Wednesday, January 2, 2013
Sharing Orders with Patients
In previous posts, I've talked about the perfect storm for innovation - alignment of an idea, policy, technology, people, and incentives. Roni Zeiger, a world class informatician who provided physician leadership for the Google Health project in the past, recently suggested an idea which I think has the potential for significant innovation in the world of patient and family engagement - Patient Friendly Orders.
Here's an analogy.
Last night I went to a neighborhood grocery store, Roche Brothers, to purchase a few vegetables. They were having a sale on romaine lettuce and a special bar code on each lettuce reminded the checker to give a dollar off per head.
Next to the cash register, a "consumer friendly display" showed each item scanned in plain english, not some odd abbreviation like Rmne Lttc, and its price. At the end of checkout, I noticed she forgot to scan the dollar off discounts, so I pointed to the display, identifying the problem. She immediately corrected it.
Imagine if every patient had access to a web page of their current hospital orders in patient friendly terminology i.e.
You are receiving an antibiotic called Ceftriaxone to treat your lung infection. It is being given once per day in your IV.
You are receiving Tylenol for your fever. It will given every 4-6 hours as needed for fever. You may requested it for pain but note that no more than 8 tablets will be given per day because more could adversely affect your liver.
You may request Benadryl as a sleep aid in the evening
I've posted the story of my mother's recent hospitalization for a broken hip and the challenge I experienced trying to obtain a list of the medications she was given (a total of 22, instead of the 2 she was actually supposed to take). Such a problem would not have occurred with Patient Friendly Orders. I could have scanned her orders from the airport before the flight to visit her and could have called the hospitalist with corrections. My mother would have immediately recognized the inappropriate nature of the treatment she was receiving since the vast majority of medications were discontinued years ago.
There are informatics, educational, and policy challenges to implementing Patient Friendly Orders, but I do not see it as much more complex than the Open Notes project we recently completed.
Maybe the National Library of Medicine, with it's wonderful vocabulary/code set resources and patient friendly educational materials could lend a hand.
Definitely worth a pilot and maybe even a new product development opportunity for a start up!
Thanks, Roni, for a great suggestion.
Posted by John Halamka at 3:00 AM
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My experience is that patients, especially "older" patients, will read anything and everything that is given to them. They will hold on to it and eventually file it away where they can find it. Reading comprehension is generally greater than listening comprehension and written orders can be shared with family and other care providers.
This works both ways. I bring printed lists (so I can give one to each person involved) of meds and medical conditions when I take a relative to the doctor's office or hospital. Healthcare professionals also have better reading comprehension than listening comprehension.
This hits home with me as well. Recently my 70 yo mom took my 80yo dad to the E.R. suspecting a TIA which turned out to be dehydration and blood sugar issues. Upon discharge he was given "canned" instructions and some changes to amounts of meds. My mom recalled a past change in the one med. had caused problems before, but "since it was written" she maybe mentioned her thoughts, but did not take a proactive stance and challenge the discharge instructions. Sure enough, with the med. amount change, the same thing happened as before, and Dad spiraled down. It took over a week to get the amount corrected. If the health system had access to the previous occurrence, as well as reasons being provided for the med. chagne, I believe it would not have all been on my Mom's shoulders to figure this all out on her own (and fail!)
When I make rounds I try to have a team present (residents, nurses, pharmacists and social worker). In addition, we review the Mar/EMAR in front of the patient to let them know what medications they are on and why, dosing, frequency, indications and side effects. Everyone also hears the overall treatment plan for the day. It can work in a military hospital but is more difficult in a busy fragmented civilian hospital. Patients are one of the most important members of the healthcare team.
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