Over the past few years there has been a lot of talk and press about healthcare information technology (otherwise referred to as HIT) revolutionizing care - including improving outcomes, controlling and/or cutting costs, etc. This includes things like clinical information systems, electronic health records (EHR) and other systems that are touted as the way out of the wilderness in our current broken and unsustainable system of health care in America. This situation is getting a lot of airplay given the current healthcare reform movement in the US.
A great deal of such claims, implemented and managed properly, have merit. The US government is going to drop more than a few billions into the pot to advance these ideas. HIT is perhaps one of the hottest areas of technology and IT at the moment, and I don't see that changing anytime soon.
However, given a negative direct experience I recently had with it, it appears that we have a long way to go to realize such goals. I had an appointment with my primary care physician for my annual physical and to renew prescriptions on medications I take long-term. The physical went well, and since I split my time between Oregon and Minnesota, I asked my doctor to write 30-day prescriptions for each of the medications and a separate 4x90 prescription for each to use for mail-order purposes. I needed the 30-day prescriptions since my supply of the medications ran out the very day I had the appointment and I could not get refills without his approval - i.e. the appointment to see him was part of that approval.
As an aside, I found it interesting that his nurse, who saw me first and asked questions, had a tablet PC with some kind of software on it where she recorded my responses, my weight and height as I stepped on the scale, and other information that looked to me like my prescription history. Even more interesting was when my doctor came in - with a paper folder containing my medical records and history. Nurse uses technology, but my doctor doesn't...hmmm.
After the appointment concluded, the nurse asked me which pharmacy (in Oregon or Minnesota) I wanted the 30-day prescriptions sent to, as she was going to do it electronically. I said Oregon - local - because I needed the refills that day. She also told me that she was electronically sending the mail order scripts to that provider separately. I then went downstairs to the lab to get my blood drawn, then leave the office and go about my business that day.
As I left the lab area, the nurse stopped me in the hall and handed me 3 paper prescriptions - problems with the download to the pharmacy, she said. I then drove to the pharmacy to drop off the prescriptions for later pickup that afternoon.
The fun really began after I arrived at the pharmacy around 5 PM. The pharmacy tech said the prescriptions were, contrary to the nurse's statement, transmitted to BOTH pharmacies in Oregon and Minnesota, and the Minnesota pharmacy 'got there first' and electronically transmitted claims for the medications to my health insurance company. Of course, my health insurer has absolutely no intention of paying their share of the scripts twice, so I was out-of-luck getting my medications that day unless I wanted to pay full-price and deal with all of this crap later.
Luckily, this fine young man had a plan - he would call my insurer and the Minnesota pharmacy to get the claim and scripts to them rescinded, and could I come back in a couple of hours and everything should be straightened out. I did so, and all was made OK by the efforts of this excellent pharmacy tech. I asked him how much time he had to spend straightening this mess out, and he said about 45 minutes elapsed over an hour-and-a-half - most of it manual and talking to human beings, not electronically generating, sending, and receiving information.
So....what we have here folks, is a failure of process. All of this great health IT - in this case, the electronic transmission of prescriptions, isn't going to get us anywhere if the process is messed up, or more to the point, takes much manual intervention to correct any problems and issues that arise. It isn't going to save time, much less money, and while my situation wasn't life-threatening, what if it was?
It would be easy to state that my doctor's assistant wasn't too sharp, but that isn't true. Perhaps the fact that I get my medications from two different pharmacies confused her order entry - which should have been picked up and reported to her by the software she was using. It is a busy office, and perhaps she was distracted while entering my orders and not paying attention to error messages the software gave her. The fact remains that this particular health IT process is far from seamless, many others are also, and we have much work to do in getting process, coordination, assumptions, and facts straight before I'm going to be convinced that this is going to positively impact care and costs as various healthcare policy wonks and pundits state.
Oh, and the 4x90 mail order prescriptions somehow never made it to the mail-order pharmacy company. I had to present forms to my doctor's office a few weeks after this incident so they could electronically sign and present them to the mail-order pharmacy for fulfillment and requisite claims from my health insurance.
Of course, this process between me, the doctor's office, and the mail order pharmacy used a straightforward, if dated form of transmission: the good old fax machine. Go figure.