Stream: patient empowerment
Topic: being a patient
Jose Costa Teixeira (May 13 2020 at 13:28):
Allow me a minor anecdotal "mea culpa" which reminded me of how important it is to make things practical:
Jose Costa Teixeira (May 13 2020 at 13:29):
I'm currently working with immunization and product traceability - frankly all of that is trivial technically - every vaccine has a barcode, so we can know the product number, lot, expiry, etc.
Additionally, I'm personally trying to maintain a record of our immunizations using FHIR.
I have everything I need.
Jose Costa Teixeira (May 13 2020 at 13:30):
So, last week we had some vaccinations in the family, and, of course, during an actual episode of care, I did not even think of asking "hold on, let me take a photo of the barcode". I didn't even check what information is taken by the nurse to the national repository.
Craig Newman (May 13 2020 at 13:32):
I know I had some immunizations a few years ago and was very excited (in a nerdish sort of way) to see what the data entry workflow was but the nurse just walked out without documenting anything (presumably that was done later). I was very disappointed.
Jose Costa Teixeira (May 13 2020 at 13:32):
It shows how easy it is to keep it cool in the office or make things thorough in a design, but reality brings so much more, and my focus on complete faced a much bigger beast - it's the reality and the tension and all of that that counts
Dave deBronkart (May 13 2020 at 13:43):
I do this all the time - as engaged as I try to be, I completely space out when the moment comes.
THIS IS WHY CHECKLISTS ARE SO USEFUL. There's no reason not to have one even for this simple encounter.
Here's the latest example of a related thing, brand new: a pre-visit questionnaire that then guides the appointment. It was drafted for the latest extension of OpenNotes, called OurNotes, but they decided to open-source it for use in making telemedicine visits more efficient. I blogged about it yesterday. NEJM: OpenNotes/”OurNotes” releases its innovative pre-visit questionnaire for COVID-19 televisits
I hope everyone's familiar with Atul Gawande's wonderful book The Checklist Manifesto, which among other things documents the rationale for doing what aviation learned long ago. Aviation had the added incentive that mistakes often had very immediate consequences.
John Moehrke (May 13 2020 at 14:43):
I am a bad self advocate... I so fully trust my doctors and nurses. 99% success and openness in my region. But I did have a total loss of immunization details when I got laid off from GE, where I had received many immunizations for the travel they sent me on to India. Wish I had thought of the simple act of taking a picture of the barcode... Of course I was far more worried about fainting, I am a bad patient that way too -- whitecoat syndrom.
Mikael Rinnetmäki (May 13 2020 at 15:27):
I have the yellow International Certificate of Vaccination. Originally got it for yellow fewer, but it has space for all vaccinations. Around 80 % of my vaccinations since are in there - I also have a hard time remembering to take it with me when I get vaccinated.
A cool thing, though, is that most of the vaccinations in there are actually stickers peeled off the vaccine packaging. No need to take a pic, no need to enter text manually. :) The nurse administering the shot just peels off the sticker and sets it to my yellow cert paper. And stamps it.
Terrie Reed (May 13 2020 at 15:31):
You will find that I tend to be a pest about patients knowing their identity of their implanted devices. I myself have a clavicle implant with 12 screws. I know the material, size, and model/version of the plate and screws because I specifically asked for my Unique Device Identifiers to be recorded in my health record during my pre-surgical checklist. Of course, they didn't record the UDI so while I was recovering I went to the basement and copied my operative notes (this was in 2013) and then wrote the manufacturer for the exact implant specifications. I say all of this because I have been trying for YEARS to get UDI on a patient checklist. For example - if you are having a hip implant, ask what will be the UDIs of the implanted devices. My campaign is "KNOW YOUR UDI". I'd love to read the Checklist Manifesto. Thanks Dave.
John Moehrke (May 13 2020 at 15:43):
I have the immunization card. index card sized thing with hand written immunization. My doctor said he couldn't use it. (which given that I am a Provenance advocate, I can totally understand the Dr position).
Dave deBronkart (May 13 2020 at 17:53):
Sooooo, geniuses (I say that with love and admiration), shouldn't there be apps and tools and things to help with this?? Are there? I imagine some of you may have already created some. Let's hear about (or create) solutions that are worth their effort, maybe?
John Moehrke (May 13 2020 at 17:55):
well, that is why we participate in HL7... because the world is still broken, and we are here to fix it
John Moehrke (May 13 2020 at 17:56):
device ID are relatively new. There are many HL7 based discussions about how to embed these details in CDA and FHIR where appropriate. There are registries of these too
Dave deBronkart (May 13 2020 at 17:58):
@Lloyd McKenzie just ported this "OurNotes" pre-visit questionnaire topic into the connectathon Questionnaire stream.
I am largely unable to participate so I hope someone can pursue it! I'll see if any of the OpenNotes people are interested.
Last updated: Apr 12 2022 at 19:14 UTC
