Biology in the News Explained

Electronic medical records fall short

It’s a funny, thing, isn’t it, how much harder it is for patients to receive test results than it is for their doctors. For example, on a standing order blood test, there apparently is no “space” in my local hospital’s registration software for the patient to automatically receive the results. While two doctors do, I have to go to the medical records department every time I have my blood taken to request that the results be sent to me.

That is, if that even works. I first attempted this a week ago and although I was called by one of my doctors within a day with the results, I still have not received them myself. And this is a small hospital with not a lot of records processing to keep track of.

I think the area of medical records may also be one of the only contexts in which people still must use fax machines (that is, if they want to move things along a bit faster than the mail will provide). In any context, to release my own medical records to myself, I have to fill out a form, sign it, and either mail it or fax it. (Because I live in a rural area and do not live close to most of my health providers, I can’t just deliver it in person).

And if what I want is a scan, sent either to me or to a doctor, it must be sent on a physical CD.

Even if you have not experienced this yourself, you can probably imagine how difficult it is, when someone confers with multiple doctors, for each of those doctors to actually have a full record of that patient’s treatment. This is because making sure everyone gets everything becomes nearly a full time job. (Keep in mind that not only do the forms need to be sent, but follow-up phone calls as well to make sure they were received and acted upon.) And incomplete records create pretty good starting conditions for potential mistakes to be made.

And if mistakes are made in this context, who is at fault?

640px-Electronic_medical_record

The current push for computerizing medical records (finally at least getting more emphasis) is both incredibly slow, and unfortunately, being done completely the wrong way. Because while hospitals are finally getting stuff on their internal computers, this does not solve the above problems: patient access to records, which is an essential requirement for many of us trying to wend our way through the medical wilderness, will still be just as difficult and bureaucratic as it ever was. And there is, of course, no need for it to be this way, given current technology.

Imagine now a world in which all test results, scans, and doctor’s notes are uploaded to a central database for each patient, accessible via the internet, with the patient having complete access and complete control over access. Patients could thus assign a username and password to anyone he or she wants, in order to see all the records immediately – or even have different levels of access, if you want the person only to see one relevant part of the record. (For example, insurance companies could only see what you allow them to see – the privacy and access halves of the equation both work for the patient.)

For the doctors who still rely on hand-written notes, well, they just need to join the 21st century, or at least hire someone to do it for them. This is not an outrageous expectation, given how computers already infiltrate every other aspect of our existence, including medically.

In this world, I wouldn’t always have to be FedExing CDs of scans all over the world; I could actually just email a username and password to the doctor in question, and be done. (There is, to be fair, at least one third-party service that provides medical record storage, but the patient would still be responsible for getting all the records there in the first place, and it’s unclear that there is any way to upload scan CDs.)

But the world we live in right now is one in which most patients don’t even have a clue what’s in their files, let alone have the know-how and/or energy to find out, because you can’t even just ask your doc’s receptionist for a copy of your own records as you leave.

And yet, here we are, finally acknowledging that patient records need to all be on the computer, but there is still a catch – I can’t even look at my own records without the filter of a doctor or a bureaucrat. Does anyone else find this ludicrous?

Why is it this way? It’s possible there is some component of foot-dragging. After all, as far as getting records on computer in the first place, there is an up-front cost, which is why most hospitals and doctors have to be ordered to do it through Obamacare.

But I think there is something more, which is that the medical community just can’t let go of their legacy of paternalism. I’m guessing there are doctors out there who hate the idea of their patients having easy access to their own records. I’m sure fear of lawsuits underlies some of this, which is why I agree with those who support real tort reform (as long as it still guarantees clear ways to censure doctors who make real, avoidable mistakes). But I doubt that is the only reason. I honestly think it never crossed the mind of anyone developing electronic records software to figure out a way to allow patient access to it. In fact, they probably spent a lot of time making it ultra-secure and as inaccessible as possible.

It’s tough being a full-time patient. We’ve all heard the calls to “take charge of your own health care” but if you haven’t permanently entered the Medical Industrial Complex yourself, or with a loved one, you don’t know the half of it, especially in an area such as oncology in which the “standard of care” delivered dutifully by doctors is pretty much guaranteed to have few long-term effects beyond a miserable death. Well, if the Complex can’t do better than this, then why make my life doubly hard by making me waste so much of my time left on earth filling out forms and placing endless phone calls to make sure the instructions on those forms have actually been carried out? Why?

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2 Responses to “Electronic medical records fall short”

  1. ellen says:

    Supposedly all the push towards EHR (electronic medical records) includes provisions for pt access. Before I left Alaska we were giving the pt a paper copy of the asset/plan portion of the note (which could include report results but that was not required. That system was at ribal hospital with the same computer system as the VA, and while it certainly has its problems, it was an amazing tool… we had acces to pretty much every single medical detail about the pt in regards to labs, xrays after a certain date, demographics, immunizations, etc. Of course the old hnd written chart would still have to be hauled out if you wanted to see an actual note of what happened, but stilll… it was an overall good system.
    There has been tons written about the problems of doctors going fully electronic, and it is far better and more informative than anything I could write, so I will leave that, except to say that sure, some of it is paternalistic but I think the majority of why this is has far more to do with practicality than anything else. In AK, the main problem was a complete lack of IT support. We were just told “You have to do this” so we did, creating all sorts of work-arounds to get things done which I am sure was in turn creating untold nightmares for future generations. WHen it comes down to it, you have a busy clinic and can’t get what you need from the EMR or can’t make it accept what you want to put in it and to call IT and then hope and pray that A. they come and B> they can actually help you… well it doesn’t really work… the rest of the patients waiting really don’t want to sit there and wait more while you figure it all out and even if they did, multiple it by 20 and the only ones left until midnight are the doctor and the patients that haven’t given up yet.
    One of the biggest probelms is that tons of computer sytems sprang up and they are tipping over each other selling doctors and hospitals EHRs, and government gets what *they* need (i.e., a list of how many times we ask people about tobacco use and domestic violence… beacause we click a box to let them know this) but it doesn’t work for the medical staff or the patients. And yet it is being ramrodded through… As of 2015 anyone not using EHR will be financially penalized (and we have already been for years in regards to billing… funny how it was the money end that was pushed thorough first). Young doctors don’t have any problems using computers and most of the older ones are fine with it too. I think nearly all of us see and appreciate the benefits of using EHR. But we have to have some support and there has to be some GOOD oversight. Honestly, its just a mess right now, and getting worse, not better.
    Anyway, here’s to patients being able (eventually) to have access to what they need. WHat you are going through is more than ridiculous. And I am pretty sure your doctor’s office could set up something where they automatically mailed or emailled you a copy of your labs as soon as they got them. I don’t know if the lab would do that… maybe if they had written permission from you and the ordering doctor??
    In the meantime, if you are in a federal system of health care (VA, FQHC, IHS, etc) you should at least be getting a copy of the progress note your doctor does before you leave the office…

  2. Thanks for the insider’s perspective. I suppose I should have assumed that this stuff is at least as frustrating to most medical staff as it is for patients, because as you allude to, most of the software is crap — add no support to that and it’s definitely a recipe for problems.

    I talked to a nurse at Swedish in Seattle and actually complemented them on having implemented software where at least any doctor at Swedish can log in and see a scan. Interestingly, she said the system wasn’t good at all, compared to where she used to work. Where was that? The VA, she said. (What’s that again about the private sector being so much more efficient than government?)

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