Patient Benefit from our Communication and Coordination of Care

(From the September 2018 Issue of MedStat)

Primary Care Matters is a guest column written for MedStat by a local pediatrician or primary care provider.

Written by Domenico Pietropaolo, MD

Shown here with his family. Dr. Domenico Pietropaolo is a graduate of The Ohio State University College of Medicine. He completed his Pediatric Residency and Fellowship in Infectious Disease at Nationwide Children’s Hospital. He has been on the medical staff since 2011 and practices at the Ohio Center for Pediatrics in Dublin.

Communication and Coordination of Care

“Why can’t these doctors just talk to each other so he doesn’t have to get poked every week for labs?” When asked to write an article about physician communication, my mother’s rhetorical questioning of the missing interaction between my father's primary care and specialist physicians was my immediate thought. Her frustration was not unique nor was it unwarranted, particularly when a quick phone call between these two doctors has simplified the treatment plan.

Related, I wonder how often busy physicians skip to the bottom of a PCP's encounter note or specialist's referral letter to only read the treatment plan. Unfortunately, in both instances, electronic medical records have allowed these communication devices to become bloated with superfluous details and minimal substance. As billing checklists are marked off and the Control-V paste function gets overused, physician-to-physician information exchange is lost as quickly as a fax machine runs out of paper. Thankfully, Nationwide Children's Hospital has made efforts to strengthen communication between outpatient physicians and the hospital staff.

Physician Direct Connect (a.k.a., PDC, or for us old timers, PCTC) serves as the most important conduit between outpatient pediatricians and specialists. By setting up a phone call between providers, the wonderful PDC nursing team has sharpened differential diagnoses, finessed patient care plans, and helped countless patient families navigate a sometimes-complicated medical system. I am quite hopeful that a proposed reverse PDC system that allows specialists to contact outpatient pediatricians will come online soon to further benefit patients.

Beyond the hospital's successes in coordinating phone calls, Nationwide Children's CareLink has become another communication tool rapidly expanding provider-to-provider communication. Not only does CareLink provide outpatient pediatricians access to a child's NCH EMR, it allows physicians to email each other in a secure manner. I have found this extremely useful when I want to direct a question to a specific pediatric specialist (e.g., what labs is my patient's nephrologist going to order so I can coordinate my own blood draw) rather than troubling the cross-covering PDC physician from the same department who may not have a specific answer for me. What I hope to see is continued better coordination of care. While the system works great for one-on-one style communication, I would also love to see CareLink have the ability to put up away-from-the-office style messages and work with a "team" email address (e.g., craniofacial clinic, hematology clinic, all the physicians in an outpatient pediatric office), such that a single physician's absence would not hamper the discussion.

To quote Albus Dumbledore from the Harry Potter series, "words are, in my not so humble opinion, our most inexhaustible source of magic, capable of both inflicting injury and remedying it." Despite the many advances in electronic communication devices and medical records, logistics in medicine occasionally remains hindered because we have not maximized our communication with peers. Whereas Amazon and UPS manage to somehow get my Prime delivery to me from across the continent in record time, two physicians and their dueling fax machines were unable to figure out that they were both ordering a basic metabolic panel from my poor father’s arm days apart. Thankfully, a simple phone call has fixed this.

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