Sunday, October 7, 2012

Wasting time and money on a long weekend

I often hear stories about physicians repeating lab tests or x-rays because it's inconvenient to get results from other hospitals or physician offices. I flatter myself that I'll make a concerted effort to track down test results before subjecting patients to repeat testing. Sometimes however, "the system" will not yield.

Here is a little story:

Earlier in the week, I saw a lady who was passing a kidney stone. We agreed that she would give it a few days but if the pain continued, we would do emergency surgery over the holiday long weekend. The complicating factor was that she lives in a community that is more than a 5 hour drive away from Saskatoon and she didn't want to come to Saskatoon if she didn't have to (that is, if she passed the stone in the meantime). For that reason, she had an x-ray done in her home community late in the week. The written x-ray report came down to me by fax and there was no mention of a kidney stone. (This can either mean that the stone is gone or that the radiologist has not noticed the stone on the x-ray.) Also, she was still having some discomfort, making us both suspicious that the stone might still be present. I needed to compare the x-ray to the one she had done earlier in the week to see if the stone truly had passed.

The challenge was that her home community is not connected with our electronic access system for x-rays (PACS). PACS allows online access to x-rays done in many places around the province as soon as they are completed. This innovation has markedly improved the speed with which we can make appropriate diagnosis. In her case, however, she would need to have the hospital make a CD with her x-ray on it and then send the CD to me. With this being a holiday long weekend, it would be well into next week before I could make a diagnosis.

She called me back to let me know that her plans had changed and she was planning to come to Saskatoon for the long weekend. She would drop a CD off at one of the hospitals when she arrived and I would pick it up in the morning.

The next morning turned out to be a vignette of frustration.

I searched around the department where my patient said she had left the CD but no one knew where was. I called her to check that she had actually dropped off and she assured me she had. I returned to the department and someone remembered where it was. I tried to open the x-ray files on a computer but was unable to do so. (Usually, loading the CD on a computer automatically opens the x-ray pictures.) I hunted down the on-call radiologist to see if he could open the pictures. He spent 10 minutes trying but was also unsuccessful.

I called my patient and told her we would need to repeat the x-ray. She came to the emergency department and registered herself. She had the x-ray repeated and I checked the results. After comparing to the previous x-ray, I could see that the stone had actually passed. I met her in the emergency department and gave her the good news.

I estimate the time I spent with phone calls, searching for the disc, and trying to open it with the radiologist was about 30 minutes. That's 30 minutes of completely non-value added time.

Also, there is the real cost of registering my patient in the emergency department, doing another x-ray, paying the radiologist fee for interpreting the x-ray, and paying my bill for seeing the patient in the emergency department.  (I've ignored any patient costs...)  If I would have had access to the x-ray electronically, I would have phoned her and the additional cost to "the system" would be zero. There is also a non-tangible cost of frustration both on my and my patient's part. When a similar situation comes up in the future, I'll be tempted to make things easier for myself by insisting that the patient come to Saskatoon to have another x-ray done.

Multiply these costs by the number of times similar scenarios play out across our health care system and you begin to see the money and resources we are squandering by not having a fully integrated electronic medical record. What a waste!

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