Can You Give An Example of How Virtualized Care Works with Electronic Medical Records?

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One of the very practical problems facing people right now is the 30 day readmission rule, that's hitting hospitals. They're not going to get paid if you readmit people to the, Well they're going to get paid less, or they're going to get a penalty, if you readmit within 30 days for certain conditions and that starts next for school year October 12.

Other countries actually have much more honorous laws than the US. The UK for instance, if you get readmitted to an NHS hospital within 30 days, NHS hospital is not going to get paid. Here we're just going to do a little bit of a penalty and doctor's and hospitals are screaming. The annual journal article came out in April 2009, while the debate on the curing [XX] format was going on and the evidence showed that 20% of medicare patients get readmitted within 30 days of discharge, and a third within 90 days.

So maybe to simplify, congress kind of said, what I'm I paying for a product with a 20% 30 day defect rate? Can we do better? So they've challenged hospitals with the introduction of this penalty. So, how might we do better? And how might we use technology to make a difference? I'll go back to my concept on collaboration on how we don't collaborate.

The eulogist don't talk to each other. If you've ever been in a hospital, if you've ever been head acronich and the neurosurgeon comes in, often he'll say, what did the orthopedist say? He'll ask you. He's not even reading the chart, and then you'll go back to your primary care doctor and say what happened in the hospital? The docs don't communicate.

And as a result of that the meriat knows more about you than your doctor. So now we have these electronic tools. In the hospital, at the end of shift, we use sign out. We actually communicate. The nurses talk for 20-30 minutes about the 20th, they don't run down the hall and pass each other and say, 32 patients check them out in epic, goodbye.

They talk, there is a value in that color. But at the time of discharge, which is arguably the biggest transition you are going to, there is no sign out. When I used to sometimes discharge patients from the hospital my sign out was the tax cab driver. Could you help them up the stairs and bring them in? Come on, we can do better than signing out to a taxi drive.

So what if a standard kit, standard process at the time of discharge the nurse in the hospital, using a slate tablet computer, makes a video call to the nurse in the office. That's how the two nurses are going to get each other, within minutes and she says hi Betty, Sally ready for discharge.

I've reviewed Sally's records which were on the tablet and I'd like to talk to you about, and they do 30 seconds, 90 seconds sign out. Same as they were always taught to do. Except now they are doing it across an institutional firewall. They're doing it from a hospital, so let's say a non affiliated practice.

Now it would be great if I had an the HIE, it would great if I could do this electronically, and have some manicane [XX] but you know what, I don't. I'll get there but if want to improve the solution next Thursday, let's use the technology I have. So I use video conferencing with a slate computer.

Let's say I use linked. It's secure, it's approved, it's at the compliant. I'll open up a link conversation with the nurse, then I'll bring up the hospital base calamitry, the hospital base DICOM, and EMR. And I'll review that with a nurse in the doctor's office and I'll use a link and I'll actually transfer it in real time.

Now, it may not go into their record, but when you call the next day and say I got discharged from the hospital yesterday for yeti yatra and this pill isn't working, they know what's about. They're not going come in or whatever. They may be able to help you immediately because they've gotten the information.

It isn't coming to them in a discharge summary three weeks later which is useless because you've been re-admitted already.