Music. Welcome to Q and A with Dr. K, a podcast by Mountain Pacific Quality Health, where we sit down with Dr. Doug Kuntzweiler and get your health questions answered, because on Q and A with Dr. K, the doctor is always in. Hello, everyone. This is Beth Brown, your host, and joining us, as always, is the wonderful Dr. Doug Kuntzweiler, Mountain Pacific's chief medical officer. Thanks again for always being here with us, Dr. K, to answer our questions.
Thanks for having me, Beth.
So we're back with what is going to be the last episode in our series. We've been talking about how to help patients feel empowered and to be more confident in the way that they are getting their health care and taking care of their health. And so in our first episode, we dove into the importance of asking questions, and how asking those questions can improve the communication you have with your providers and to help you better understand
your health. And so I would invite people to go back and listen to that episode if they haven't already. And then we talked with you, Dr. K, and with one of our pharmacists, Kyla, about truly knowing your medications and taking advantage of your pharmacist, because your pharmacist is such an amazing and available health resource for your health care and for
your health. So today, what we're going to talk about is some of the ways that technology can help us better manage our health and better navigate our health care and how to feel empowered and more confident about how we use health information technology, or HIT, or health IT has different names. So Dr. K, let's start with what are we talking about? What all can HIT, or health information technology, encompass?
Everything that I don't understand. I am one of the boomiest of the boomers, and almost nothing that I was using at the end of my active medical career existed when I started in practice. I grew up during the polio epidemic in the 1950s, and I, over the course of my life, had gone from iron lungs used to ventilate people to home
ventilators. So health information technology takes in all of this, mostly electronic, not exclusively, but mostly electronic technology that centers around every aspect of health care. So it encompasses things like electronic health record. Do the electronic medical record instead of handwritten notes. Now, everything is digital and
available digitally. It includes things like patient portals, which are they sound like something you crawl into, but basically, it's just a website that allows you to access information about your health care, all of the monitors, the sophisticated monitors that we use in the hospital. Now, even the billing is all done electronically. Now, nothing
gets mailed anymore. It's all digitized, and it also encompasses things like medical jewelry, like fitbits and the rings and other watches that track how active you are during the day, how many steps you take, some of them even track your sleep. Continuous glucose monitors, it used to be that diabetics were poking themselves in a finger twice, three times a day, and they wound up with nothing but scars on their
fingertips. Now there are monitors that go on their their arm, around their abdomen, and they continuously monitor the glucose. And some of them then will Bluetooth it to their telephone so they know minute to minute what their blood sugar is, just to see change in in the management of diabetes. And there's just almost no end to it. Blood pressure monitors are all digitized now and record and
it's just incredible. When you you think about the technology that we are surrounded with that relates to our health, it is amazing.
And to your point, a lot of these technological items were very much used by providers and were not so much used by the patient, but now that has been another big shift over time that it's not just the providers getting into those electronic medical records or electronic health records, but we're encouraging patients to get into them too via those patient
portals. So can you talk about that shift a little bit of why it really is becoming something that patients use as much, arguably, as providers, and why that is important, and maybe people should try to overcome their fears or their discomfort with some of these electronic or digital tools.
Yeah, when I started in medicine in the late 70s, the chart was created by the people providing care, the physicians and the nurses. And the thinking was that, is our chart, and patients weren't granted access to it. They had to go to extraordinary measures if they wanted their chart or wanted to be able to read it. And it was this sort of Neanderthal thinking that, well, I made this chart, it's mine. Even though it is about the most intimate details of your health, you're not allowed to look at
it. And so over time, there was this change where patients demanded to be able to look at their charts. And that has gradually changed. And now what providers have come to realize is that the patient who has access to their chart and sees what's going on is a better patient. They're more involved in their health care, they are more likely to be compliant with recommendations and with the decisions that they have helped to make about their treatment.
So it has gradually shifted, and who is more concerned about your personal health than you are, and this access to your chart and to your information allows you to be intimately involved with that. And if it's going to be useful, your medical record, all of these technological things we've talked about that relate to your health, they need to be accurate, and you are the only person who really can provide that that accuracy. I I've had charge where my birth date was wrong or where my name
was spelled wrong. If you think about things like reconciling your medication list, you know, if you're young, it's probably not very relevant, but as you age, you wind up getting put on more and more meds every few months, one is stopped, another is started, and it doesn't take any time at all before nobody knows what you're actually taking, probably including
yourself. But with an electronic medical record in the digitization in the pharmacies, it's much, much easier to keep that medical record accurate, and it needs to be complete. People see different providers, and they sometimes, you know, when they're asked about their medical history, they will forget that, oh, a cardiologist two years ago said I had a mitral valve problem, that sort of thing. And if that's all in your chart, then it is going to be complete, and you should have
it because it is. It's readily available to all of your providers then, and everything can be in there, including your advanced directives, which we've talked about on other podcasts. So the health technology is not going anywhere we we have to live with it. I know it gets frustrating, especially people in my generation can get pretty frustrated with it, because I'm not as computer savvy as younger folks, but it's not going anywhere, and on the whole, it leads to better care, I believe.
So we need to be involved.
Okay, that's great. And you talked about our chart of our electronic health record, and some of the different items that might be in there about us, including medications. What sort of information needs to be in there for that electronic health record to be complete? What are some of the other different things that people can expect to see or that our providers use when we're getting health care that are in that electronic health record or in our chart, as you said?
Yeah, the things that are important to your health and so an accurate history of your health, including all the problems, all the surgeries, anything that's been a problem for you, your family history, everything you know about your family history that you can find out that should be in there, things about your social history, like how ambulatory you are, whether or not You have food safety, whether or not you live in a safe environment, whether or not you are engaged in society, or
whether you know you're living by yourself. All those things have huge impact on our health, our health status, and so all of that needs to be in there, and it needs to be kept up to date and kept accurate.
And yeah, I appreciate talking about where you live or some of the other things that may be affecting your health that we might not think of, beyond the surgeries we've had or the conditions that we've been diagnosed with, and mental health as well, correct? We're talking more about some of the things that we're feeling or experiencing emotionally and behaviorally, beyond just physically.
Yeah, and things like habits like, Are you a smoker? Do you drink alcohol? How much exercise do you get on a regular basis? All those things should be in there.
So when we think about how we can be a proponent for our health, where we're in there advocating for ourselves and using that electronic health record to do that, what does that look like?
Well, I think one of the first things is look at your chart, and if there are discrepancies or things that are inaccurate, you know, talk to your provider about correcting them. And that shouldn't be any kind of an argument is, you know, you had your gall bladder out and that's not in there, then it needs to
be. The other thing I think of that is one of the big benefits of this is that there are programs that will translate if English is not your first language and that's probably the language your chart is going to be in. There are translation apps that can translate all of that for you. There should be things in there that deal with the preventative measures, things like, what's your vaccination status? Are you current? Are you up to date? Have you gotten all the vaccines
that you should at your age? And almost anything in there is relevant, and you just want to make sure that it's complete and that it's accurate, and then you're in a position to help share in decision making. You will have a better understanding of your health status. You should have a better understanding of what your provider has talked to you about in terms of treatment and and there should be a note that your shared decision making is to do this or do that do the other thing.
So you talked about notes. Let's build on that a little bit because, yeah, a lot of times now, when we go in to see a doctor, they're on a laptop, or they're on a tablet or something, and they're taking notes, or they have someone in there with them that's helping them take those notes. So what can you tell us about those appointment notes? I guess sometimes they're also called
office visit summaries. What is happening there, and how can that help improve what we're doing as patients and what providers are doing?
Yeah, you have a provider sitting down with somebody who has some kind of a problem, and you got to look them in the eye. You have to touch them and let them know that you're there and that you care about their health. Now there are different ways than to take notes. You can have a scribe who watches the interaction, and they have training, and they learn the language, and they can take notes, and then after that, you
can go and meet your notes. I used to just jot down little notes to jog my memory, but I did it very sparingly, and most of the time I was engaged face to face with the patient, but I would turn and make a little note on paper. You could do the same thing with a laptop, but I've had providers who were just staring at their laptop the whole time and hardly ever looked at me. And frankly, it's
it's not a good experience. Now, what's in the notes the electronic medical record should have all of that historical stuff that we talked about, your past medical history, to your family history, all those such things. Your medication must blah, blah, blah, the appointment note, or what we always refer to as a progress note, then, is a record of what is happening during this particular visit, and it might be a follow up for a chronic
problem. Maybe you've been switched to a new medication, and the provider was to check in, see how you're getting along with that, see if it's working, see if you're having any side effects. So it's it's more focused on today's problems, and there are various formats that are used, but it's a way to record in some sort of routine fashion. What's going on with you today?
I have had providers that have headsets, too, that they just talk into those so that could be a little bit better than having your nose in a laptop.
Yeah, one thing I do like I have a cardiologist who dictates the progress note, and he does that in front of me at the end of our visit. And I like that because it gives me an opportunity. If there was something I didn't understand, or if he says something that it actually is inaccurate, then I can, I can correct him right there. And it shows a level of confidence between the two. I trust him and he trusts me and and there's some interesting research as to how all of this electronic stuff
affects patients. One of the studies I read shows that if the patient has access to his notes, there's about a 60% increase in adherence to their recommendations. You're more likely to keep follow up appointments, you're more likely to fill your prescription, you're more likely to take the medications or to do whatever therapies exactly the way they were prescribed to you. So it really is important.
That's awesome, yeah, because sometimes we don't catch all those details when we're just having a conversation with our provider, but if we can go back and look at what was written down, then it sinks in and we understand it better. So that makes a lot of sense. So we're going to talk about telehealth a little bit, you know, speaking of digitalizing healthcare and some of these things that are becoming more electronic, we're even getting some of our health care via
digital means. But before we really jump into that, let's talk about a term that people may be hearing called electronic prescribing, or e-prescribing. What is that? Does that tie into telehealth? Is that something different?
So what used to happen if a medication was going to be prescribed is, towards the end of the visit, the provider pulls out a prescription pad and writes generally, allegiably the medication. And the dose and how it's to be taken, and how much medications to be given, whether or not to be refills. And they hand that to the patient, who then has to keep the dog from eating it, take it to the pharmacy, hand it to the pharmacist, who has to try and decipher the handwriting.
Probably can't. Has to call the provider. Says, What on earth did you write here? I'm exaggerating some, but this stuff really does happen. You know, when you write 30 or 40 prescriptions a day, your handwriting gets worse and worse as time goes by and so e-prescribing is doing this electronically, and most commonly, what happens is you, you make a decision about what you're going to prescribe, which medication it should be a joint decision along with the patient.
And then you go to the pharmacy that is going to supply it, and from a list, you pick the medication, and you click on that, and then it will give you options for you know, are you taking it twice a day or once a day, or how are you taking it. And so you click on the correct option for that, and then the number and refills. So it takes the whole handwriting thing out
of it. It takes the whole passing the prescription from provider to patient who has to keep track of it and get it to a pharmacy, because things legitimately did get lost occasionally, or ringing down or
who knows what. So it takes that out, as long as the prescriber has done his clicks accurately, and this is where mistakes can happen, but no system is mistake free, but as long as they are careful in their clicks, then you get the correct dosage and the correct instructions on how to take it, and there's a record right of the way the pharmacist doesn't have to remember or file it, or, you know, do something else to record that you got it.
It's it's right there in their computer banks, and so it automatically reconciles your prescription list. And most of these programs also incorporate things like alerts, like if you're prescribing two medications that might interact adversely with each other, you'll get an alert if the patient happens to be allergic, say, to a particular type of antibiotic, and that's what was prescribed, an alert will sound. And so it's it's much better at doing that than human beings
are. So it really is a better way to prescribe medications. Now there, there are some controlled substances that, in order to make sure there isn't any any fraud or abuse, that you still have to have a written prescription for it. But in general, most everything at this time is electronic.
Okay, so that's when, you know, my doctor asks where my pharmacy is, and then they're just sending that prescription right over, that would be another reason why having one pharmacy is good to just simplify that whole process, even though it's been simplified so much already by the electronic process.
Yeah, one thing we haven't talked about in all of this is that there's a lot of proprietary stuff, and like electronic health records, it would be nice if they all transferred to each other. And so if you are in hospital, a that uses Meditech as their EHR system, and you're traveling and you go to a different hospital, and they use Epic as their electronic health record, it's it's not guaranteed that Meditech is going to send your record to Epic, and they're very
proprietary. They're very worried about people stealing their trade secrets and whatnot. It's getting better, and there are government offices that are working on this. Legislation has been passed to try and make these all more uniformly available, and we're getting there, but it's been slow, and a lot of it is because, you know, corporations are worried about their secrets being stolen.
Sure, yeah, I think that's where health information exchanges come into and states have been trying to work on that as well, by creating a higher level system that helps those specific hospital systems communicate to one another better. So I know health information exchanges have come into play there too to support some improvement there. That might be for a different episode. That's an explaining what a health information exchange does. But okay, so let's talk about telemedicine a
little bit. In about two years, from 2019 to 2021, the use of telemedicine exploded from just about 15% of patients using telemedicine to 86%, so almost nine in every 10 people were using telemedicine to go see their doctor. And of course, we had a pandemic in the middle of that, and so that really helped people lean into using that
telemedicine. But now it's here, doesn't appear to be going anywhere, but there are times when using that telehealth or telemedicine appointment makes sense, and there are times when you really should go see a doctor in person. So first, let's talk about, if someone has never done a telehealth appointment, what does that look like? And then secondly, let's talk about when should you use those type of appointments versus when should you really try to get in to see a doctor in
Well, the appointment looks very much like person? a Zoom meeting. If you've ever been in a Zoom meeting or a Teams meeting, or used FaceTime on your telephone when you're talking, so it should be two people looking at each other on a screen. You need to be able to hear and language needs to not be a barrier. If there is a language barrier, then, as I said, there are lots of apps around that can do translation for you, but that's what it
looks like. It's like watching your provider on a TV screen in real time. And that's good, you
Yeah, it seems like those sorts of follow up know, you get some body language, you get some facial expression, you might get better understanding of what they're saying. So it works pretty well for some things. Not so well for others. It works pretty well for things like psychiatry, which in large part involves talking to people and watching their reactions. It can work pretty well for dermatology, if you have a good camera. I know dermatologists who love looking at things through telehealth and
making a diagnosis. It's pretty good for managing chronic disease, if somebody's not having an acute problem right now, but let's say they're diabetic and maybe their sugars are a little bit out of control. You're right there with the provider at the screen, and they can ask you about what your diet, what your activity level, that you're doing with your medications. So it's it's good for those kinds of things, stable, chronic and mild kinds
of problems. If, on the other hand, you are genuinely sick, maybe you have a new condition that hasn't been diagnosed yet. Maybe you have symptoms that are worrisome to you more than minor, then it's it's not so great. You shouldn't be trying to diagnose people remotely, when what you really need is, as I said earlier, to sit down face to face and to touch them. That touch is a huge component. You get so much information when you're face to face, watching the patient breathe, watching
them move. You know, you get more subtle facial expressions when you're really face to face, and then you can touch them. You can see if their skin is sweaty or dry. You can feel if they're warm or cold. You can press around, we call it palpation, but press around and find tender spots. You can feel masses. Pretty difficult to do that through a tele medicine console, so you have to be a little
careful how you use it. And I think for the most part, providers love it because it means better follow up with their patients, especially in rural areas like Montana, Wyoming, Alaska, Hawaii, the states that we are most active in, it's difficult, like if you live in Jordan, Montana, it's a hell of a long way to anywhere where you can see a provider face to face. And so it fills in for that, but it has definite limitations too. appointments were sort of management of your conditions.
That's also where those technologies come in handy, too. If you do have something that you're using at home to monitor either your glucose levels or your blood pressure, or, you know, those kind of things that send data right to your phone, and then you can share that information with your doctor.
Right. And there are new technology, of course, is advancing like crazy. There are stethoscopes that you can have in the home, and you hold it up your chest, and provider remotely can listen to your heart, do you want the same way blood pressures can be taken that way? When I was in the ER, we had an agreement with University of Utah Burn Unit, and they gave us a television camera, really high quality, high resolution television
camera. And when we got burn patients, we would call University of Utah, and the burn resident would be there, and we would move the camera around, show them where all the areas were that were burned. And from taking that information, they could advise us whether or not we could take care of the patient locally, or whether they should be transferred to the burn unit. So it's pretty amazing, especially when I think back on how things were when I
started in medicine. It's it's completely technological now,
Yeah, it is amazing, and that's a way for other providers to connect with specialists, like you said, for those people to look at burns, that's just amazing. And you mentioned the psychiatry thing too. So that's getting people access to health care where, again, if they live in those remote areas, they might not have a psychologist or a counselor of some kind, right there in their little town of 200 but they can talk to somebody on FaceTime or on Zoom or Teams and get the care that
they need. So that's super cool, and it's really breaking down a lot of barriers. Are there other ways that you can think of those? Are some great examples, but how else is this health information technology really just improving our access to health care?
Well, one of the things that when I talk to people about this, one of the things they're most exciting about, is self scheduling. A lot of clinics and offices now are allowing patients to self schedule. And that is, is huge. You're not sitting on the phone forever, you know, waiting for the front desk person to finally
get finished and get to you. And there isn't a lot of trying to mash your schedule into there, as you can see what's available, and you can pick out the time that works for you, the time when you know you have transportation, because that sometimes is an issue, especially in rural areas. So that's, that's something that people don't often think about.
The technology this made it available, and that's, that's really quite good, and that also has sped up follow up appointments and has improved people keeping those appointments far fewer no shows. So even though I'm an old curmudgeon, I have to say that, on the whole, this technology has really made health care better and the more involved the patient is, the better it's going to work.
So speaking of being a curmudgeon, there are people out there who are a little intimidated by but also concerned by technology, and that's not being a curmudgeon. There are some legitimate concerns there about I don't want everyone to know about my health information. I don't want that information to just get out over the internet. And so when people have those real concerns about the security risks of sharing that kind of information via technology. What should they
know about that? Are there things in place to help put their minds at ease a little bit? Or what do we have to tell people about that concern, Dr K?
Yeah, it really is a concern. And if you followed the news at all, you know that in the last few years there have been a couple of breaches in some big health care systems of people's medical
information. There's federal law that all providers have to follow the HIPAA Act, Health Information Portability and Accountability Act that guarantees that everybody that gets federal dollars, which is essentially every health care provider, has to follow those rules, and they have to have safeguards to keep patients healthcare information safe. And there are significant fines, including even jail time, especially if you release
information maliciously. But significant financial fines for companies that allow sloppiness and somebody hacks into their system, or, you know, they inadvertently give information out, because it's not just your healthcare information, usually, there's access to your social security numbers, sometimes even things like your credit cards, your bank accounts. So it's, it's no laughing matter. Where
it's, it's very serious. And I think it's fair game to ask your provider how they are ensuring that HIPAA is followed in their office.
That's great. And so I do think that we have providers who do try very hard to follow those guidelines and regulations. But like you said, there are breaches that happen even when people have tried to take those steps. And so when that does happen to a person, where their hospital or their provider notifies them that there has been a breach, and of course, they're working on it, what should the individual do in that case?
Well, I would first check and make sure that they have reported the HIPAA violation, because that's part of the law. They have a fairly short time frame that they have to report that they've lost some data, that there's been a violation, and so the first thing I would do is call the provider's office and see what they're doing about it, make sure that they have reported it, because they are
mandated to report it. Health and Human Services as an Office of Civil Rights, you can call them, they have ombudsman who can help you follow through and follow up on your reports and make sure that you know everything is done. No way it should be done.
So there are other risks, but I think what we really want to say today is technology is sort of taking over health care in a lot of ways, and it's good to get involved and understand those ways better so that you can again have those tools to be more active in your own health care.
Yeah, absolutely. And I would say to folks who are in my generation, you know, it really is going to help you if you're not very computer savvy. You know, find a niece, find a nephew, find a neighbor kid, somebody who is very savvy with computers, and
have them help you navigate. I I use about three different hospital portals now, and I find it challenging at times, but it really is rewarding too, when you'll get a much better picture of what's going on and and I think it will give you some assurance too, that, you know, you see how much people care and how much time and effort they're putting into the care for you. And so I think it's reassuring as well.
That's great. Yeah, so if you need the help, ask for it. Especially young people today, seem to have been born with smartphones in their hands. So they they get all that.
Some of them, almost literally, were. They can't speak yet, and they're playing with mom's iPhone.
That's so true. Yeah, all right, any closing thoughts that you want to leave us with today, Dr. K?
No, there are lots of other places you know, you can go to get information. As always, if you're going to go to the web and learn about these things, make sure you're on a reliable site. But even places like Mayo Clinic, Cleveland Clinic, Johns Hopkins, they will have a lot of information on medical technology, and there's a lot of good information in the CDC to World Health Organization. If you're concerned about security, you know, look up the HIPAA Act and see exactly what it says.
That's perfect. And we'll include some of those more reliable, top resources when we post this about this topic today with our podcast episode. And so that's our show for today, and that ends our series on helping you feel more confident about getting your health care and taking an active role in your
health. If you have any questions about that, or any other questions for Dr K, he's always here to answer them, please email us at Q and A with Dr k@mpqhf.org and we'll have that email address with this episode as well, you can submit your question, and we will keep it anonymous, but get you the information you need. Thanks, Dr K.
Thank you.
Thanks everybody for listening. Have a great day.