Monday, February 22, 2010

Keeping My Child Out of the ER: The Importance of Accessible Data

By Amy Costello, Project Director, New Hampshire Institute for Health Policy and Practice

Last Thursday, after a scary afternoon of trying to manage my daughter’s asthma at home, we ended up in the Emergency Room. Elizabeth is 20 months old.  She has had asthma-like symptoms with a cold so I was able to recognize that she was having difficulty breathing. I called our family physician. She was out of the office and the covering physicians were booked for the rest of the day. I made an appointment for Elizabeth for 9:15 the next morning, and crossed my fingers that the breathing would get easier instead of worse.  At 6:00 that night, with Daddy out of town and Elizabeth retracting under her ribcage, I packed her, her older sister, and some Sippy cups into the car for a field trip to the Emergency Room (ER).

We were triaged immediately and Elizabeth received a nebulizer treatment in the hallway while we waited for a room to become available. The staff was great! Elizabeth responded well to the treatments, tolerated the chest x-ray (which indicated pneumonia), took her foul-tasting antibiotics and steroids, and slept on me until she was discharged at 11:00 that night. Friends pitched in to take care of Katie. All in all, a positive experience.

After checking in with the family physician the next morning, I went in search of a nebulizer. In my opinion, we should not be managing asthma in the ER if we can help it. It is so much easier (and much more cost-effective) to administer nebulizer treatments at home.

I had the prescriptions for both the nebulizer and the precious breath-giving medicine it delivers. That wasn’t the problem. I picked up the medicine in the drive-thru of the Rite-Aid down the street from my house. Rite-Aid told me that the nebulizer might not be covered by my insurance. What? I have fantastic insurance. I called the insurance company to inquire about this and learned that I needed to get the nebulizer from a contracted vendor. I understand the use of that financial model, but the reality is that the contracted vendors are located in Hooksett, Lebanon and Nashua. My baby needs to breathe, and she is in Dover. I pleaded with my insurance company, “She needs her treatment in an hour.” The nice woman at the insurance company, Ellen, told me that some of the vendors might have satellite offices. She asked me where I live and for names of towns close by, as she was not familiar with the geography of New Hampshire.

This invoked some questions. “Why are you asking me for names of surrounding towns? How are you searching for this nebulizer? Is it by town? A 10 mile radius? 25 mile radius?”
“No,” she responded. I am searching by the names of the towns that you give me. I look it up in an Excel spreadsheet.”
I can find the closest Starbucks faster than Ellen can locate a nebulizer? This can’t be right.

Ellen suggested that she make a couple of calls and call me back. In twenty minutes, I had directions to the durable medical equipment shop that had Elizabeth’s nebulizer waiting—in Portsmouth, only 20 minutes away. I could pick up the nebulizer and return home to administer Elizabeth’s medicine. Just in time.

My issue with this scenario is not about insurance coverage, contracted vendors, or even customer service. It is about data. Why wasn’t the Portsmouth satellite office information in the Excel spreadsheet? Why was all the data organized in an Excel spreadsheet, instead of in some kind of web-based locator system that Ellen or I could access? This is equipment that delivers medicine that stops an asthma attack! This equipment keeps kids out of the Emergency Room. It is 2010. I should not have to explain that Portsmouth is near Dover to someone over the phone, who then has to make phone calls to find oxygen equipment.

This data needs to be organized in a way that enables patients to treat and manage their families’ health outside of the Emergency Room. This does not require a full-blown implementation of Electronic Medical Record, or Health Information Exchange. It requires a thoughtful arrangement of the data to be used with tools that are currently available to us.

Tags: Citizens Health Initiative, Electronic Medical Record, emergency room, ER, Health Information Exchange

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