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An Overdose of Bureaucracy

(Bob Croslin)

I have been blessed with good health as I’ve gotten older, so my interaction with health care providers over the past few decades, I’m grateful to say, has been confined mainly to visits to my general practitioner, dermatologist and optometrist for periodic checkups.

A recent test result, however, required some follow-up from specialists (I’m fine) that involved visits to both a big institutional provider and a local practice. Medically, the experiences at the two practices were outstanding — the docs were skilled, personable, asked good questions and gave complete, informative answers to my questions.

Bureaucratically, however, the encounters were time-consuming, unnecessarily complex, frustrating and ended up seeming fairly disconnected from the matter at hand.

The big institutional provider had clearly spent a ton of money on consultants in structuring its digital operations — reflected in a glossy website with a tidal wave of information, a “patient portal” where records and appointments were available online, and a set of online forms where I responded to questions in the course of providing my medical history. Sounds tech-savvy and efficient, but the road was bumpy. Some inquiries on the medical history forms were redundant. I found a number of grammatical and syntactic errors. Other questions offered only non-sensical choices. In inquiring about medications I was on, one section, for example, asked whether I ever took aspirin or ibuprofen. There was no “occasionally if I’m sore after tennis or golf” answer possible — once I said yes, I was funneled onto a page in which the only answers about my aspirin consumption began with “1 a day” and ranged up into daily consumption totals I can’t even imagine.

The questionnaire didn’t allow me to proceed until I picked an answer, so I was faced with the option of either lying or stopping the questionnaire. And, of course, when I went to my appointment, my doctor, as good as he was, hadn’t looked at my medical history and asked a bunch of questions that I had already answered.

In between, I got a barrage of e-mails and calls from the institution, some useful, some not. Along with reminders about my appointment time, I got an annoying call to make sure I understood what the deductible was on my insurance plan. On the day of my visit, the institution’s claims to its goal of providing personalized care didn’t extend much beyond valet parking. The waiting area was as impersonal, and not much more comfortable or visually appealing than a bus station. Staff were pleasant and well trained, but in the end, the “personal care” that the institution claimed to be its hallmark ended up seeming like a hollow promise. It’s just too big a place, with too many agendas, to deliver that kind of care.

My visit to the smaller, local health care provider was a little more creature-comfortable and personal but still beset with bureaucracy. Nothing online or high-tech there — I was given a clipboard with about 20 pages of forms. For each, I had to print my name and birthday at the top before proceeding to answer the medical history questions below. On many pages, I had to print and sign my name yet again in the body of the form along with the line at the top.

Midway through the slog, a nurse interrupted me to take my pulse and get my weight and height. She asked me several questions — all redundant from the forms — that she input into an electronic record. When I finally met the physician, he, too asked questions that I had either answered with the nurse, on the paper forms or both.

I’m curious as to what happened to those 20-plus pages of filled-out forms after I left, but I probably don’t want to know.

My experience bore out everything we reported a year ago in a cover story about electronic health records (EHRs). After $35 billion in federal subsidies, most doctors and hospitals in Florida have them. But the EHRs from different companies often can’t communicate with each other — the big institution e-mailed PDFs of test results to my smaller provider, for example, but its EHR couldn’t just port over my medical history to the smaller provider’s EHR. As I experienced when I filled out my medical history online, the EHRs often provide choices via boxes to check, eliminating subtleties that written notes would capture — and that a physician might find useful.

The bottom line to our story last year was basically that the EHRs had helped docs streamline the way they order tests and prescribe medications, but — as per my experience — weren’t doing much to make things easier or cheaper for patients.

The disconnect between first-rate medicine and third-rate customer service is disconcerting — if you’re worried that you may be sick, you don’t need a lot of bureaucratic complexity and confusion. You’d think that the health care pros who are so good at medicine might focus just a little bit more on making things just a bit easier — and more comforting — for the patient in the time and space between the front door and the examining room.

— Mark Howard, Executive Editor
[mhoward@floridatrend.com]

 

Read more in Florida Trend's April issue.
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