We generate a lot of paper.
Our lives are filled with forms, prescriptions, outside medical records, letters from insurance companies, consult notes from outside providers, lists and other items our patients bring with them to show us, and multiple other sources.
And I thought we were going paperless …
Every day I get dozens and dozens of faxes.
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Faxes? Who still faxes? Just as members of the nonmedical community scoff at us for still using pagers (“How 1980s!”), many people cannot fathom that we still use fax machines to communicate and receive information on our patients.
“Can’t you just email it to me?”
“Isn’t it in the computer?”
Last week, while I was out on vacation, one of my patients came in for an interim visit, to go over a number of acute and chronic issues that had come up in the previous few weeks. Unaware that I was not here he had walked into the practice to see me, so he was placed on the schedule of one of our nurse practitioners.
Once the NP had taken him back to the exam room, he said “I saw my cardiologist last week, he did some blood tests, and made some changes, do you have them?”
Apparently my patient was flabbergasted that this information was not immediately available for review. He said that the cardiologist told him he was going to send it over, why didn’t we have it?
The practitioner tried to reach the cardiologist’s office, left a message, looked through our fax machine, and did ultimately realize that despite the fact that this provider was not on campus he used our hospital’s lab, so he was at least able to find those.
With this information, along with some input from the patient, he was able to piece together some of the picture, but nonetheless it was not complete, not ideal, not truly patient-centered.
It turns out that the day I left for vacation, the cardiologist’s office notes, test results and plan had been faxed over in a seven page fax, which ended up here:
Waiting to be scanned, waiting to be added to the media section of our electronic health record, waiting, waiting, waiting, and maybe not the ideal place to leave critical information involving patient care.
With our electronic health record, all providers who use the same system in the outpatient setting at our institution have notes that are visible to each other.
Interestingly, some practitioners still find it hard to not fax over copies of their office notes, even when we share the same electronic health record. Some have an employee whose only job is to print out office notes from the EHR, and fax and mail them to the provider who requested the consultation. While this is better than nothing, they’re creating work for themselves, not knowing that a simple click of a routing button in the EHR can send it to any provider in the system.
An incredibly useful improvement in our electronic health record is that since EPIC holds such a large market share, it now has the functionality to retrieve records from other institutions that share the system. Therefore if our patients had a cardiac catheterization at another institution several miles away, across town, or across the state, and they use EPIC, we are able to retrieve the report. Coming soon will be functionality to retrieve these from anywhere in the country.
And our hope is that, as improvements of interoperability continue to mature, ultimately we will be able to retrieve any electronic health record into our own, from anywhere in the country, or even anywhere in the world.
Wouldn’t it be nice, if our patient had a CBC done in an emergency room while they were away on vacation, that we would be able to pull that information directly into our system, and compare it to his prior, to see whether there was a clinically relevant change?
For now, lots of stuff comes to us in the form of paper: photocopied old handwritten notes, printed copies of outside electronic health records, faxes, printouts of outside radiology reports, reams of paper printed by an emergency room on discharge, all brought in for us to incorporate into the patient’s health record.
So what do we do with all of these faxes? We need to figure out how to get them into the electronic health record in a meaningful way, where they’re in the right place, at the right time, for the right person to take action necessary to make a difference for our patients.
Right now, the colonoscopy report done at an outside institution that comes to us in the mail as a printed report gets opened, reviewed, labeled with the patient’s name, date of birth, medical record number, and placed into that pile for scanning. Often a chart note summarizing the report is created.
The staff member scanning it in will often simply attach it to a file in the media section of the EHR, label it “colonoscopy”, and then they’re done.
In an ideal world, this report should satisfy the order that was placed for a colonoscopy written by me, and also serve to satisfy the EHR’s health maintenance requirement for colon cancer screening.
As it is, we have to scan that report in, then go to the health maintenance section, click that the colonoscopy was done on a certain date, when the next one is due, and any other relevant clinical information, oftentimes having to reference the scanned image of the colonoscopy report.
Wouldn’t it be nice if this all happened seamlessly, electronically, smoothly, behind-the-scenes?
A fix for the fax.
Maybe then we wouldn’t mind all this paper so much.
Date: August 20, 2015