This Wall Street Journal article by Lucette Lagnado reports on how David Langer, Chief of Neurosurgery at Lenox Hill Hospital in New York City, is attempting to better document healthcare interactions in his Hospital by providing Patients with short (6 mins) videos comprising screen shots and narrated discharge notes (provided by his nurse).

A few thoughts I had on reading the article:

> I think this is a fascinating attempt to document healthcare interactions but I wonder if similar could not just be achieved by just strategically placing a GoPro camera (or having the Patient wear a pair of Google Glass) when the Doctor is normally consulting with their Patient?

> I wonder what would happen in the event of a poor surgical outcome. Does the Patient still get a video explaining everything and if so can this be used by lawyers if they wanted to consider taking any action against the Surgeon/Hospital?

> I wonder if this short video would support continuity of care any better than a written record? If Ms Monato presented at a GP or to a A&E at another hospital would this video be useful or would the Doctor there prefer the Patient brought in access to the full electronic record that the hospital has? There’s no mention of this in the article but surely it’s not the case where  Patients are getting a video without electronic access to their Hospital record?

> In this example I can see some issues arising from the lack of resolution of the brain MRI images being  provided in the videos eg. I can easily imagine that one of the first things that Ms Monato’s father (a retired Doctor) wanted to do on watching the video was to zoom in on the scanned images.

> How will we start to train Medics to produce these videos? Maybe it’s the longer university degrees taken in the USA but the only neurosurgeons here in the UK/Ireland that I’d ever agree to operate on me couldn’t even make a decent go of reading a weather report never mind recording a piece to camera about some surgery they had just finished and it would be inconceivable for them to agree to letting a member of their staff record a summary of their work for the world to view.

>  In the article it’s revealed that the Patient “shared the video with others” including “her friends and even her children, ages 8 and 12“. I wonder how the hospital will work with these carers or will they be expected to just make do with advice from their friends and social media connections? If this video record service took off and became commonplace I wonder if there might be additional pressures on Patients to share this content with friends/family?

> “Dr. Langer, who helped develop the software with a tech partner, says he believes it takes some of the confusion out of doctor-patient exchanges. Patients “would go home and call back and say they didn’t understand, and then ask me the same questions,” he says“.

From experience I have the feeling that video isn’t the best medium with which to try and develop Patient Documentation feedback loops. Not only would it be easier to develop electronic discharge notes based on questions/feedback that comes from Patients when there isn’t video content needing transcribing but I can imagine Patients will also have questions of the video that in an electronic written record would be less problematic to manage eg. you can cut and paste a confusing phrase into Google from a text document in ways that it’s not possible with a video (eg. how do you spell “cerebellum”? etc).

> “Dr. Langer’s neurosurgery unit…   …has launched a clinical trial of the program to test if it improves outcomes…   …about 110 patients have so far participated“. I can’t wait to read this paper, this is the type of thing that Hospitals should be spending their marketing budgets on. Imagine if more Hospitals were publishing the results of taking innovative approaches like this?

> “At the Cullman Regional Medical Centre in Cullman, Ala., an electronic-discharge system called Good to Go, in which nurses make an audiotape of the dos and don’ts at the patient’s bedside, has been widely implemented. Cheryl Bailey, the chief nursing officer at Cullman, says the program has made both nurses and patients focus more on discharge. Nurses, for their part, put in more effort because they know their supervisors may review the tape later, she says. However, only about 14% of patients use it once they get home and she isn’t sure why”

I think this highlights a major challenge with documentation of healthcare encounters. It may always be the case that the majority of Patients don’t interact with the electronic documentation of their care but this evidence should not be used to justify not providing Patients with access to resources but instead used to identify and invest in the things that early adopter Patients/Carers are interact with and asking for.

It should also be a reminder of how important it is for us to create documentation processes that don’t take Healthcare Professionals away from the work they do caring for Patients.

 

> “Other doctors in Lenox Hill’s neurosurgery unit have also begun using the virtual-office-visit software” I think this is all confusing enough so we should be very careful about the language being used eg. there’s nothing virtual going on here, this isn’t comparable to an office visit, etc.

> “Mitchell Levine, chief of spinal neurosurgery, is concerned the rise of technology in health care could distract physicians from their main task: communicating on a human level with their patients. “I basically like to talk to the patient, that is my style,” he says. Although he may at some point begin to use the virtual-office-visit software “incrementally,” for now he prefers to “stare my patients in the eye and tell them what I have to do,” Dr. Levine says“.

Perhaps Dr Levine should consider if his Patients would like his videos to be made live with a strategically placed GoPro or Google Glass (worn on the Patient/Carers head)?

> “Days after being discharged from Lenox Hill to a rehabilitation facility near Princeton, Ms. Monato said she was feeling much better. She said she received a new videotape from Dr. Langer containing her post-op MRI and his assessment of it”

I think the video production time delays aren’t likely to be a big problem in this instance where we have a $1 Million funded trial that has so far only processed 100 Patient videos, but as this service is scaled it will be interesting to watch what happens as the surgical workload makes it hard to schedule time to make the videos.

I wonder if Patients/Carers would find a written record available the next day preferable to a video available a few days later?

What do you think about these developments in video recording discharge notes? Will they be something else we’ll have to accept that our Dog will get before our Daughters?

 

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