I recently needed to get a CT scan done as part of a full physical examination.  The ordering doctor and the imaging center are associated with a very large group in the Central Florida area.  Upon leaving the visit with the physician, I was handed a hard copy of the order for the test.  The receptionist told me I had to call to make the appointment for the CT, even though it was in the imaging center right next door to the office and was part of the same healthcare conglomerate. 

I called to make the appointment.  I provided my demographic information, seemingly under the impression that the scheduler would be finding me in their computer database, since I had just left an appointment with a provider within their group.  To my dismay, I was asked what seemed like a million questions, all of which were previously answered.  I eventually got my appointment and figured all was good. 

Upon arrival for my appointment, hard copy order in hand, I gave it to the receptionist at the imaging center.  The receptionist immediately informed me that the hardcopy order I just handed to her was not physically or electronically signed by the ordering physician, and as such, there was doubt I would be able to have the test. 

The receptionist told me that she had faxed (yes, actually faxed) a copy of the order to the doctor to get the signature, which would be faxed back.  I actually offered to walk the order down the hall to get it signed, which the receptionist politely declined. 

While waiting to see if the test was going to actually happen,  I was handed a clipboard with a two-page form to complete.  To my now utter disgust, the form asked all of the questions that I answered when I made the initial appointment with the physician, and again, when I made the appointment with the imaging center.  And oh, when I arrived at the imaging center to check in, I did that via a webpage that I was directed to from an email on my phone.  In checking in, I answered many of the exact same questions, and made my copayment even prior to walking in the door. 

Ultimately, the signature was received, and I had my test with only about a 30-minute delay.  Upon leaving, I asked the technician if I can have a copy of the test (CD or whatever medium).  I could clearly see a CD duplication machine at the receptionist for this purpose.  Instead of them merely giving me a copy right there, I was escorted to the hospital front desk, where an individual then escorted me to the medical records department.  I waited until being greeted by someone who had me fill out a medical release form, almost identical to one of the many forms I had to compete when I went to the physician and again to the imaging center.  Upon completing this hard copy form, the medical records representative walked down the hall to the very imaging center I had just left, picked up the disc from the exact place where I saw the duplication transpired, and returned to where I was standing to hand me the disc. 

Outside of the unbelievable inefficiencies that existed through the entire process, it made me think about how there is no interoperability, even within the same system.  I understand that interoperability issues exist across provider groups that are not associated with each other.  That being said, I was dumbfounded at the fact that there were so many hard copy documents, repeating the same documents, the inability of the imaging center to get an electronically signed order sent to them directly, no way for the physician office to schedule the test, and anything else that existed with the visit.  They were, however, able to easily take my copayment with no issues.  I know it is all about the money. 

As an FWA person, this really got me to thinking about the unbelievable waste that existed, and the increase in costs that were associated with my visit.  Did someone really need to have me sign the same form to get the test result?  No.  Did that same person need to walk down the hall to get the disc and hand it to me? No. 

When I retired as an OIG agent and began working with Advize, I was constantly reminded of the phrase “provider abrasion.”  At the OIG, this was a foreign concept.  If a provider committed FWA, we wanted that issue resolved.  I would often say that if a provider took a dollar, we wanted two back.  But now, as I sit on the other side of the coin, I am also wondering about patient abrasion. It seems that people in the delivery continuum care very little about patient abrasion. 

Whether it be waiting in a room for an hour for a provider, having to complete the same forms repeatedly, or being placed in an endless queue of recorded prompts and the like, it made this personal experience really stand out that interoperability is really just to an extent, smoke and mirrors.