justen

Update: A lot can happen in a week. On Monday, my mother’s pulmonary specialist said he believed her condition was worsening and that she would likely need a tracheotomy, and that she might never be able to breathe on her own again. Given her advance directives, this was not good news to hear. I ended up having to argue with the specialist in order to get his “consent” for a second opinion. The second pulmonary specialist agreed that a tracheotomy should be a last resort, not a first option. For the last several days, my mother has been breathing on her own for short periods of time, and with a mask to help her breathe. She will soon be moved down from critical care, and in the next few days she is scheduled to be transferred to St. Francis Hospital for several weeks of recovery…

My mother had a serious heart attack on Wednesday, while she was already in the hospital for a mild heart attack and a bad case of pneumonia. I got into Charleston on Thursday, and have come to call this hospital “home” since then. (It now seems that there is no need for the apartment I rented here earlier this year, when she had several stays in the hospital. As it turns out, you can get used to something resembling sleeping, even while upright in a chair.)

All of this has helped me to realize I have come to much prefer being on the provider side of the healthcare equation.

The only distraction I have found here is pretending to care about the healthcare information technology in place at this hospital, which consists of Soarian, Opus, and still a bunch of paper. No svelte tablets or thin clients or patient room workstations, although one of the nurses does carry around a clunky notebook and there are a few other notebook carts bandied about. Workstation security (and thus information security), sadly, but not surprisingly, seems to be a fairly low priority.

There are disadvantages to working in healthcare and dealing with the healthcare system. For instance, I know that this hospital is below the state and national average for heart attack and heart failure care, but she was able to make that decision in the ambulance, and chose this hospital above my objections. Transferring her now is not an option. Sure, there’s a whole list of what the hospital can and should do to fix their substandard care rating, and healthcare information technology could even help. But none of that really matters, here and now, to me as a son.

Being involved in your care decisions requires you be awake and competent; the ventilator means my mother cannot be involved, and the propofol ensures she is not. The draconian rules surrounding chart access, and the fact that said charts still use advanced dead tree technology, present an incredible challenge just to stay up to date on my mother’s care, even with constantly being here, and even with the most patient and accommodating providers.

Will modern information technology and processes fix everything? No, but smarter healthcare information technology can be a catalyst, a conduit, and a foundation for smarter healthcare.