Thursday, October 15, 2009

Medical Records: Yours, Mine and Ours

Remember the chaos that ensued on Seinfeld when Elaine peeked into her medical chart? I found this video clip yesterday in "Grand Rounds," the weekly medical blog carnival. It arrived just in time to remind me that we've made some progress in patient ownership of medical records.

Some years ago I started keeping a personal copy of my medical records: list of medications, lab results...I keep these pages in a three ring binder. Cumbersome, but so far it's manageable. Later this week I'll be asking yet another doctor to hand over a sheaf of papers to me, so I called the new doctor's office today to make this "special" request in advance. "Oh," the office manager said to me, "Well, come in early if you want THAT: you'll need to sign some papers for us."

Today’s technology for patients
Blogger epatient Dave wrote earlier this year about his personal experience with medical records, including electronic versions of personal health records, or PHRs. Dave was not an early adopter of electronic medical records (EMRs). Recently, though, he became persuaded and began to import data. To his dismay he found serious errors of both omission and commission in his chart. His advice?
  • Find out what's in your medical record....and correct what's wrong
  • Get started manually moving your data into Google Health, HealthVault or some such system
Dave specifically recommended manually entering your medical data, as he found numerous errors that resulted from using the data import/export function.

Use of “more sophisticated electronic health records" was associated with better screening and better diabetes care in a RAND study published last week. The study is one of the first to demonstrate a link between electronic health records and higher quality care. After studying several quality improvement strategies, lead author Mark Friedberg said “The strategy that showed the most impact (on better performance by family practice physicians) was use of advanced electronic health records.” You can read the complete report in the October 6 Annals of Internal Medicine.

Keep it Patient-Centered
A report published in July by the California Office of the Patient Advocate (yes, I was surprised to learn about that office, too!) said
Health IT is not the complete solution to the problems plaguing our current health care system, but it is an important part of the solution. The next few years are likely to see a burgeoning of health IT initiatives, all of which can have an impact by:
  1. Simplifying the health care system, making it more transparent to the user, facilitating connections and transitions; and making it easier to navigate
  2. Providing easy access to usable information to support choice of plans and providers, and usable information for treatments and other interventions
  3. Helping create virtual communities to support self-care management and efforts to live in a healthy way, while creating new, timely, and efficient ways for patients and clinicians to connect
  4. Linking individuals and groups who are working on consumer engagement so they understand the most current issues and challenges, and the most current creative ideas and solutions
The optimistically-named "From Patients to Partners" report goes on to say IT will only work if the technology is “user centered.” The IT focus needs to move away from static and one-way technologies to mobile and dynamic technologies that allow for a give and take between people. (emphasis mine)

A Call to Action
Change is gonna come; you better believe it. Health Information Technology, (HIT or Health IT) is an important part of the Obama administration stimulus plan for healthcare. Thought leaders David Kibbe and Brian Klepper writing yesterday in The Health Care Blog, said
Aneesh Chopra, White House CTO, has taken steps to open the discussion (about EHRs and other HIT) …to make innovation an explicit goal over at the HIT Standards Committee, of which he is a member. .. (The planners) are signaling that they want input from the experts, from the public, and from those who will be affected… If you have an opinion about EHRs, PHRs, standards for health IT, or any other aspect of this new regulatory framework, now is the time to stand up and speak your mind. (emphasis mine)
How did medicine fall so far behind the rest of the world in data handling? I’ll leave that for another day. But I’m becoming more confident that someday I’ll be trading in my three ring binder for a zip drive—or a password, or...?

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