I reconnected with Bev Johnson and Marie Abraham this week, from the Institute for Family Centered Care, in Bethesda, MD. They are embarking on some exciting projects (in my opinion), which includes supporting the implementation of a patient Web portal at Medical College of Georgia, an institution that has been well described in the patient-centered care literature.
As Bev and Marie asked me about experiences with patient portals, they asked me to provide them with a workflow I use to bring in patients’ families into care, using the After Visit Summary. I thought I’d just write about it here, so everyone can see it.
One of the things I have noticed in the era of the EHR/PHR is that there is always someone else or others supporting patients that are not with them physically. This part isn’t new, but my ability to support that vital group (families and community) is.
What I do, then, is use the After Visit Summary to compose a letter to that person or people, with the patient helping me write it. The “letter” is printed out on the hard copy, and then permanently stored for viewing on the PHR of course.
I start by asking, “who is at home or in your life who assists you with your health?” This can be a mother, father, brother, sister, son, daughter, friend, etc. I ask what their name is. For this example, let’s say the patient is a 65 year old female and the someone is her son. It goes something like this:
Dear Mr. Smith,
I saw your mother, Karen, today at the Capitol Hill Medical Center, who came in to see me about her cough. Today, I listened to her lungs, her heart, looked in her throat, checked her ears and her nose, and checked her stomach. She has a normal temperature today and her lungs sounded normal. I didn’t see any signs of a serious infection today, so I think this will improve in the next 1-2 weeks.
In the meantime, I think it’s fine to use a mild cough suppressant, to take at night, which I prescribed, and okay to eat and drink normally. It is fine to continue the aspirin she is taking once a day for her heart as well.
If she has a temperature over 100 degrees, the cough gets worse, she has trouble breathing, or you are worried at all, please call our office our consulting nurse line on the phone. If there isn’t an immediate concern, then feel free to send a secure e-mail about this or any other issue.
It is good to get things like this checked out. I appreciate the visit and we’re here to help you get well.
Ted Eytan, MD
This is a general approximation. The key elements of this workflow are:
1. Engaging the patient to learn about their support system and their interest in a communication directed that way.
2. Typing the letter with the patient, to confirm the history and plan. This is a time when very useful questions come up, like “is it okay to eat a regular diet?” or “when should I stop taking that medication?” The patient is very helpful in making sure that what I say makes sense to them! I actually practice slowing down during this time. I get to do necessary documentation work with the patient as a partner, and make sure that our concerns are appropriately felt about what is going on.
3. Providing the patient with an explanation they can take to the person(s) in their life, who have questions of their own, such as, “Did you tell the doctor about symptom X?” and generally want to know more than “The doctor said everything’s okay.”
All of these elements generate very important conversations in my mind, about what is most important for healing in the moment, and over time. It doesn’t really take any extra time to do this. In fact, I’ll say that it takes the same or less time to do this if you factor in what I see a lot of, which is many clarifying questions at the end of the visit. This allows some time for those to come naturally, and be answered in writing.
The piece of this that I most enjoy is that the patient helped me write the story of the visit, and later imagining that their loved one can see that they were thought of during the care experience.
So…to the health care provders out there – what do you think? Want to give it a try? Have you given this a try?
To the patients out there – what do you think? What if your doctor did this for you? Would you think about asking them to give it a try?