It’s frustrating, not to mention dangerous. I had a patient with limb-threatening pyoderma gangrenosum (confirmed by biopsy) with tendons exposed who I’d started on high dose prednisone. He got admitted to the hospital for pain where another biopsy was performed but since he’d been on prednisone for several weeks, the second biopsy didn’t show the characteristic changes of pyoderma. The inpatient team told the patient that he’d never had pyoderma and they abruptly stopped his prednisone without weaning him. It’s a miracle he’s alive.
It’s true that the inpatient physicians made poor clinical decisions, but the genesis of the problem was that even though the wound center is affiliated with that hospital, they didn’t have easy access to his wound center records. “Interoperability” of electronic health records across the continuum of care isn’t just a nice thing to have, it saves lives and limbs. So, why don’t I solve the problem and use the hospital EHR in the wound center? The reason is that both the hospital and I would lose our financial shirts if we did, besides which I couldn’t do my job. My hospital EHR can’t even begin to support outpatient coding and billing, not to mention the fact it can’t store photographs or the clinical data that I need. I must have an EHR that’s purpose-built for wound management.
July 20th will be the 52nd anniversary of the moon landing. More than half a century later, it’s finally possible to have the tools you need for outpatient wound management seamlessly integrated into the hospital EHR. An interoperable app inside the hospital’s EHR can make the integration possible. That’s a giant leap for mankind.