Brief Observation on “Med Reconciliation”

Patient is seen by her nephrologist and there is documentation in her Plan of Treatment: AVOID ALL NSAIDs. The physician never noticed in the med list that the patient is taking an NSAID (and has been for years). The only reason I picked up on it was because the patient told me she hadn’t been able to get her Celebrex approved by insurance so the orthopedist changed her to meloxicam. Having read the nephrologist’s note right before the patient came in, we have the following exchange:

Me:”But you’re not supposed to take an NSAID like meloxicam”

Patient: “I’ve been taking celebrex for years. Nobody told me to stop”

Me: “OK, I’m telling you to stop”

Patient: “So I can use advil every once in a while for pain? Tylenol doesn’t help”

We have an extended conversation about what NSAIDs are.

What IS it about EHRs that make straight-forward information difficult to see?

 

 

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Gimme My Patient’s Damn Data

HIPAA (Health Insurance Portability and Accountability Act) was created in 1996 to protect patients’ personal health information (PHI) in addition to other things. One of its most frequently misunderstood sections involves the release of medical information. Although it specifically allows for treating physicians  to access their patient’s health information in order to provide continuity of care without needing a patient to sign a release form, it is not unusual for this to be a problem. My office has had difficulty receiving necessary records from specialty offices and hospitals. Recently one of my patients was seen in a Kroger Little Clinic where she was treated for a urinary tract infection. Since her symptoms persisted, I needed the urinalysis from the clinic in order to determine future therapy. You’d of thought I was asking for gold from Fort Knox. In my long association with HIPAA I have found it mostly intoned by medical office individuals who have been poorly trained by the entities that employ them. Kroger has not appropriately educated their staff as to the ins and outs of a complicated law, thereby bringing about the following exchange on Twitter: Screenshot 2015-03-15 09.20.48

Ultimately I was able to get the UA results, begrudgingly, from an NP who I know called me a bad word as soon as she got off the phone. She was right. By the end of the day, I didn’t care what she thought of me. Just give me my patient’s damn data!

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