E-Patient Update: Before You Call Me A “Frequent Flier,” Check Your EMR

Posted on April 28, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While there’s some debate about what constitutes an emergency, there’s no doubt I’ve had a bunch of ambiguous, potentially symptoms lately that needed to be addressed promptly. Unfortunately, that’s exposed me to providers brainwashed to believe that anyone who comes to the emergency department regularly is a problem.

Not only is that irritating, and sometimes intimidating, it’s easy to fix. If medical providers were to just dig a bit further into my existing records – or ideally, do a sophisticated analysis of my health history – they’d understand my behavior, and perhaps even provide more effective care.

If they looked at the context their big ‘ol EMR could provide, they wouldn’t waste time wondering whether I’m overreacting or wasting their time.

As I see it, slapping the “frequent flier” label on patients is particularly inappropriate when they have enough data on hand to know better. (Actually, the American College of Emergency Physicians notes that a very small number of frequent ED visitors are actually homeless, drug seekers or mentally ill, all of which is in play when you show up a bit often. But that’s a topic for another time.)

Taking no chances

The truth is, I’ve only been hitting the ED of late because I’ve been responding to issues that are truly concerning, or doing what my primary doctor or HMO nurse line suggests.

For example, my primary care doctor routed me straight to the local emergency department for a Doppler when my calves swelled abruptly, as I had a DVT episode and subsequent pulmonary embolism just six months ago.

More recently, when I had a sudden right-sided facial droop, I wasn’t going to wait around and see if it was caused by a stroke. It turns out that I probably had an atypical onset of Bell’s Palsy, but there was no way I was going to try and sort that out on my own.

And given that I have a very strong history of family members dropping dead of MI, I wasn’t going to fool around when I felt breathless, my heart was racing and I my chest ached. Panic attack, you’re thinking? No, as it turned out that like my mother, I had aFib. Once again, I don’t have a lab or imaging equipment in my apartment – and my PCP doesn’t either – so I think I did the right thing.

The truth is, in each case I’d probably have been OK, but I erred on the side of caution. You know what? I don’t want to die needlessly or sustain major injuries to prove I’m no wimp.

The whole picture

Nonetheless, having been to the ED pretty regularly of late, I still encounter clinicians that wonder if I’m a malingerer, an attention seeker or a hypochondriac. I pick up just a hint of condescension, a sense of being delicately patronized from both clinicians and staffer who think I’m nuts. It’s subtle, but I know it’s there.

Now, if these folks kept up with their industry, they might have read the following, from Health Affairs. The article in question notes that “the overwhelming majority of frequent [ED} users have only episodic periods of high ED use, instead of consistent use over multiple years.” Yup, that’s me.

If they weren’t so prone to judging me and my choices – OK, not everyone but certainly some – it might occur to them to leverage my data. Hey, if I’m being screened but in no deep distress, why not ask what my wearable or health app data has told me of late? More importantly, why haven’t the IT folks at this otherwise excellent hospital equipped providers with even basic filters the ED treatment team can use to spot larger patterns? (Yeah, bringing big data analytics into today’s mix might be a stretch, but still, where are they?)

Don’t get me wrong. I understand that it’s hard to break long-established patterns, change attitudes and integrate any form of analytics into the extremely complex ED workflow. But as I see it, there’s no excuse to just ignore these problems. Soon, the day will come when on-the-spot analytics is the minimum professional requirement for treating ED patients, so confront the problem now.

Oh, and by the way, treat me with more respect, OK?