Medical Records

[TromboneAl]

I've been surprised at how far behind the medical industry is concerning records. I figure it is about 20 years out of date.

Examples: Lena's surgeon wants us to have the PCP fax records to her, and my sister is waiting on some test results that are being mailed to her doctor.

Also, there are medical records from my past which are lost forever, or would at least require major work to locate.

So, I was wondering if from now on I could make a point of getting the results of exams or tests myself, and scan them in. It would be simple to have them all in a folder of google docs, with a copy on my iPod touch or future device.

My Intergoogle research shows that I am entitled to all my records, but I'm not sure this effort would be worth it.

 

[easysurfer]

My only experience of getting a copy of my own medical records was before FIRE'ing to apply for individual health insurance. Other than that, I wonder if you had your own set to "refresh their memories", would that help or just confuse them with more data to keep.

 

[rescueme]

Actually, the opposite is true for us. I go to three doctors (my PCP plus two specialists) in routine care for my T2 diabetes, along with the clinic that does my BT's.

All are quasi-members of a local (teaching) hospital and medical records are all on-line. In fact, when I have a BT done, I can call and let an office know in preparation for either an upcoming appointment, or just a follow-up if they are adjusting meds for any reason. The doctor will get the BT lab report within a few hours, and get back to me with follow-up info.

BTW, I always request a copy of my BT results to be sent to me since I keep a spreadsheet of all my "numbers". Sure, the doctor will get the results but I'd rather get them before I show up for an appointment and be surprised when a number isn't quite normal.

It's kind of funny since the government talks about trying to streamline the medical practice by having records on-line, but we've had this on-line info exchange for many years.

Just our situation.

BTW, you should get a copy of your BT results regardless of how well the records are managed. It's your body, and your results. It's not to hard to interpert the results and even help your doctor interpert what is going on, especially if it's due to your lifestyle - which the doctor does not see.

 

[braumeister]

I've been surprised at how far behind the medical industry is concerning records. I figure it is about 20 years out of date.

Ain't it the truth!
Our PCP went to electronic records about two years ago, and it has been interesting to watch him constantly using his laptop while examining us.

When DW saw him a week or two ago, he mentioned that his practice was premature in going electronic. Now he's not happy with the system, but it's proprietary and he has been told that it's impossible to convert the data to any other system. That's nonsense, of course. I did that sort of thing routinely when I was w*rking, but he's not tech savvy enough, so he's probably stuck with it.

Similar to rescueme, I have all my lab numbers in a spreadsheet, going back over 20 years, so I can see any trends in a heartbeat (something my PCP can't do). It gives me some comfort to have that data.

 

[REWahoo]

Ain't it the truth!
Our PCP went to electronic records about two years ago, and it has been interesting to watch him constantly using his laptop while examining us.

If he uses it to do your prostate exam I wouldn't think you'd call it 'interesting'.

 

[TromboneAl]

Our dentist, OTOH, uses a modern system with voice recognition, etc.

 

[bbbamI]

The only copies of medical records we have requested have been when DH went through his RT for prostate cancer. A friend of mine (a cancer survivor) told me we should request them for future reference as it shows the area and the amount of rads given.

Of course we always get the lovely photos of every colonoscopy that has been done. Those have always been given to us without a request.

 

[Cato]

The state physicians need to agree on a common system or at least maximally 3 different platforms with ? software brokers which allow the systems to talk to one another - I'm in Alberta, Canada and can access any operative, consultation, discharge report, lab results or imaging report done anywhere in this province for the past 3 years. Sure is helpful.

They are trying to set it up so that I can also look at any images done in the province.

 

[East Texas]

I ask for, and receive, copies of all tests. It's interesting that my dentist has a completely paperless (including x-rays) system and my doctor has file folders.

 

[retiredncolorado]

I retired almost two years ago from w*rk*ng over twenty years in the Health IT industry. Other than these posts reminding me why early retirement was so appealing I have some advice.

Regardless of the governments attempt to automate the industry and the billions of dollars spent so far (we spent over $50 million on one project) the lack of enforceable standards limits the usefulness of a interoperable EMR. Until a nationally accepted standard is established and adopted there is little hope that the medical community will be able to provide more than episodic treatments.

So, my advice is to get a copy of your results and treatments in a format that is acceptable to you and make sure your physician is aware of prior results.

Good luck,

Now, back to planning my next trip!

 

[JakeBrake]

Our dentist, OTOH, uses a modern system with voice recognition, etc.

Our dentist has the latest electronic gadgetry. I am beginning to think this is largely a sales tool. He likes to switch the TV in front of the dental chair from the soaps, Fox, CNBC, or whatever to a much larger than life view of my bad teeth or X-rays.

Who knows? He may be able to upsell from an extraction or filling to multiple implants.

 

[obgyn65]

The new EMRs we use are very complete, very detailed. Sometimes you have no choice but to enter the chief complaint, review of system, medical /surgical / family histories, allergies, etc as patients talk to you. Otherwise you run the risk of missing important information. I feel bad sometimes about typing on a computer while sitting in front of patients, but they understand it is in the interest of time and data accuracy.

Our PCP went to electronic records about two years ago, and it has been interesting to watch him constantly using his laptop while examining us.

 

[Bestwifeever]

The new EMRs we use are very complete, very detailed. Sometimes you have no choice but to enter the chief complaint, review of system, medical /surgical / family histories, allergies, etc as patients talk to you. Otherwise you run the risk of missing important information. I feel bad sometimes about typing on a computer while sitting in front of patients, but they understand it is in the interest of time and data accuracy.

I really hate talking to the doctor's back, just hate it. I wish you would all be provided with some kind of equipment that let you at least face us even if you have to be inputting everything (and I can't believe everything the MDs have to do these days--not putting any blame on the docs at all). There must be an app for that.

 

[Leonidas]

I really hate talking to the doctor's back, just hate it. I wish you would all be provided with some kind of equipment that let you at least face us even if you have to be inputting everything (and I can't believe everything the MDs have to do these days--not putting any blame on the docs at all). There must be an app for that.

There is. When I go to the doctor's office the nurse uses a laptop on a stand and faces me while she asks questions, takes my BP, etc. She enters the data and my response to questions into what I assume is a diagnostic program. When the doc comes in he has a touchscreen tablet with all my data. I'm face to face with everyone during the process.

The lack of national standards is, as someone already pointed out, the big hurdle in all this. It amazes me that test results are faxed or mailed when they should at least be emailed, if not entered into a secure database that my doctor can access.

My former employer (non-medical) started going all digital in the late 70's, but many of our counterparts were still using typewriters, paper and carbon paper until the late 1990's. There is still no national standard for those records either and none of those systems will talk to each other.

I'm not much encouraging government to create new regulations, but this medical record issue just screams for someone to take charge and force some change.

 

[noelm]

When I moved to the US from Sweden, I got a shock of my life that US trumps to be the best in many things. Americans don't like pointing out anything thats not good with the system but the fact is, its true that medical record keeping is as dated as in India (just to give an example, as I know how they are maintained there.)

In Sweden, govt has implemented a system all across the country and EVERYONE has to enter the data to that system only so no matter which part of the country you go, all of your history is accessible at one click. US is too complicated to implement such system due to different regulations and state issues. Here in NY, they still give me paper prescription. I haven't used a paper prescription in decade (in Sweden.) All it takes is govt. willingness to streamline the system. Of course, they could take help from countries like Sweden who have done it successfully.

When I left Sweden, I got a hard copy of all my records at just one request. I doubt, I will get such in the US, so I am making my own notes. The good point for me is, I am pharmacist (though not working as one in the US) so I can make record better than any layman but what about those who don't have such advantage?

 

[Tadpole]

Well color me paranoid but in the last month I have decided that the lack of interoperability of medical record keeping systems is a real money maker. It enables doctors and laboratories occupying the same building to charge fee for service charges each time the patient visits a room in the same building and part of the same organization. I recently experienced this. Over a two day period visiting five different offices in the same organization my weight, blood pressure, and pulse were measured five times. Additionally, five times I had to provide a list of pharmaceuticals and dosages and sit while these were entered into computers. After providing this list, I had to sit there and go over each and every one to confirm the dosages I had just given them. The day before this my own GP who is across the street from this facility performed the same ritual and gave me a EKG that was repeated at the other facility the very next day. The similarity of the routine between offices made me suspect that my insurance had been analyzed and they had determined the list of things they could charge for at each visit. I asked why they didn't just share the data and the consistent answer was that they couldn't see the data on other computers in the building. Assuming they no longer are in the dark ages with respect to information storage, I couldn't help but wonder if keeping the data isolated like this was deemed the best configuration for making money.

 

[TromboneAl]

In Sweden, govt has implemented a system all across the country and EVERYONE has to enter the data to that system only so no matter which part of the country you go, all of your history is accessible at one click. US is too complicated to implement such system due to different regulations and state issues.

With many things such as this, I see two ways of solving it:

1. Design a system using a committee, political wrangling and special interest group lobbying.

or

2. Examine the systems of ten countries, choose the best, and copy it.

This really isn't rocket surgery.

 

[calmloki]

Well color me paranoid but in the last month I have decided that the lack of interoperability of medical record keeping systems is a real money maker. It enables doctors and laboratories occupying the same building to charge fee for service charges each time the patient visits a room in the same building and part of the same organization. I recently experienced this. Over a two day period visiting five different offices in the same organization my weight, blood pressure, and pulse were measured five times. Additionally, five times I had to provide a list of pharmaceuticals and dosages and sit while these were entered into computers. After providing this list, I had to sit there and go over each and every one to confirm the dosages I had just given them. The day before this my own GP who is across the street from this facility performed the same ritual and gave me a EKG that was repeated at the other facility the very next day. The similarity of the routine between offices made me suspect that my insurance had been analyzed and they had determined the list of things they could charge for at each visit. I asked why they didn't just share the data and the consistent answer was that they couldn't see the data on other computers in the building. Assuming they no longer are in the dark ages with respect to information storage, I couldn't help but wonder if keeping the data isolated like this was deemed the best configuration for making money.

The Oregon flavour Kaiser Permanente health insurance company shows how things can be done: all electronic, records accessed from any KP office, pretty much one stop shop buildings - PCP visits, immunization clinic, blood draw unit, echo/x-ray unit, pharmacy, optical unit... You can check in at the front, show your ID and pay the co-pay, and then cycle through the various stations. Fast, efficient, and no multiple iterations of "name, address, sex, are you allergic to.., etc." Gotta believe it saves KP and me money and know it saves me time and frustration.

When we were down in California we discovered that the California KP is different than the Oregon KP - had to request a California KP ID number - but once I did that the KP system worked just the same and my records were right on tap for the California offices use.

 

[Nords]

With many things such as this, I see two ways of solving it:
1. Design a system using a committee, political wrangling and special interest group lobbying.
or
2. Examine the systems of ten countries, choose the best, and copy it.
This really isn't rocket surgery.

Better still, I don't think this is a government problem at all. I'm certainly not excited at the prospect of spending my tax dollars on fixing it. Imagine if the government (any government) had been in charge of designing personal computers.

Instead, this medical-records chaos is an entrepreneur's fantasy. Let them sort it out so that all the medical institutions have to get on board or get bought out. Once Medicare/CMS choose a "solution" for their data then the cat herd will quickly fall into formation.

Here's a company that's making money just from the "simple" process of transferring MRIs online instead of by bicycle courier:
BEAM by OneMedNet

 

[Cato]

The system is great when it works, and it mostly works well. However it seems to be a fairly complex system consisting of a Patient and accounting database, and the other systems feed into it (lab reports, imaging results, consultations, operative reports etc), and these secondary systems all extract data (patient demographics and newest complaint) from the primary system. Consequently, there is shambles when the primary system fails - we are simply not geared to go back to a paper system, patient demographics have to be entered manually etc.

Then there is the problem that (I'm probably going to have to duck now) software writers are born fiddlers, I belong to the school that if something is not broken and works well, do not fix it, but every so often a new upgrade comes along and new niggles and problems crop up which were not present on the original system and the system gets slower and ssslllooowwweeerrr. Complaining to the software representative is futile and somewhat dangerous - it's like telling a new mother her baby is ugly

 

[Sue J]

My PCP's office is all digital and I love it. She comes in with her laptop and we go over all the blood test results and if I want a copy printed she can do that and I pick it up at the appointment desk on my way out. She has easy access to all my history. I do feel like for the first 5 minutes she's looking at the screen rather than me but after that her attention is directed at me.

The office also has an online patient portal where I can check statements, appointments and prescriptions. If I need a refill I can ask for that and she will get a message and send it in. All prescriptions are electronic unless you ask for paper ones.

In February and March I had a mammogram and then a couple of biopsies. The specialist that I went to for the first biopsy wasn't affiliated with the same hospital system as the mammogram facility so I had to go back to the mammogram place, pick up my films and take them to my appointment. When I later needed a biopsy under ultrasound the hospital for that procedure was the same as the mammogram facility so they had access to my films digitally. They even had my previous years films in digital form, which was nice. Zoom in, compare side by side and make digital notes. Very efficient.

BTW, I was lucky and everything was negative.

 

[TromboneAl]

Instead, this medical-records chaos is an entrepreneur's fantasy. Let them sort it out so that all the medical institutions have to get on board or get bought out.

Just hope that your betamax doctor can talk to the VHS doctor. Or your Blu-ray doctor can talk to your HD DVD doc.

 

[harley]

The Oregon flavour Kaiser Permanente health insurance company shows how things can be done: all electronic, records accessed from any KP office, pretty much one stop shop buildings - PCP visits, immunization clinic, blood draw unit, echo/x-ray unit, pharmacy, optical unit... You can check in at the front, show your ID and pay the co-pay, and then cycle through the various stations. Fast, efficient, and no multiple iterations of "name, address, sex, are you allergic to.., etc." Gotta believe it saves KP and me money and know it saves me time and frustration.

When we were down in California we discovered that the California KP is different than the Oregon KP - had to request a California KP ID number - but once I did that the KP system worked just the same and my records were right on tap for the California offices use.

I'm with Kaiser Mid Atlantic. Their systems are fantastic too. Online mail order prescription refills, same or next day test results with email notifications when they're ready, full medical records at the doc's fingertips, automated reminders for various things, ability to email a question and get a response from the doc or NP. Only problem I've seen is that there's a glitch in the system that keeps reloading an old work phone number as my secondary contact number no matter how many times and ways I get it changed. But not a big deal since the primary number is right. I've been truly impressed with the improvements over the past 5 years or so.

 

[chinaco]

Not everyone has caught up.

Our medical providers are often reduced to the lowest common form of communication and (if not record keeping).


It is starting to change... but will take a while.

Where I see change is with larger providers.... they seem to be investing in technology. Some of the small practices will take their time (unless something forces the change).


The medical community has some pretty good practices when it comes to medicine and treatment.... But when it comes to records and communications... it is behind other industries.... it is a symptom of a highly fragmented industry with many many small players.

 

[Bestwifeever]

.... Americans don't like pointing out anything thats not good with the system but the fact is, its true that medical record keeping is as dated as in India (just to give an example, as I know how they are maintained there.)....

Actually, isn't this thread a good example of how Americans are the polar opposite of "not pointing out anything that's not good with the system"? I think Americans are pretty quick to point out the flaws we perceive in how things are done in our country!