A Management and Information Perspective on Healthcare

It’s 3 p.m. on a Thursday. You’ve got a doctor’s appointment in an hour; he wants to follow up on a cholesterol drug he prescribed. You turn to the screen on your desk and study the dashboard. All company systems in all regions are in the green zone. The logistics problem in Phoenix yesterday has been solved. No news on your competitors today. The system will shoot a note to your Blackberry if anything comes up. You email your wife about dinner and check your son’s flight on your screen – he’s coming home from college. Off you go.

At the doctor’s office you approach the receptionist. She looks through a stack of manila folders and finds yours. She asks for your insurance card and makes a photocopy of it. You sit and thumb through a three-month-old news magazine. At 4:30 a nurse calls your name, and your 4:00 appointment begins. She weighs you and checks your blood pressure and writes some notes in your file.

At 4:50 the doctor enters the examining room, asks about the family, and opens your file. On top is a report that had been faxed over from a lab across town, but only after the nurse had asked you where the report was. You’d gone there last week to have blood drawn. You had shown your insurance card and handed the clerk a script specifying the tests your doctor wanted; it was a handwritten scrawl you couldn’t decipher. “Is this for PSA?” the technician asked. No, you say, cholesterol. “Oh, yes, I see.”

“Your numbers look good,” the doctor says. He rifles through the file. “Are you taking any other medications?” Just the aspirin a day he had suggested, you reply. “How old are you?” he continues. “Have I sent you in to get your PSA test?”

You show the doctor an article you found on the Internet about the effect of grapefruit juice on cholesterol drugs. “I haven’t seen this,” he says, handing it back. You had this because you had set up your home page to collect news on cholesterol. You also use another site to shoot you emails with such news.

The doctor takes a small tablet and writes something in Latin. At the clerk station you hand over the $15 co-pay and as you wait for a receipt you look at the floor to ceiling shelves of manila folders. You gaze up at the smoke alarm on the ceiling.

Now you drive the little piece of paper your doctor gave you over to a pharmacy near your office — battling afternoon traffic for a half-hour. The GPS unit in your car alerts you to current traffic snarls. At the pharmacy you trade the piece of paper for three months of pills, after once again showing your insurance card and then waiting another 25 minutes for the prescription to be filled. Finally, you are out of the pharmacy at 6:00 p.m., realizing you might not make it to the airport in time to pick your son up for his 7:00 p.m. arrival. Fact is, he will most likely need to take a taxi. You send him a text message, using your phone.

Now let’s create one more scene, just to drive our message home. At 10:30 p.m. that night your son is watching a basketball game on TV, playing an online war game with participants all over the globe, sending instant messages to three friends, and purchasing movie tickets online.

As you prepare for bed, you suddenly feel weak and dizzy. You have a smashing headache. It is scary. Your spouse calls 911. Two emergency medical technicians who have never seen you in their lives show up, check your vitals and encourage you to go to the emergency room. There, sitting with a clerk, you fill out several forms and hand over your insurance card. You wait 56 minutes (the average in California). A nurse directs you to an examining area, checks your vitals again and writes on a paper chart. Eventually a resident, still in training, shows up, takes the chart, and asks, “Are you taking any medications?” You don’t see a manila folder, but you suspect it’s lurking somewhere.

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