There was a time, not too long ago, when a woman might find herself in a paper gown on a gynecologist’s table while the office staff called her primary care provider (PCP) to find out when she had her last Pap test.
“This was frustrating for me, my staff and my patients, who might already have been in the stirrups,” says William Anyaegbunam, M.D., FRCOG, an obstetrician and gynecologist who practices at Complete Women’s Care of Clifton Park. “At times, I would do the test just in case, unintentionally duplicating services and driving up cost.”
No more. Now, Anyaegbunam reviews his patients’ records through the Hixny health information exchange (HIE). Before a woman even enters the exam room, he knows about any relevant tests performed by her PCP—and any observations noted during office visits.
OB/GYN or PCP?
Pap tests are one of the most common areas of overlap between gynecologists and PCPs, but they are by no means the only tasks that either doctor might perform. Many PCPs offer some women’s health services—and some gynecologists offer limited primary care—so the opportunity for duplication is significant.
In particular, this is true for women with chronic conditions such as endometriosis, polycystic ovary syndrome (PCOS), uterine fibroids, and more. If you or someone you know have any of these conditions, then you’re familiar with the medical intervention involved in getting a diagnosis and developing a treatment plan: repeated blood work, frequent ultrasounds, changing medications for pain and hormone control, and even magnetic resonance imaging (MRI), computed tomography (CT) scans and surgery.
Without proper coordination, the process can become not only time-consuming and uncomfortable for consumers, but expensive (an MRI can cost as much as $2,000 in the Capital Region) and dangerous if lapses in communication result in delayed diagnoses or unchecked complications.
A Network of Support
“It’s not uncommon for patients to have multiple providers,” Anyaegbunam explains. He estimates that about 40 percent of his patients have conditions that require ongoing care. “Hixny collates the data from all these visits into one platform, bridging the gap between the providers.”
Kathryn Leopold, M.D., FACOG agrees. As president of Women’s Care in Obstetrics & Gynecology, a large practice with offices in Saratoga Springs and Glens Falls, she estimates that up to half of her patients have conditions that require continuous management.
“Properly caring for these patients requires coordination of care with their other providers, including primary care, endocrinologists, oncologists and others,” she says.
In fact, HIEs like Hixny provide a seamless way for gynecologists to compare notes and synchronize medication plans, as well as laboratory and imaging orders, with their colleagues. Because Hixny functions in real time, pharmacists, lab and imaging technicians, surgeons and other members of a woman’s care team can work together to deliver high-quality care.
Why Focus on Women?
“In the absence of adequate communication between providers, insidious medical conditions can go undetected,” Anyaegbunam says.
Some gynecologic conditions are notoriously hard to diagnose. For example, the federal government reports that endometriosis affects more than 11 percent of American women between the ages of 15 and 44—and it takes an average of six to eight years to diagnose.
This may be, in part, because 63 percent of general practitioners feel ill at ease diagnosing endometriosis, as determined by a National Institutes of Health study. Collaboration between PCPs and gynecologists could help speed the diagnosis and avoid problems, including infertility and a declining quality of life.
Even women whose conditions are easier to detect can benefit from ongoing communication between a gynecologist and PCP. Take polycystic ovary syndrome (PCOS), the most common cause of infertility due to a lack of ovulation. An estimated 5 to 10 percent of women worldwide have PCOS.
Complications include obesity, high blood pressure, high cholesterol, diabetes, depression and endometrial cancer—all of which require management by an informed, coordinated care team. That’s why Anyaegbunam most often coordinates care with his patents’ PCPs when hypertension, diabetes and lipid issues are involved, especially if he is planning surgery.
To demonstrate the importance of collaboration using Hixny, Anyaegbunam describes a 20-year-old woman who first visited him in the very early stages of pregnancy, appearing to have a miscarriage. She underwent a series of tests—including a pelvic ultrasound, CT and positron emission tomography (PET) scans, and tissue analysis after dilation and curettage (D&C). She also visited a medical oncologist and a cardiothoracic surgeon.
Finally, the team determined that she had choriocarcinoma—a cancer of the placenta that had already spread to her lungs. After extensive treatment, including surgery and chemotherapy, she is now a cancer-free mother of two.
“Had care been fragmented, the patient most likely would have suffered harm,” Anyaegbunam says. “But fortunately, all of her complex health information from multiple providers is available through Hixny—easily accessible to all of her participating providers, facilities and organizations.”