We Need Electronic Health Records Now: A Personal Tale

Last week, shortness of breath after exertion led to an urgent visit to the doctor. What I first thought was a recurrence of bronchitis turned into an up close a personal encounter with medical technology and a much-maligned system that at its best works very well indeed. It also left me convinced that, while I still doubt that electronic medical records can be the big money saver that advocates claim, EHR can definitely improve the quality of care and save lives.

CT scan of pulmonary embolism
CT scan of a pulmonary embolism. (Wikipedia)

I have been a member of Kaiser Permanente Mid-Atlantic for many years and my experience began in urgent care at a Kaiser facility about five minutes from home. After I described my symptoms, they put me on oxygen and began tests. When blood tests suggested the possibility of a clot but a chest x-ray was inconclusive, they gave me an injection of the anticoagulant Lovenox and shipped me by ambulance to a second Kaiser facility equipped with a CT scanner.

Because Kaiser has an excellent EHR system (developed at great cost and after a couple of painful false starts) and requires doctors and nurses to document everything in the system, the staff at Kaiser Capitol Hill knew everything that had happened at my neighborhood facility. They continued the tests and treatment and when the CAT scan showed a dangerous pulmonary embolism, they decided I belonged in the hospital.

Another ambulance ride took me to Holy Cross Hospital in Silver Spring where I spent an uncomfortable day and a half being poked, prodded, tested, and generally well cared-for. Holy Cross is heavily used by Kaiser and is hooked into their system, so again the staff instantly knew everything that had been done. (It was also kind of cool to get the results of tests run the night before on my iPad, including the good news that a cardiac enzyme test for possible heart damage was negative, while lying on my hospital bed.)

I realized how useful the EHR system really was  when I got a new roommate after I had been declared stable and was waiting for my wife to come fetch me. A man in his 80s and apparently suffering from some level of dementia was brought in, though neither he nor the hospital staff seemed to know exactly why (there is absolutely no privacy in a hospital room.) He remembered that he had suffered an allergic reaction to penicillin during World War II, but wasn’t sure what led to his being taken to the hospital. Without good access to his medical records, the nurse was having a bad time just trying to figure out what meds he was on. Both he and the hospital staff were at a huge disadvantage because they had no history to work with.

It’s going to take a while, and a lot of money, before the U.S. health care system comes close to matching the EHR systems of organizations such as Kaiser and the Veterans Administration. Both have the enormous advantage that their doctors are employees, not affiliates, and therefore can be required to use the system. But building a national EHR system is vital work, and the much-maligned Affordable Care Act should help spur things along.

As for me, I’m happy to say that I’m doing well. The  anti-clot treatment seems to be working as the shortness of breath is gone. I’ll be on blood thinners for some months and I’ll be a lot more careful about flying once I get back in the air. Flying, especially long flights in cramped conditions, are a well known risk factor for the deep vein thrombosis that leads to pulmonary emboli and the nine legs I flew, including two of more than 12 hours, in the month before I landed in the hospital, certainly didn’t help.

On a personal note, I want to thank the urgent care staffs of Kaiser Permanente Kensington and Capitol Hill and the staff of the monitoring unit at Holy Cross Hospital for the treatment I received during this adventure. I don’t think I could have asked for better care.