Monday, July 27, 2015

The SA Coroner Is Now Saying Snail Mail Is Really Not Good Enough. Secure Electronic Communication Is Becoming The Standard Of Care.

This appeared a little while ago.

Delayed hospital letter to GP led to patient death

20 July, 2015 Paul Smith
A leading cardiologist has been criticised for using 'snail mail' to inform a GP that he had prescribed warfarin to an elderly patient, with the letter arriving four days after the patient died.
Marjorie Aston suffered a fatal subdural haematoma when she fell and hit her head at her Adelaide home on 4 January 2013.
She had originally been prescribed warfarin for chronic atrial fibrillation two weeks earlier by Professor John Horowitz, (pictured) the director of cardiology at the Queen Elizabeth Hospital.
Professor Horowitz told the 86-year-old that she would need monitoring and should make an appointment to see her GP, Dr Fong Liew.
After the consultation, Professor Horowitz dictated a letter to the GP informing him that he had "arbitrarily” started Mrs Aston on a daily dose of 5mg of warfarin.
The letter also made it clear that she would need monitoring “until the dose is right”, the implication being that Dr Liew should take on the responsibility for the job.
However, although Dr Liew’s practice and the hospital was “separated by a carpark” — a distance of about 100m — the letter took two weeks to arrive, by which time Mrs Aston had already died.
In a inquest that concluded last week, the SA Coroners Court was told that although Professor Horowitz had referred Mrs Aston for an urgent INR test following his consultation —  a test that was carried out — he had made no provision for Dr Liew to be copied in on the results. 
Professor Horowitz told the court that it was common practice for a specialist such as himself to communicate with a GP by sending a letter by ordinary post.
However, deputy state coroner Anthony Schapel was dismissive. 
 “Consideration should be given to the issue as to whether the general practitioner, on the advice of the specialist, should both initiate and manage the patient’s warfarin therapy,” he wrote in his findings.
The coroner added: “[Where] the specialist initiates warfarin therapy but does not intend to manage that therapy, the specialist should immediately advise the patient’s general practitioner, by the most efficient method of communication available, that warfarin therapy has been initiated and that the general practitioner is expected to manage that therapy.
“In this regard, the practice of communicating with general practitioners by way of ordinary post should be curtailed and be replaced by a means of communication that would include email and/or facsimile transmission.” 
More information: 
The full article is here:
The Coroner is right about a move to e-mail - but it would have been much better had he suggested a compulsory move to secure clinical messaging - rather than the now virtually obsolete facsimile or insecure e-mail. A little more specificity would have been very good indeed!
He also should have been suggesting that the time has well and truly come for specialists to adopt secure messaging!

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