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There are many ways to approach the nebulous concept of information.
These include mathematics, physics, mechanicals, symbolic relations, grammar, 

Pragmatism is seldom given the priority it deserves.

This article give's an example of the how information is used, perhaps in 
life-death decision making.

What is the relation between Information and the bottom line?  (Or, in this 
case, the entelechy of the last line!)



Information Does Not Equal Communication
Published: Nov 13, 2014

By Fred N. Pelzman, MD

Information is everything, communication is the key.
Recently, we were contacted by the medical director of a subspecialist fellow's 
practice at one of our affiliated hospitals.
She wanted to discuss ways to improve communication between our practices, and 
expressed considerable frustration about the information received in 
consultation requests from the providers in our practice sending patients their 
She noted that they had "read-only" access to our electronic health record 
(through an information-sharing agreement between our hospitals) and said that 
they were able to see the consult order in the system (which has a section for 
clinical comments), as well as read the provider's notes to glean information 
about why the patient was being sent to see them.
Apparently the fellows at her practice were frustrated about the lack of 
clarity in the consultation requests, not being able to extract from all of 
this what the clinical question being asked of the subspecialist was.
We had a long discussion about how important this was and how her fellows spent 
enormous amounts of time reading through the chart to find out what the 
patient's complaints were, what their past medical history was, what 
interventions had been tried for the specific complaint, and what specifically 
the provider sending the patient to them was asking their assistance with.
This is perfectly reasonable; there is a real expectation that when you refer 
to someone that you clearly delineate your question to them, to make it easier 
for them to help you care for your patient.
This is an art form, being able to wisely use your consultants, to know how to 
engage them to help you improve the condition of your patients. For our interns 
and residents this is part of the learning process, and in looking back at 
their consultation requests we found the quality and clarity of the consult 
question at times lacking, at times nonexistent.
This is an education deficit, a gap in what we are teaching them, but we hope 
to help them learn this process as they continue to grow as clinicians.
As we talked over this problem, we came up with a plan for ways to continue to 
educate our providers on the best way to communicate with consultants and ask 
them an appropriate clinical question, to help make their lives easier as they 
see our patients in their practice.
I then mentioned to the medical director that, in the nearly 20 years that I've 
been at this practice and we have been sending patients to them, there has been 
no mechanism in place for them to communicate back to us. We send patients to 
them, and they disappear into the black box of the hospital down the street.
No letters, no e-mails, no phone calls.
Patients return, and we ask them what the specialist did, what they tested them 
for, what they told them to do, what they gave them to try. The response is 
usually "they did some tests, they gave me some medicine, but I can't really 
recall the details."
Their hospital still has no outpatient electronic health record, so the 
fellow's notes are typed as simple word-processing documents, printed, and 
saved to a paper chart.
They are complaining that they have read-only access to our electronic health 
record, but read-only access is better than no access. Never a thought about 
sending your consultation note back to the requesting provider.
Seems like an obvious deficit, something missing from the consultation process, 
which would really allow us to take better care of our patients.
We talked about different ways to improve this problem, and over the course of 
the next half hour we jury-rigged a process whereby their practice 
administrator would remind the fellows to print a copy of their notes for bulk 
faxing to our practice once a week.
Someone at our end would go through those faxes, identify the referring 
provider, and transport the paper to their mailboxes, ultimately to allow them 
to be reviewed and then scanned into our electronic health record.
Not very technologically savvy, and likely to quickly be forgotten as the busy 
fellows go about their days.
Pretty damn clunky, if you ask me.
This is, of course, a temporary fix, albeit an ugly one; there are plans in the 
works for them to get the same electronic health record as us about a year from 
now, so we hope that at least then we will be able to see their consultation 
The consultant rendering the opinion that you never hear about is not much help 
at all.
Collecting all of the far-flung information that is generated on our patients 
when they are outside of our physical practice is one of the major goals of a 
patient-centered medical home. An office visit goes much more smoothly when you 
have the notes from a consultant the patient has seen near their home, or the 
inpatient records of a recent hospitalization when they were in Florida, or the 
results of a blood test or urine culture done at an urgent care center several 
days earlier.
On our inpatient service, each medical team is assigned a transitions 
coordinator, who rounds daily with the team to find out what their needs are, 
what they can assist with in reaching out to collect that unavailable 
information and bring it where it can do some good.
This is just the kind of support that is absolutely critical to making team 
huddles productive in a patient-centered medical home, that there is someone 
who can do the legwork to run those things down.
This is about practicing up your license. The days are gone (or should be) when 
an intern should have to chase down information from multiple different 
locations. We should be given the support to add these members to our team, so 
that the doctors can go on doctoring, and spend less time doing these 
administrative tasks.
Providers will be more satisfied with their lives in the outpatient practice 
and, ultimately, patients will get better care.
As we move ahead transforming the healthcare system in this country, many 
different players are coming to the table to try and help us fix all of the 
things that are broken. Whatever models we end up with, be they 
patient-centered medical homes or accountable care organizations, or some other 
set of initials, having the resources necessary to do care coordination and 
transitions of care are critically important.
Without this, the system will only continue to crumble, as care continues to be 
duplicated, fractured, dissipated, and uncoordinated.
Information without communication is uninformative.

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