Everyone Has A Story: Scott Duarte

Monthly series featuring personal accounts navigating our healthcare system

The easiest patient I encountered surprisingly wasn’t the one with the fewest health issues but the patient with one simple thing – a portable file cabinet.

Before entering the field of healthcare technology, my background as a physical therapist took me to various places – from cardiac and trauma ICUs to athletic fields and training facilities to peoples’ homes. Regardless of the location, one of the most common hurdles I faced was treating patients with incomplete information.

The Challenges of Treating Patients With Incomplete Information

In particular, as a homecare therapist, I often found myself wearing multiple hats on the initial visit – playing the role of not just physical therapist but also nurse, occupational therapist, speech pathologist, and more – to evaluate if other services were needed. The real challenge emerged when I visited a patient armed only with the discharge paperwork from their previous medical facility or simply a referral for physical therapy with a single line of information.

If I did get discharge paperwork, it typically contained a brief reason for the referral, a medication list, and a convoluted medical history represented by a string of International Classification of Diseases (ICD) codes. Sometimes, it contained none of this information. Oftentimes, there would just be a simple line stating the patient fell at home and needed physical therapy. Little did I know that beneath this seemingly straightforward case lay a complex web of unanswered questions.

Patching Together Fragments of Patient Health Information

With just fragments of information, I had to unravel the mystery of why they fell and what their prior level of function was, understand their past medical history, and ensure they were taking the right medications, to name a few. This was made even more difficult as many of them struggled with memory challenges. 

A common issue I faced was the discrepancy between the medications listed on the patient documents I had received and the actual medications present in the patient’s home. This often led to a time-consuming process of contacting the primary care physician for an updated medication list, waiting approximately 2 to 3 business days for a call back, and sometimes discovering that the office wasn’t even aware of the recent hospitalization.

Two Examples, A World of Difference

Let’s start with a  simple example. A patient I treated was referred for a fall at home caused by a lack of balance and strength. However, a more comprehensive patient history would have revealed a decade-old stroke (that the patient had forgotten about), resulting in significant physical limitations like loss of strength, diminished sensation, and lack of flexibility throughout their lower left side. This critical information, absent from the referral documents, significantly impacted the effectiveness of the treatment plan.

Then I encountered an 85-year-old retired nurse who handed me a portable file cabinet on my first visit. She recognized the communication gaps between her specialists, primary care physician, and the local hospital. Her proactive approach involved consistently requesting her clinical documentation upon discharge and organizing it meticulously. While her diligence was commendable, it underscored a broader issue – the systemic lack of interoperability in healthcare. It was a revealing moment because the widespread lack of information in healthcare has become so ingrained that everyone has simply accepted it, which is concerning.

The fundamental difference between the two patients wasn’t the severity of their ailments but rather the accessibility of their healthcare data. The concept of a longitudinal patient record, a comprehensive compilation of data from various healthcare sources, becomes paramount in even the simplest cases. Regrettably, the first patient received a suboptimal plan of care at first due to information gaps, while the second, equipped with a wealth of information, enabled me to tailor a more effective and specific treatment plan.

I compare it to getting a piece of furniture from IKEA. In one situation, you have clear instructions, and in the other, you’re left without them. While you can still put together both pieces eventually, the time spent grappling with information gaps in the latter case might result in a misplaced screw, tripling the time spent on the project or, in my case, not treating a patient to the best of my ability.

Patient Care Should Not be Hindered by Insufficient Information

Medicine should not be a guessing game hindered by insufficient information and that’s where my mission lies. The importance of data flow in healthcare cannot be overstated – it’s the key to unlocking a patient’s complete medical history, ensuring accurate diagnoses, and enabling healthcare professionals to deliver personalized and effective treatment plans. Prioritizing interoperability is not just a choice, but truly a necessity for the well-being of patients. 

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