Why Your Health Records are Stuck in the 20th Century
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Reuters
August 12, 2013

The United States has spent a lot of time and money to digitize healthcare records, but the effort has not gotten very far yet.

This is what patient advocate Dave deBronkart experienced recently when a relative went from a hospital to a rehabilitation facility after a hip replacement. Her chart had to be transported and then retyped upon her arrival, where her hyperthyroidism was transposed to "hypothyroidism."

"She could have been prescribed the opposite medicine she needed, with disastrous consequences," says deBronkart, who is known as e-Patient Dave on his blog and social media accounts. His family was well-schooled, though, and after they asked to review the records, they spotted the mistake.

 

The whole scenario would have been avoided with a more advanced record-keeping system that could transfer her records electronically.

Electronic health records in the United States are supposed to take full effect by 2015. Without that technical backbone, the promise of the Affordable Care Act - to provide better healthcare to more people for less money - may fail, according to experts.

The HITECH Act of 2009 provided the incentive money for the medical establishment to switch to electronic record-keeping. To date, doctors and hospitals have received more than $6 billion from the government to make the change, according to the Health Information Management Systems Society, a nonprofit organization promoting information technology.

RELATED: HOSPITAL MEDICAL RECORDS STILL A PAPER CHASE

And even more money is coming for upgrades to meet a second phase of requirements, which allow for increased patient interaction with their own medical records.

About 93 percent of doctors say they use some type of electronic record-keeping, which can mean anything from physicians' notes to billing, according to management consulting company Accenture Plc.

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But only 45 percent are using their systems to access data from outside their own organizations, which could simply be mean looking up labs.

Far from worrying about the possibility that your data may be compromised, most experts have the opposite concern - that the systems are so closed off that the right people cannot access them.

And many electronic health record systems do not coordinate with each other because their development was left to the free market, says Kaveh Safavi, managing director of Accenture's North American health industry unit.

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This means digitization is still in the experimental phase and that your doctors may not have settled on what software they are going to be using. In fact, Black Book Rankings, which tracks the implementation of electronic health records, says that 17 percent of physician offices plan to change systems in the next year.

Probably the only visible difference is that your doctor suddenly put a laptop in the exam room, and instead of scribbling on paper chart, he or she types your information. If your physician is one of the few using an advanced system, the next specialist you see would also have all that information.

PATIENTS' ROLE
In many cases, though, it is up to patients to make sure their information is correct.

To keep track of your own data, deBronkart recommends asking to review records at each step along the healthcare path is the best course. "As patients, what we do and don't ask for has some power," he says.
When moving among doctors, make sure that each has all the pertinent updated information about you.

You do not even have to be high-tech about it - a simple piece of paper in your wallet with all of your medications listed can be helpful.

But you can also tap into any of the off-the-shelf diary or note-taking apps, which are especially good for monitoring recurring minor symptoms. A program like Evernote, for instance, allows you to attach a photo to each entry, which you could use to note changes in skin texture or swelling. Then you can present the information to your doctor at your next visit.

NEXT STEPS
Keeping up with your own records will get easier as the next phase of healthcare reform comes about. Known by the lyrical term "Meaningful Use II," mandates to be met by 2014 require electronic health records to be available to patients.

RELATED: HEALTH CARE COSTS DIVE WITH A TELEPHONE FOLLOW-UP

So far, interaction has mostly been in the form of test results available on a patient portal. But soon something called Blue Button access, named after a Veteran's Administration program, will allow you to access your medical records. Another approach is OpenNotes, a program that lets the patient view the notes the doctor has written, and possibly comment on or question them.

DeBronkart was a patient in a three-year study on OpenNotes that found both doctors and patients were highly satisfied with being able to share information this way.

"For me the real impact was that I was able to seize a moment and act on the question," he says, "something that's normally in other industries but somehow mysteriously missing in medicine.