Interoperability Prolonged My Life

A year ago tonight I received a phone call from my primary care physician, late on a Friday night, before a long 3-day holiday weekend. Can’t be good news I thought. The conversation went something like this:

Dr. Feinberg: Dr. Kaplan, this is Dr. Feinberg.

Me: Hello Doctor. Do what do I owe the honor of your call late on a Friday night before Labor Day?

Dr. Feinberg: When you were admitted to the hospital in Indiana earlier this week did anyone tell you that you were in heart failure?

Me: No. I would have remembered that. After the cardioversion he told me to follow up with a cardiologist at home in a couple of weeks. I was still in atrial fibrillation and would need additional treatment.

Dr. Feinberg: Did he mention you had an ejection fraction (EF) of 10%?

Me: What? No!

Dr. Feinberg: The transesophageal echocardiogram (TEE) they did before the ablation to look for clots in the atrium showed a markedly decreased ejection fraction with global wall abnormalities. Even though TEE is not the best way to assess EF, particularly with a fib with a rapid ventricular rate, that is not good.

Me: Could explain why I have no energy.

Dr. Feinberg: Sure. I need to start you on an ACE inhibitor tonight. I will call in a prescription.

I met Dr. Feinberg a few months before I was diagnosed with severe heart failure this time last year. I mentioned his name when I was admitted to an “outside hospital” and this ended up in my electronic medical record and through interoperability he knew more than I did about my care.

Several major clinical trials have looked at the use of ACE inhibitors in people with heart failure. All of them showed significant benefit. A meta-analysis of five such trials that included over 12,000 people with heart failure showed that ACE inhibitors significantly reduced the need for hospitalization, improved survival, and lowered the risk of heart attacks. Symptoms of heart failure such as dyspnea (shortness of breath) and fatigue were also improved.

Dr. Feinberg: Do you have a cardiologist?

Me: Not yet. I am scheduled to see someone on September 14^th.

Dr. Feinberg: Okay. See if you can get in sooner. I will call in the ACE inhibitor but this is going to require a cardiologist to manage.

I took a couple ACE inhibitors that weekend before I ended up getting admitted to my local hospital. The cardiologist I was going to see in 2 weeks was on call so I was introduced to him sooner.

Me: How do you know my EF from the TEE?

Dr. Feinberg: It was in your chart from the hospital you were admitted to and I received a flag. I tried to leave you a message earlier but your voice mail was full.

Me: You saw my chart from another hospital without trying but you couldn’t send me a text or message me on Twitter or something?

Dr. Feinberg: No. Where can I fax this prescription?

Me: Fax? I don’t know. I don’t even know the pharmacy’s phone number let alone their fax number. Can you order it electronically?

Dr. Feinberg: I don’t usually do this part – the office staff does it. I don’t know how it gets to the pharmacy. I guess I can call them.

In November of 2015 I wrote a piece “Interoperability Should But Will Not Happen“.

I was wrong about this.

It is happening. Across hospital systems and portals and through a system of alerts and messaging between systems.

In the past year being seen at a couple of community hospitals, a university medical center and a worldwide referral center, the one thing I have not had to do is concern myself with medical records from place to place. All the providers can see what the other has done. One cardiologist already knows that a medication was changed by another or how many cardioversions there have been since my last visit to their institution.

What has facilitated this is Epic’s Care Everywhere which is designed to provide a framework for interoperability. The platform allows information flow from Epic EHRs and non-Epic EHR across state and national borders, according to the company’s website.

This I did not know in 2015. By March of 2016, Epic’s Care Everywhere exchanged a quarter billion patient records.

And my physicians in my community hospital, at Loyola University Medical Center and Mayo Clinic can view information from the respective institution with this interoperability.

Now if we could just get the diagnosis that you are in heart failure from the doctor who made the diagnosis. And eliminate fax machines.