On the road to meaningful use
If you follow my Twitter feed, you know I had a little accident early Wednesday morning during the just-concluded HIMSS conference. I stumbled into the bathroom in my Orlando, Fla., hotel room in the dark about 6:30 a.m., did my business, then turned to my left to use the sink. Unfortunately, the sink was not to my left. I fell down and hit my face against the edge of the bathtub and immediately started gushing blood.
It took a while, but I mostly got the bleeding stopped with the help of some towels (I’m sure the cleaning
staff wondered if I had murdered someone), ice and, courtesy of the front desk and a Walgreens across the parking lot, moist towelettes, antibiotic ointment, gauze pads and surgical tape.
The clerk at the front desk offered to call an ambulance to get me to an ER. I have a high-deductible health plan, so this early in the year, I’d have to pay the hefty bill entirely out of pocket. I wasn’t going to die from a cut just above my eye. Fortunately, there was a Walgreens right across a parking lot from the hotel, so I was able to get some other first-aid materials to clean the wound and completely stop the bleeding.
After going back to sleep for a couple hours, I got myself over to the convention center around lunchtime, still wondering if I needed to get the cut checked out. This being HIMSS, there were plenty of clinicians around. I happened to be in a session where HIMSS Vice President Pat Wise, R.N., and Chicago medical informaticist Lyle Berkowitz, M.D., were present. They both recommended I get medical attention as soon as possible. (Too bad nobody carries suture kits to IT conferences.)
With the help of Google Maps on my BlackBerry, I found two options: a hospital 0.7 miles south of where I was in the convention center or a walk-in urgent care clinic 0.9 miles north. The single review connected to the clinic listing said it wasn’t worth it, go to a real hospital instead. Again, though, I have a high-deductible plan and this wasn’t a life-threatening injury. Having followed this industry closely for more than 10 years, I think I have more realistic expectations of how a healthcare consumer should behave. I chose the urgent care clinic.
Rather than waiting hours in an ER, I was in and out in about an hour with six stitches slightly below my eyebrow. Instead of a $300 (minimum) ambulance ride plus who knows how many hundreds—if not $1,000 or more—for ER services, I got there for $7 in a taxi. This clinic, which doesn’t accept insurance as a way to keep costs down, charged $55 for the visit (after a $20 coupon that I didn’t know about until they volunteered it), plus a couple hundred for a physician assistant to clean and stitch up the wound.
This clinic was in an aging, shabby strip mall not far from the tourist traps and second-class chain restaurants of International Drive. It seemed like a typical, old-fashioned, paper-based practice. I filled out my medical history and presenting condition on the hated, ubiquitous clipboard, then sat down in the waiting room, surrounded by outdated magazines. Shortly thereafter, a nurse brought me back into an exam room, took my vitals and got everything ready for the PA to fix the cut.
After the stitching, I was pleasantly surprised to learn that the practice wasn’t so stuck in the past after all. The PA ran my credit card, then told me to sit tight for a few minutes while he documented my case so I can take a report back to my own physician when I get the stitches removed next week. He sat down at a computer and started typing away. About five minutes later, I was handed a printed, detailed, discharge summary.
That’s right, this practice, that seemed old-fashioned on the surface, had an electronic medical record (I didn’t catch or bother to ask who the vendor was). Since the practice doesn’t accept Medicare, Medicaid or any other insurance plans, it’s not eligible for federal EMR incentive payments, but it probably wouldn’t qualify for “meaningful use” anyway since it’s not totally electronic. I didn’t see any orders entered electronically (though they still may have been), nor was I offered the option of receiving the clinical summary electronically. I think they ran the lidocaine they ordered as a topical anesthetic through an interaction checker to make sure it didn’t contain any sulfa, which I had indicated I’m allergic to.
I imagine this is where countless thousands of small medical practices are on the road to meaningful use. They have some elements of an EMR that fit existing workflow, but nothing comprehensive and no interoperability. I’m glad the summary was at least typed so there won’t be any issues with handwriting when I go to my regular internist next week. I’m also happy they checked for drug-allergy interactions.
Score two points for patient safety and one more for consumerism. I’m confident I got the right care for a reasonable cost, and that I’ll recover quite nicely.
Great story Neil. Glad to hear you’re recovering well from it. Nice to hear that the urgent care is electronic even if it’s only partially electronic. That’s still one step closer to achieving the EHR nirvana.
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[…] one thing, Rhoads mentions my post detailing my injury at HIMSS and the consumerism and EMR use that played into the care I received […]
I’ve never been to an urgent care clinic but have always been uncertain about the quality of care they provide – mainly because of unfamiliarity than any predisposition I have. But I’m glad that your experience was smooth and efficient, and this may give me some confidence to try one out in the future if the situation arises.
[…] one thing, Rhoads mentions my post detailing my injury at HIMSS and the consumerism and EMR use that played into the care I received […]
[…] of EMR and workflow in a hospital. I love reading first hand experiences with EMR. Reminds me of a great experience that Neil Versel documented at an urgent care during HIMSS. I look forward to hearing your comments on the […]
[…] On the road to meaningful use […]
I have begun to usethe urgent care clinic which is 7 minutes from my home because it is closer than our local primary care provider and the times I have had to use it have not been urgent; my son had pink eye, my daughter needed glue stiches for a clean cut in her hand and I got bit by a dog and needed a tetnus shot. I seem to also leave with some sort of a partying gift with a logo and found each experience to be hassle free although I do not recall leaving with a print out of the condition or treatment. Recently, my son fell out of a tree house and had to have 6 stitches in the back of his head and needed to be seen as he also had large visible bruising on his back. Neither my husband or I were around as we were commuting home at the time and our friends contacted us to inform us they were taking our son to the urgent care. After initial panic, my first gut reaction was he neeed to go to a hospital, but my friends were so calm, cool and collected and my prior positive experiences at urgent walk in care were so good, that the tinge of doubt I had for about 5 seconds on where he should go, quickly subsided. As it turns out, our son is fine and the doctor or PA (not sure) who attended to him was wonderful, empathetic, paternal and confident. He even managed to sewture up my son without leaving him with a bald spot so as to avoid any teasing at school and YES, I got 2 ceramic mugs this time, instructions and scissors. Once the sewters were removed, they were placed in a little plastic zip loc and given to my son almost as some sort of a badge of courage for having endured such trauma. All in all it was a positive experience and what was even more impressive, although I’m not sure this is customary, but we received no hassle about having to have consent forms to let our son be seen or treated. As long as we provided insurance info by phone and gave the okay, the clinic was okay. Thumbs up for the walk clininic in my neighborhood and their crack staff!
I thought I might also add to my earlier post that I did have an emergency room experience earlier in the year for which I am still perplexed by the various invoices I have recieved by hospital which do not cleanly correlate back to my insurance statement and each bill from the same hospital I might add looks different because I guess there are different systems for the doctor who treated me and the labs and things like that. One invoice is very vague, the other is very detailed. I just put it all to the side because it looks hard to understand and I’ll need to make phone calls to sort it out. I did get a nice print out of my condition and was advised to see my primary doctor. As I was leaving, some nice nurse whispered in my ear how I should insist on an x-ray as you never know if there is a blood clot that no one can see by just checking. I’ll admit, that scared the hell out of me, but at that point, i just wanted to get back to work and figured I would take my chances. All and all, not a great experience, but there was some relief in knowing I was going to live and perhaps simply just having a panic attack.
[…] back in February when I cut my face open at the HIMSS conference and needed medical assistance while 1,000 miles from home? I blogged then […]
[…] my HDL cholesterol. I last went for a physical in March 2011, about a month after I ungracefully cut my face open on a bathtub in Orlando during HIMSS11, so I was probably due. This practice lets patients request appointments — not actually choose […]