On May 19, 2012, 31-year-old Greg Price died three days after surgery. Price’s family and experts alike attribute his untimely death to gaps in communication within the health care system. And, unfortunately, the gaps that led to Price’s death were not isolated incidents nor a freak confluence of circumstances.
A Strong Case for Synoptic Reporting
Last month, the Health Quality Council of Alberta issued its Continuity of Patient Care Study. The report identifies thirteen areas for improvement within the Alberta Health Services system. The number one recommendation reads in part:
Alberta Health and Alberta Health Services should strongly consider making additional investments in the provincial electronic health record and e-referral system to standardize workflow processes for all specialized healthcare services…
The report goes on to detail the specific objectives of investing in the electronic system, which include confirmed receipt of electronic referrals, management of appointment scheduling and notification, report generation and transmission to the referring provider, notification of incomplete, delayed or denied referrals and notification where patients have not completed scheduled follow-up.
In short, the electronic system should make it easy to share information and more difficult for important tasks and information to slip through the cracks, as occurred in Greg Price’s case.
The patient was referred to a surgeon for consultation, and faced a three-month delay in obtaining an appointment. However, there was no procedure in place for the surgeon to notify the referring physician of the expected delay or the referring physician to inquire as to availability.
- Synoptic reporting systems equipped with electronic referral systems make it easy for clinicians to communicate, and can trigger follow-up when necessary to ensure continuity of care.
The patient was scheduled for and underwent a CT scan considered critical to his care, but no follow-up appointment was scheduled and the patient was not contacted with the results of the scan.
- A properly configured synoptic reporting system would have triggered a follow-up appointment task.
The patient was referred to a urologist who was away for an extended period of time, and the referring clinician did not know of the urologist’s unavailability.
- An electronic referral system would have enhanced communication and clarity between the two physicians, so that the specialist’s unavailability could have been promptly noted and an alternate referral offered.
To further aggravate the communication problems, none of the three primary care physicians involved in Price’s treatment had access to his full medical record.
Of course, the specific breakdowns that occurred in Price’s case aren’t common to every patient. But, neither are they unusual or isolated problems.
A synoptic reporting system can improve continuity of patient care by automatically transmitting reports, triggering follow-up tasks, enhancing communication surrounding referrals and test results and tracking patient follow-up. That means better, more thorough care for patients and reduced risk of liability for institutions.
Synoptic reporting, with its shared access, standardized workflows and automated report distribution, can mitigate and even eliminate the communication gaps that jeopardize patient care.