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

The result of my clumsiness

The result of my clumsiness

staff wondered if I had murdered someone), ice and, courtesy of the front desk, 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.