Medical Records in the hands of Patients

Each time you go to the doctor’s office, they start by scanning through your medical record for notes entered last time, as well as vital signs (including pulse & blood pressure), past test results, medications & vaccines,  etc. If it’s your first visit, the doctor begins by looking over any medical history and health records or narrative of symptoms you provide.

That information doesn’t automatically follow you as you see multiple healthcare providers. Your primary care physician may be a general practitioner, but you may also see an allergist, cardiologist, dentist, dermatologist, gynecologist, radiologist, urologist, and more. Because each office or medical facility maintains its own records and doctor’s notes, you likely have to give nearly the same information again and again each you visit someone new.

These various practitioners may each treat symptoms according to their specialty without coordinating with everyone else you’re seeing to address your overall needs, so medications and procedures prescribed by one specialist can conflict or interfere with prescriptions provided by another.

Obtaining Your Medical Records

Patients have a right to their medical records, but actually obtaining them can be difficult and expensive. In Texas, for example, the legislature allows for a $30 retrieval fee for the first 10 pages, $1/page for pages 11-60, $0.50 each for pages 61-400, and $0.25/page after that, plus the cost of mailing or putting the records into an electronic format on CD-ROM.

Because of the high costs, most patients have incomplete copies of records – as little as necessary – and doctors are not excited about sharing. Some doctors have voiced concerns with giving patients access to their medical records since their notes might offend patients and increase the chance of lawsuits, so that’s affecting what they write. Others have said that because doctors are paid based on what they write about what they did, rather than what they actually did, their notes are often meaningless to other doctors.

Incompatibility in Medical Records

Modern offices are replacing old paper records with Electronic Medical Records (EMR), but chances are that each office uses a different system with information stored in incompatible formats. What’s needed is either a standard format for storing all medical records (unlikely) or a way to easily interface with Personal Health Records (PHR) that patient control.

Three months ago I wrote about My Family Health Portrait, a free tool from the US Surgeon General that fits that description. Because it lets users store any captured data onto their own PC or interface with Microsoft HealthVault and (soon) other PHR and EMR systems, it addresses the incompatibility problem and should make it easier for patients to (1) get medical record data from their doctors and (2) provide access to that data to other doctors they authorize.

Rather than taking your PC or thumb drive with you to the doctor’s office, you may want to store the data in a trusted service online, but because of recent articles about high-profile hacking attacks and privacy concerns, last week I addressed the question, How Safe is your Personal Health Information?

Physician & Patient Attitudes

Sharing medical records and visit notes has broad implications for care quality, privacy, and shared accountability. As reported in The New York Times, a new study found that physician opinions varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care.

The ultimate solution to these physician concerns lies in healthcare reforms and incentives. To understand the government role and how it affects both doctors and patients, be sure to watch this 20 min TEDMED video.