In preparation for the trip to India, I finally got my immunization shots at University Health Services (UHS). It was my first real appointment at UHS and I wasn't completely sure what to expect. However, as a result of all the classes I've taken at the health informatics classes I've taken at the School of Information and the School of Public Health, I found myself hyper aware of the environment, how the staff and providers interacted with patients, and how information was accessed and collected.
For some reason, I had forgotten to enter my health insurance information prior to my appointment, so I was sent back to the main registration desk to enter that information. It was a relatively quick and painless process - I provided my health insurance card and student ID card to the receptionist and answered a few additional questions. The information was being entered into the computer, although I wasn't sure whether or not it was into the infamous Epic system that was being implemented in the larger University of Michigan Health System (UMHS). Once the receptionist confirmed that my health insurance information had been successfully entered, I made my way to the immunizations department and hoped that they would be able to see that my information had been entered into whatever system they were using.
Right away I was taken into a separate room to get my immunization shots. It was a small 5 ft x 6 ft office, with one wall taken up by the nurse's desk. This was the first time in a year or so that I had had an appointment for any reason, class discussions about patient-provider communication prepared me for the information dumped on me almost immediately. As she spoke, the nurse periodically referred to my seemingly incomplete immunization record from my provider back in Seattle, a variety of little reference cards explaining how to take different medications, and a written checklist of the different immunizations that were generally given to students traveling to India.
Between the explanations of "traveler's diarrhea", "malaria", and the "Japanese encephalitis", my gaze drifted occasionally around her work space. The wall behind her computer was pinned full of pieces of paper, including what looked like a diagram depicting how to carry out treatment, flyers with medical information, and a folded piece of notebook paper with written translation from Chinese characters to English words like "immunization" and "insurance". The area on her desk around her computer was crowded with a container of cotton balls and other materials for administering shots. I felt the contextual inquirer within me rise and struggled to resist the urge to take pictures of her work space and ask questions about how she operated.
What was also interesting to me was the interaction between the nurse and myself. Having read a lot of literature and listened to lectures about the effect of electronic health record (EHR) systems had on patient-provider interaction, I found myself analyzing my interaction with this nurse.
Yes, she spent a good amount of time entering information into Epic on her computer (this time I could see the screen and recognized the Epic logo). And yes, this meant that she had to turn away from me when she did this. But no, this did not bother me and I did not feel like she was not giving me enough attention. I think that given the amount of technology I've been surrounded with growing up and being in the field of information technology, waiting for people to enter information into a computer was something I was very used to. Strangely, all I could really think about was how anyone could navigate through all the tabs.
Moving away from the technology component of my interaction with the nurse, I also quickly recognized that I was starting to get lost in the medical jargon. Thankfully, I knew that most of this information - the names of the vaccines, the diseases, the medications, the methods of treatment, the methods of prevention, and the side effects of the immunization shots - was going to be included in the flyers that she was sending home with me. At the very least I could look this up by myself online. But still...I felt the information overload. For a majority of the time I simply smiled, nodded, and answered questions about my medical history as best I could (Seriously? Was I expected to remember which dose of Hep B I had taken more than ten years ago? It's not my fault it wasn't indicated in my record from my Seattle provider!).
In class we had had extensive discussions about this kind of interaction between the provider and the patient. Because of the knowledge providers hold over patients (general medical knowledge and information about the patient's health), it is very easy for there to be an unbalance of power between the two. As a result, patients may feel uneasy about asking questions (assuming they even know what kind of questions to ask) and providers may unintentionally come across as being condescending.
Note that this is all something of a generalization based on what I have learned and heard. There is certainly a move toward changing that balance of power and making care more "patient-centered" through improving their health information literacy and the communication between patient and provider. While I sensed hints of this during my appointment, it was nothing that I was concerned about....merely amused.
After three immunization shots and one drawing of blood (to check my titers, whatever that is...), I finally left UHS knowing that this experience is exactly the thing that I would be responsible for in India. What is the provider-patient interaction like? How is information passed between the patient and the provider? How many different points of information access are there? How well-synced are these points? How different (or similar) is it compared to what I just experienced in the U.S.?
Looks like we might have our work cut out for us...
-Lan
For some reason, I had forgotten to enter my health insurance information prior to my appointment, so I was sent back to the main registration desk to enter that information. It was a relatively quick and painless process - I provided my health insurance card and student ID card to the receptionist and answered a few additional questions. The information was being entered into the computer, although I wasn't sure whether or not it was into the infamous Epic system that was being implemented in the larger University of Michigan Health System (UMHS). Once the receptionist confirmed that my health insurance information had been successfully entered, I made my way to the immunizations department and hoped that they would be able to see that my information had been entered into whatever system they were using.
Right away I was taken into a separate room to get my immunization shots. It was a small 5 ft x 6 ft office, with one wall taken up by the nurse's desk. This was the first time in a year or so that I had had an appointment for any reason, class discussions about patient-provider communication prepared me for the information dumped on me almost immediately. As she spoke, the nurse periodically referred to my seemingly incomplete immunization record from my provider back in Seattle, a variety of little reference cards explaining how to take different medications, and a written checklist of the different immunizations that were generally given to students traveling to India.
Between the explanations of "traveler's diarrhea", "malaria", and the "Japanese encephalitis", my gaze drifted occasionally around her work space. The wall behind her computer was pinned full of pieces of paper, including what looked like a diagram depicting how to carry out treatment, flyers with medical information, and a folded piece of notebook paper with written translation from Chinese characters to English words like "immunization" and "insurance". The area on her desk around her computer was crowded with a container of cotton balls and other materials for administering shots. I felt the contextual inquirer within me rise and struggled to resist the urge to take pictures of her work space and ask questions about how she operated.
What was also interesting to me was the interaction between the nurse and myself. Having read a lot of literature and listened to lectures about the effect of electronic health record (EHR) systems had on patient-provider interaction, I found myself analyzing my interaction with this nurse.
Yes, she spent a good amount of time entering information into Epic on her computer (this time I could see the screen and recognized the Epic logo). And yes, this meant that she had to turn away from me when she did this. But no, this did not bother me and I did not feel like she was not giving me enough attention. I think that given the amount of technology I've been surrounded with growing up and being in the field of information technology, waiting for people to enter information into a computer was something I was very used to. Strangely, all I could really think about was how anyone could navigate through all the tabs.
Moving away from the technology component of my interaction with the nurse, I also quickly recognized that I was starting to get lost in the medical jargon. Thankfully, I knew that most of this information - the names of the vaccines, the diseases, the medications, the methods of treatment, the methods of prevention, and the side effects of the immunization shots - was going to be included in the flyers that she was sending home with me. At the very least I could look this up by myself online. But still...I felt the information overload. For a majority of the time I simply smiled, nodded, and answered questions about my medical history as best I could (Seriously? Was I expected to remember which dose of Hep B I had taken more than ten years ago? It's not my fault it wasn't indicated in my record from my Seattle provider!).
In class we had had extensive discussions about this kind of interaction between the provider and the patient. Because of the knowledge providers hold over patients (general medical knowledge and information about the patient's health), it is very easy for there to be an unbalance of power between the two. As a result, patients may feel uneasy about asking questions (assuming they even know what kind of questions to ask) and providers may unintentionally come across as being condescending.
Note that this is all something of a generalization based on what I have learned and heard. There is certainly a move toward changing that balance of power and making care more "patient-centered" through improving their health information literacy and the communication between patient and provider. While I sensed hints of this during my appointment, it was nothing that I was concerned about....merely amused.
After three immunization shots and one drawing of blood (to check my titers, whatever that is...), I finally left UHS knowing that this experience is exactly the thing that I would be responsible for in India. What is the provider-patient interaction like? How is information passed between the patient and the provider? How many different points of information access are there? How well-synced are these points? How different (or similar) is it compared to what I just experienced in the U.S.?
Looks like we might have our work cut out for us...
-Lan