The news release posted below is a true problem, and a problem with the health care delivery system. Having spent many years working within the field I can testify there is a break down in communication and information sharing that occurs and electronic medical record are not the answer. I have had physicians (both primary care and cardiologist) request we do not send them reports, because they are bogged down with them and won’t read them anyway. Yet from the health care delivery stand point there must be a trail of documentation to support the delivery of services to allow reimbursement for your services. Another concern from the physician standpoint is who is responsible for acting on issues without stepping on the toes of the other health care providers…Yep a turf war.
So how is the best way to ensure your physicians stay actively involved in your heart recovery?
- Hand carry the reports if able to your physician
- Ask your physician to review the reports with you
- Question the data provided – what does it mean, how does it compare with previous reports
- Be an active consumer not passive
Yes your physician will hate it, as you are requiring more of their time, you probably learned some information from the internet – God Forbid – and that you have an opinion. Not every physician responds this way, some are learning to embrace the empowered and educated patients as well as the use of technology, but many despise it due to time constraints.
Many times the issues found during rehabilitation should be addressed promptly, yet it can take months to get in with cardiology unless it is emergent. I can’t tell you how many times cardiology offices would tell me to send the patient to the ER as it was the quickest way to get the issues addressed, yet the patients were stable and didn’t require ER services, instead they needed consultation and medical management to prevent the problems from being life threatening.
One physician I worked with got annoyed with me for highlighting the pertinent facts on the reports I would send over. I knew he wouldn’t take the time to read the report unless I used highlighter, red ink, urgent notice, immediate response required notices etc….and still to would not get responses. This is due to the health care delivery system. My belief is the use of more mid level providers to review records, determine course of action, follow up with the issues…and this is more necessary with electronic records.
Electronic records are wonderful, they allow the practitioners to follow the course of care, the issues that arose and the care received. However access is limited on a need to know basis and thus health care practitioners are not allowed to access records which may have very detailed pertinent information that will effect the delivery. There needs to be time and access for chart review.
Toronto, ON – The discharge summaries that should follow patients from cardiac rehabilitation to their primary-care providers, who use them for planning continued care, don’t reach the intended person about half the time, a prospective study suggests . The summaries that do reach primary-care providers, moreover, often are missing key information on patient medications and clinical status, according to the authors, led by Peter A Polyzotis (York University, Toronto, ON).
“Although more clinical evidence supporting the effects of [cardiac-rehabilitation] summary transmission is needed, results suggest that more standardized strategies for [cardiac-rehabilitation] summary information gathering, generation, and transmission are required,” the group writes in a report published online January 8, 2013 in Circulation:Cardiovascular Quality and Outcomes.
In this study, conducted between September 2008 and March 2011, a survey was sent to a sample of 138 primary-care providers, nearly all physicians, associated with patients enrolled in eight cardiac-rehabilitation programs in Ontario. Of those, 71 (51.5%) received a discharge summary, the primary end point of the analysis; 64 of those also completed the survey.
According to their responses:
- All providers actively wished to receive a summary, preferably by fax (61.3%), conventional mail (26%), or electronically (13%).
- 89% reported that the summary was received in time for the patient’s first postrehab visit.
- 77% of providers reported that the summary information would be used.
Medications, patient-care plan, and clinical status were rated by providers as the most important elements of the discharge summary. But that information was reported as missing in 19%, 4.7%, and 22% of cases, respectively.
As to why so many discharge summaries did not reach primary-care providers, it was found that many summaries were addressed to other persons at the primary-care provider’s location or were otherwise misdirected and that some patients failed to complete their assessments at the end of their rehabilitation program.