• Getting Care Among the Siloes

    Harvestore_Silos_Britton_MichiganWhen we say that an organization has “siloed” information, it means that the data collected by units in that organization are trapped in those units’ bins. Michael Porter thinks that we need to break down those siloes to achieve higher value health care.

    The first principle in structuring any organization or business is to organize around the customer and the need. In health care, that requires a shift from today’s siloed organization by specialty department and discrete service to organizing around the patient’s medical condition.

    That makes sense. But I want to describe what the problem looks like from the patient’s perspective.

    I have a congenital arrhythmia and osteoarthritis. These problems are treated by different sets of specialists: electrophysiologists and orthopedic surgeons. These doctors work in different clinics: mine actually work in different hospitals. Neither group’s records are accessible to the other. My primary care doctor works for a third hospital and—of course—she can’t access the records of either group of specialists.

    This matters because I am getting my hip replaced in June. (BTW, on the advice of some of my Twitter followers, I checked on whether I could get my brain replaced during the same procedure. I appreciate the concern, but it is not yet an option.) Now, it seems to me that the surgeon and the anesthesiologist who will do my hip ought to know as much as they can about my heart problems. For example, does the nature of my arrhythmia affect the choice of anesthesia? I have no idea. But if it’s a relevant question, the anesthesiologist’s electronic health record will not have the answer.

    This understates the problem. I have lived in four cities and two countries over the last 15 years. I have filed lots of forms over the years to get my records to follow me from hospital to hospital. In my experience, filing these forms doesn’t reliably result in the transfer of records.

    Moreover, when old records have caught up with me I have been surprised by how inconsistent they are. Why is this? In a sense, the problem is me. At each new clinic, the docs get a history from me. They are relying on my memory for the details of my diagnoses, the dates and nature of my procedures, and the medications and dosages I taken. It’s clear from comparing the records that I haven’t always told the same story the same way. My memory is not great, especially for information that I only half understand.

    But I have a better memory than many aging patients with multiple chronic conditions. The problem is the information system, not me. My surgeon ought to be able to learn about the details of my arrhythmia by consulting the records of the cardiologists who diagnosed me. Siloed information leads to medical errors, which is to say that it regularly but invisibly kills patients.

    @Bill_Gardner

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