Thinking of surgery? Focus on communication

Allison Arthur aarthur@ptleader.com
Posted 10/4/16

In the event you need surgery, take note: Miscommunication while being passed from caregiver to caregiver is a problem, and a new electronic medical records system is aimed at ensuring you have …

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Thinking of surgery? Focus on communication

Posted

In the event you need surgery, take note: Miscommunication while being passed from caregiver to caregiver is a problem, and a new electronic medical records system is aimed at ensuring you have access to your information.

And if you expect to recover in a long-term care facility after surgery, visit the site before you arrive as a patient, and don't assume the facility you like best would take you in.

Those were two take-aways from Port Ludlow health forum during which Joshua Brocklesby, a registered nurse and the director of informatics at Jefferson Healthcare, and Dana Gargus, a long-term-care ombudsman for Kitsap County, made presentations focused on informing seniors about how to navigate new technology that improves communication, and about old laws designed to protect patient rights.

MYCHART RECORDS

Brocklesby's talk focused on MyChart, an electronic medical records system available at Jefferson Healthcare through Providence Health Services of Seattle. MyChart is part of an electronic records system called Epic, which Brocklesby said is being used more and more around the country by providers.

One of the first things he noted is that one study estimated that 80 percent of serious medical errors involve miscommunication during the hand-off of a patient between medical providers – for example, from a primary care physician to a surgeon, from the surgeon to the after-surgery care team and from the after-surgery care team to the home caregiver.

There's a new movement called “transitions of care,” which is focused on improving the hand-off between providers.

MyChart comes into play because patients can take a more active role in their care and get information from, and ask questions of, their care team. MyChart allows patients to schedule an appointment at their convenience and even pose a question to the doctor. The questions go through the doctors’ assistants, but doctors also respond.

Signing up for MyChart is a bit of a rigamarole. To do it, you need to have email and you need to have visited your provider recently to get a pass code to sign up – or call 1-877-596-7768 for help.

The communication goes both ways. So the doctor's office also will send patients on MyChart reminders of appointments as well as messages about the need to get a flu shot, for example.

Brocklesby urged people who are contemplating surgery to use the proxy option. Essentially, with a proxy, you can have access to your loved one's medical records.

However, that, too, requires some assistance and a recent visit to Jefferson Healthcare.

Brocklesby showed how he can access the records of his children. Because he has proxy rights to access their charts, he can review test results, send a message to the doctor and even ask for a refill on a medication.

MyChart also offers detailed information about medications and current health issues. And you can review who accessed your information, if that's a concern.

An advantage to those traveling snowbirds in Port Ludlow is that they can download their records onto a thumb drive to take those records with them on vacation. Florida popped up as a place someone in the audience was going to visit soon, and it was noted that it's possible the hospital there isn't on the Epic system. It also was noted that if the patient is conscious, that person could give the provider access to her MyChart.

One woman said she had taken the time to physically print out her information and had taken it with her on her travels, in the event that she needed to get a refill for an important prescription.

TWO CHARTS

Which brings up a bit of a surprise about MyChart. If your loved one is going across the water to Swedish Medical Center in Seattle, you need to have two MyChart accounts – one for Jefferson Healthcare and one for Swedish, Brocklesby said.

Although Jefferson Healthcare is an affiliate of Swedish, a separate MyChart account still is needed for patients who go there.

Note that doctors still communicate and put information into the system and have access to the information, but you still need two accounts to see your own records.

Another point to be made about communication and what MyChart will and won't do: It will give you access to your last visit summary, and list your medications and directions for taking them, but it won't give you the notes your doctor makes about you. You can request those notes.

PATIENT RIGHTS

Gargus, Kitsap County's regional long-term-care ombudsman, reminded the audience that it was Ralph Nader who first brought to light concerns about nursing homes after two disasters in the 1970s: one in which a nursing home caught on fire and 32 people died, and another in which people got sick from food service.

It was under President Richard Nixon that the ombudsman program started, and later regulations were enacted giving rights to care-center residents.

Because nursing homes receive the vast majority of their funding from the federal government through Medicare and Medicaid, those laws apply.

And Kitsap and Jefferson counties both have ombudsmen who can help people resolve disputes between facilities and residents, she noted.

Short-term stays can turn into long-term stays without warning, she said, encouraging people who know they are going in for surgery to check out beforehand the long-range facilities where they expect to recuperate.

Gargus noted that Medicare only pays for care in a long-range facility if the patient spent three nights in the hospital beforehand, and then it only pays for 20 days of follow-up services in a nursing home.

“The majority of people enter long-term care in chaos or in an emergency and make decisions without much time,” she said. “Have your records all together."

You can ask about the doctors who practice at the long-term facility. You can ask if you can bring your family pet in for a visit to help you recover, or if your wife, who works days, can visit you late at night.

But be forewarned, she said.

“If you think you are going to get the same level of medical care that you got in the hospital, it's time to re-evaluate your expectations. The doctors are not going to be making rounds and coming to see you every day. In fact, you might not ever see a doctor. There's a doctor giving oversight, and they're probably talking to the nurse about you,” Gargus said.

“You have to have a big mouth; if you are not getting what you need, you need to tell them,” she said.

FACILITIES NEAR YOU

While Kitsap and Clallam counties have a number of care facilities, Jefferson has only one, Life Care Center of America in Port Townsend. Jefferson Healthcare has a swing bed program as well, which takes in people recovering from surgeries such as hip replacement.

Just because you may like a facility doesn't mean it will take you in, Gargus advised.

“The caveat is that where you want to go, they might not be available for you to go there. There's no guarantee of an open bed, and it's their choice if they want to take you on as a resident,” she said.

If the facility looks at a patient's chart and decides it would be difficult for it to meet that patient's needs, the facility may chose not to take you on, she said.

“A word to the wise: Know what's in your chart. Don't assume that everything is hunky-dory. I've certainly seen people blackballed out of the system,” she said.

Gargus also urged people to have a durable power of attorney for a substitute decision maker. People can go into surgery thinking all is fine, but there could be complications that could change that.

“If you do have a durable power of attorney and you want it respected, make sure you have lots of copies of it,” she said.

SURVEYS OF FACILITIES

Perhaps one of the best tips from Gargus: Every long-range care facility that accepts Medicare and Medicaid patients has been through an unannounced survey (inspection), and that survey is supposed to be available to the public in the facility’s lobby.

But if you don't want to go to a facility personally to read the survey, you can compare facilities online by going to

medicare.gov/nursinghomecare. By entering your ZIP code, you can pull up a list of facilities within a 50-mile range of where you live. There are 65 facilities listed within 50 miles of Port Townsend, and you can compare three at a time. Note that facilities in Sequim, Oak Harbor and Everett as well as Marysville, Friday Harbor and Seattle are options for comparison.

The comparisons provide an overall star rating, health inspection information, staffing and quality measures.

Ultimately, both Brocklesby and Gargus said, communication is important, and they both impressed upon the audience that the more you set yourself up to communicate with your health care providers and health facility providers, and the more you know about your own medical records, the better off you'll be.

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