she would have to wait 21 days for his medical records. Twenty one days is a long time to wait for treatment for a dangerously distended bladder.
In response to Regina's story, Ted Eytan asked a great question: Is it meaningful if patient's can't use it? (http://www.tedeytan.com/2009/05/28/3086) I would like to add a second question. Is it meaningful if no one (including medical professionals) can easily access it in a timely manner?
Comments
Dear Mrs. Troop,
I am sorry that you think the “healthcare industry is broken.” Thankfully, when the clinicians' attention was turned to your husband, instead of the “electronic health record,” he received the care he needed.
The current frenzy over EMR’s and “meaningful use” has deflected the focus away from the practice of medicine and ignores the obvious. What is broken is the fact that many EMR vendors are competing in the same space, the business domain. They offer no solutions for busy practitioners in the clinical domain, where the clinicians operate.
Your husband’s “badly distended” bladder is not uncommon. A patient was transferred to me with the same problem. She had her bladder emptied expeditiously. The difference is that we never lost her “diagnosis” or her document of clinical activity because of the clinical information management system that I used and perfected for more than seven years in my private practice.
In December, 2008, I received US patent 7,464,043 for the process.
We are presently working on the open source module for the system and will, in the near future, be making it and the entire project available to clinicians nationwide.
Sincerely yours,
Evan Earl Dussia, II, MD
Posted by: Evan Earl Dussia, II, MD | Jun 2, 2009 1:01:24 PM
Dear Mrs. Troop,
I am sorry that you think the “healthcare industry is broken.” Thankfully, when the clinicians' attention was turned to your husband, instead of the “electronic health record,” he received the care he needed.
The current frenzy over EMR’s and “meaningful use” has deflected focus away from the practice of medicine and ignores the obvious. What is broken is the fact that many EMR vendors are competing in the same space, the business domain. They offer no solutions for busy practitioners in the clinical domain, where the clinicians operate.
Your husband’s “badly distended” bladder is not uncommon. A patient was transferred to me with the same problem. She had her bladder emptied expeditiously. The difference is that we never lost her “diagnosis” or her document of clinical activity because of the clinical information management system that I used and perfected for more than seven years in my private practice.
In December, 2008, I received US patent 7,464,043 for the process.
We are presently working on the open source module for the system and will, in the near future, be making it and the entire project available to clinicians nationwide.
Sincerely yours,
Evan Earl Dussia, II, MD
Posted by: Evan Earl Dussia, II, MD | Jun 2, 2009 1:06:48 PM
Dear Mrs. Throop,
I messed that up. Not only did I misspell your name, I missed the fact that the poor man with the distended bladder was Mr. Holliday.
The rest of the post is accurate.
Sincerely,
Evan Earl Dussia, II, MD
Posted by: Evan Earl Dussia, II, MD | Jun 2, 2009 1:13:21 PM
Dr. Dussia,
Thank you for your comments! It sounds like you have developed a great solution - and open source, no less!
The title "Nothing Personal" was a play on words. There is no single person, entity, hospital system, medical facility, software system, etc. to blame for the current health care crisis. There are many wonderful people out there who are developing, implementing, and sharing solutions.
When I say the “health care system” is broken, what I mean is that there is simply no overarching system in place in the U.S. It functions as countless pockets of caring and generosity and hope…and other pockets where things either don’t make sense or don’t happen.
Dr. Levy’s post (also published today on THCB – direct link below) provides a helpful real-world analogy for the current situation. The health care “system” is full of dangerous cracks. We greatly appreciate the people like yourself who work to do the best work they can and (even better!) *share* it with others. In (grossly simplified terms) what we need to do at this point is figure out how to fill in the cracks.
(http://www.thehealthcareblog.com/the_health_care_blog/2009/06/the-infrastructure-chronicles.html)
Posted by: Cindy Throop | Jun 2, 2009 4:43:35 PM
The problem is always with the money. We live in a world of greed. Here, Dr. Dussia, who probably has a healthy practice and time on his hands since he has time to post - has a potential solution to a terrible problem. However, instead of sharing this process or software as shareware immediately, he must make profit from it. Is this in order to survive in this world, or in order to advance?
How many more lives will be lost in this process of obtaining a patent, investing in marketing, obtaining copyright infringment insurance, professional liability insurance, separating assets, hiring lawyers and so on?
Why not just help people without expectation for something in return?
Where is society as a whole headed?
What ever happened to doing the right thing for the right reasons?
When kids are little and people ask them "What do you want to be when you grow up?" They have a reason for their choice. These kids want to be police to help others, they want to be firemen to be the hero, they want to be doctors to save lives.
How do we as adults let society warp us so much? Jeffrey Gitomer said it best the other day: "First you think about it, then you pray about it, then you become an example of it, and then you DO SOMETHING ABOUT IT. Give value first, without any expectation of return, and the law of reciprocity (the law of attraction) sets in.
Not from the person you gave something to. If you give without expectation, then the world pays you back, and that payment is not one-for-one – it’s ten-for-one. Or more. It’s the true law of attraction."
Why can't more of us operate that way?
Posted by: Anon | Jun 3, 2009 11:37:06 AM
Amigo Anon,
Move to Venezuela. What you are talking about is precisely the system that I have created here for all my people. Everybody works for free. No savage capitalism. It's wonderful here. People complain but I don't care. I subsidize the beer made out of cheap yucca root and that keeps them happy over the week until Thursday then Friday I give them another dosis. I think we added a little natural coke to it, which is healthy too and if you don't believe me you can ask Evo Morales.
Who needs healthcare? No, we don't. Aren't we all just going to die someday? When I started in government I promised healthcare to all Venezuelans but then I said: "That's just too much money! I'll just let those sick pendejos die quicker, anyways they can't drink my yucca root beer!".
Crazy American doctors just want money. Dr. Evan already makes money from medicine, and now he has to make money from computer programs? How insensible. Why doesn't he just live out of thin air like all my people in this oil blessed country.
Socialism is the best. No money problems for the people since me and my peers take care of that unpleasant stuff. They eat what they need to survive, anyways, the world is under populated so I am helping make the world a greener place to live.
And here we have the "Law of Attraction" too. We truly turn you into a guru. You see you have very little food so you spend your time meditating so the hunger feeling goes away. If you meditate long enough sitting in the crowded corners of Caracas then you get to attract some coins. I heard some fill those pots twice a day.
And if you don't like Venezuela you can always go to Cuba where my friend Fidel Castro will give you a warm welcome. But hey, Cuba has no oil so you have to find clever ways to eat since there are no Chavistas that have coins to give out.
Free healthcare is my motto. Evil money should be eliminated from the people. I can manage it all myself.
Gracias Hermano,
Hugo Chavez
Posted by: Hugo Chavez | Jun 3, 2009 3:50:16 PM
Amigo Anon,
I forgot to tell you this: In Venezuela and Cuba you can NOT make anonymous comments protesting any situation, no matter how right you may be. We have to protect the integrity of our system therefore we can not allow anything perturbing, you must understand. I'm sure you do.
Well, sorry, you can post anonymously, but then you will be sentenced to 10 years in jail. This is a friendly warning my friend.
But, you can protest about anything you want of the money adoring Americans with a special permit that we give you that costs a mere $100,000.00 per year since we know you will profit from it eventually.
If you critizice the American healthcare system we will give you a special discount. But you must promote Health Tourism to Cuba and Venezuela in order to get this benefit.
We have to "destroy" those capitalistic physicians in the US somehow and we need your help.
Did I tell you that I practice the "Law of Attraction" to win my votes and perpetually stay in power? Yes, I attract with oil stolen from my people. For a greater cause of course. They will be paid back tenfold in the future, or in heaven.
Do you want a book?
Your Socialist Amigo Hugo
Posted by: Hugo Chavez | Jun 3, 2009 5:36:20 PM
Dear Fake Hugo Chávez (aka Equally Anonymous Cynic) -
Anyone would know that the real Hugo Chávez would use an accent on his last name.
Thanks to our wonderful healthcare system, Regina Holliday is going through a special kind of personal hell that you wouldn't wish on your worst enemies, including Fidel.
This isn't the place for cheesy political satire. In fact it's in really poor taste, compañero.
Human suffering goes beyond politics.
Posted by: Claudio Luís Vera | Jun 3, 2009 7:13:19 PM
I must be doing something wrong with the "Law of Attraction"!
I keep attracting political activists with socialist tendencies dedicated to healthcare IT blogging.
Why don't you try to fix the problems in latin america? Because you know you won't get anywhere!
And you are right it's Chávez with an accent and his second surname is Frías with an accent as well.
By the way, it's not compañero, but camarada.
Socialist politics is the culprit of human suffering!
El Camarada
Posted by: Hugo Chavez | Jun 3, 2009 7:52:03 PM
Hello,
Hugo is being facetious but I do get his point.
Dr. Drussia does not have to give away his solution for free.
Healthcare may be expensive but at least its better than in most countries.
John
Posted by: John Schene | Jun 4, 2009 11:16:19 AM
Dear Anon,
Who said anything about money? I certainly didn't. I would be glad to explain open source to you, but I sense you only wanted to have a political rant.
I had a discussion with a 25 bed hospital this morning and the administrator rightly observed that this service is a method for emergency room docs in isolated hospitals to share clinical information about the folks who live in sparsely populated areas.
There are solutions. While it is difficult to provide anything for free--the servers need electricity and our spouses like to eat regularly--the answers to the reasons why ambulatory care facilities and hospitals have not bought into the current commercial off-the-shelf systems is simply because what they offer clinicians is not helpful in the workplace.
The business solutions work in the business domain, but not in the clinical domain.
I am going to do something I hadn't planned to do--shameless self-promotion.
I don't propose to sell any software. I plan to provide a service to clinicians, practicing medicine on the front lines, for about $75 per month. Necessary and sufficient clinical information accessible at the point of service with no incremental workload for the clinicain user.
Posted by: Evan Earl Dussia, II, MD | Jun 4, 2009 11:58:56 AM
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