Thoughts on Care

Well, my wife is pretty much recovered from her hospital stay, and we finished our last follow-up visit which went even better than expected. As I've said before, I'm not usually on the patient side of the health care environment. The experience was frightening, and I can readily admit to being an annoyance to all of the very patient people who provided for my wife through our four-day tour of Hunterdon Medical Center, despite trying to be as pleasant as possible.

My only real previous experience with the patient end of care was when I was on vacation in Gatlinberg, Tennessee and wound up in the ER at Fort Sanders Sevier Medical Center, which has the distinction of being one of the busiest ER's in the whole state. While they had a very nice EMR and seemed quite technologically enabled, I spent about 16 of the 20 total hours in that place waiting for a chance to talk to a medical professional of any variety. The staff was overworked, their triage was unable to keep up with demand and space was so limited patients were literally lined up along the halls in gurneys, with the scene reminiscent of the Crimean War imagery so often invoked during historical discussions of Nursing. Care focused on technical achievement of patient outcomes at the expense of expressive activities.

Fast-forward to Hunterdon, and this sleepy community medical center couldn't be more different. The EMR was underutilized and paper charting was the norm, and there were moments where I questioned the technical competence of the care provided. However, their expressive functions were so good, the environment so precisely engineered to promote calm and healing that the technical aspects of care seemed like a much more workable deficiency. Coming from a technologically enabled, large-scale care environment in Cleveland where two major health systems are currently engaged in fairly intense competition for patients and acquisition of hospitals, I've felt for some time that there was little difference in the quality of care delivered from one hospital to another. Indeed, barring large differences in the typical quality indicies used to compare hospitals nationally, how should a patient choose between patronizing one institution over another?

After my (albeit limited) experience on the patient side, combined with my knowledge of care delivery, I would say the greatest single factor should be the patient experience. I'll even get heretical here, and posit that the patient experience within a competitive care environment is more important than use of technology such as EMRs and novel devices. Why do I say this? Well, because if a patient's health care provider only spends about 10 minutes with them each hospital day, or if that patient waits for several hours in a glorified holding pen, they really stop caring about the information technology and high-tech devices of that institution. Those things don't let them communicate that they need more pain medication, or that the vesicant solution currently running through their IV burns so badly they burst into tears. That pump may be accurately delivering its dose, but it still can't adjust the fluid concentration to relieve suffering.

Disney is now getting into healthcare, and have several case studies on the effectiveness of improving the patient's perception of care and expressive functions over technical achievement. I watched one of their webinars, and while I wouldn't rush to call them in at $300 an hour (or whatever they charge), it did make me reconsider my role. IT is not care; it is facilitative technology. No EMR implementation is going to be successful that does--as its end result--improve the perception of care delivery by the patient. You may wow them on Day 1 with Tablets, COWs, and CPOE, but by Day 3 the patient doesn't give damn. They just want their fears to be allayed and their suffering to be relieved, and everything else just falls to the wayside.