It’s my understanding that doctors don’t have any simple way to look up my medical records. Indeed, every time I have seen a new doctor, I have to fill out my medical history. There was an initiative by the Obama administration to computerize all medical records. Does anyone know what’s happening with this?
Thanks,
Rob
Electronic Medical Records are being utilized across the country. Not every medical provider is yet connected to the data repositories though, that will take some time. Individual providers often require you to fill out a medical history anyway. There are various reasons for this, they may not be connected to a medical record repository, they may need your permission to access your records, and it will take them time to change their practices and stop requesting a paper form for you.
Even if many practices are using EMRs they aren’t all using the same one. Proprietary software solutions often don’t play nicely together.
And yes, the PPACA and related legislation included provisions to encourage (pdf link) the use of Electronic Medical Records.
The law includes penalties of 1% of their Medicare billables for those health care providers that do not implement EMRs by the deadline in 2015. The penalty increases in following years.
This is also to try an catchy any discrepancies between what the medical records say, & your actual medical history.
Don’t worry. The number of people with easy access to your sensitive medical information keeps increasing exponentially.
That’s a good point. There are really two issues here - one is elements of your real medical history not showing up, and one is erroneous information actually showing up. Imagine if your Electronic Medical Record was like a credit report or criminal record - you could walk into most any doctor’s office and the first thing the doctor would do is lecture you on not taking care of your diabetes - notwithstanding the fact that it is your father that was diagnosed with diabetes and his record shows up on your report because your names are similar and you lived in the same home for several years. You’ve filed disputes with EquiMed, ExperiHealth, and Transunion Healthcare Records Solutions, but they are dragging their heels and demand that you send them verified pictures of great-grandpa between the ages of 5 and 10 on great-great-grandpa’s farm. You also can’t get a pilot’s license because dad’s poor health keeps showing up on your medical certificate background check. You’re hopping mad.
Cite, or is this just a random political jab? HIPAA has pretty much been doing the opposite for years.
I’m not sure what kind of cite you’d need for this. When your hospital chart was on paper, only the people who took the time to go track down your folder could access your information. Now anyone with a login can look you up.
HIPAA provides for some very stiff penalties for these kind of shenanigans, of course, but certainly the shear number of people who can see your history has gone up considerably.
I don’t know about that. Last year I was treated out of state for an injury and it took a full MONTH to get my medical records transferred to my local doctor. The process was positively byzantine. You cannot even get a doctor or hospital to send your own records to yourself without a complex procedure.
What people do not realize is that while most doctors have electronic medical records, there are literally hundreds of different providers and formats of electronic records. When I went electronic I limited myself to evaluating only six providers in detail before choosing one. There is NO central repository of information. The different records are not compatable with each other, and do not communicate with each other. While doctors will soon be required to transmit records electronically, since they are not compatable, what you get is basically a huge file which is an uploaded copy of the patient’s chart which the receiving doctor must then scroll through to try to find information. It’s pretty much even more time-consuming and annoying as paging through a paper chart, especially when you are not familiar with the format.
For example, my EMR has a handy graph function. If I want to track your blood pressure, I can quickly generate a graph. If I get an old chart, I have to look at each visit, find out where that record records the blood pressure then scroll down to the next page. I often find myself having to take notes with a pad and pencil to keep track of information.
Let’s not even start with the patient portals! Every doctor has a portal and each one has its own format and you as a patient will need a unique user ID and password to use each one. You may be able to look at data from each physician but the physicians themselves do not have access. If fact, I have also asked patients to print out labs from their other doctors and to send it to me so that I can see it.
Finally, let’s not forget HIPPA. The security needed is so tight it makes it near impossible to share information anyway.
So in summary, your individual doctor may have electronic records but that doesn’t mean there is or ever will be any centralized “data repository”.
P.S. The US needs UHC!
FORGET HIPPA. It’s HIPAA, dammit.
EMRs in this nation are a patchwork of hundreds of different proprietary and freeware programs, most of which don’t talk to each other, many of which are no longer even supported by their original vendors and are not getting upgraded. Converting to an EMR generally takes millions of dollars and thousand and thousands of hours of worktime. Learning how to chart takes a LOT of time for physicians, nurses and other care providers, every time there’s a startup or a significant upgrade.
A few big systems are emerging, like EPIC (20% of EMRs for ambulatory population in 2012), Allscripts (13%), eClinical (8%), NextGen & GE (both at 6%), Cerner (3%), with the remaining 45% or so split among the next few hundred.
It’s a mess, and order is coming very, very slowly. I think it will need some sort of UHC to make a true EMR.
But EMR security will continue to be a huge problem. Unauthorized access of EMRs is growing by leaps and bounds. Yet clamp down on access too much and physicians can’t get needed information.
Damn. Need to proofread. Also words cannot describe my burning hatred for EPIC. It is the most incomprehensible, user unfriendly system that is trying to take ove the world. I also hate eclinical but I think it’s mostly the users who create the problems there. Strangely enough, I actually love my EMR.
Going back to the OP, however, understand that just because you use the same system doesn’t mean you have access to all records on that system. Take EPIC, for example. I have privileges at two hospital, both of which use EPIC but I had to get separately trained and have a separate logon and password to access each one. Kaiser here also uses EPIC but since I don’t have a Kaiser EPIC logon, I can’t access patients’ records if they used to go to Kaiser.
The best way to explain it is to use an analogy to something like facebook. Everybody has their own facebook page. Suppose you posted on 10 different friends’ pages and they are all private. You then meet another friend who wants to see what you posted. You can’t just give them access to everything you’ve ever posted on facebook. They have to go to each separate page, and make a friend request, get accepted and be given authority to view the page. You can’t just say “I grant you access to view anything I’ve ever posted anywhere on any facebook page” becauswe each page is individual. (At least I believe that this is how it works. I’m not actually on facebook so if I’m wrong just ignore the entire analogy).
Strangely enough I love Epic. Both as a clinician and as part of the quality assurance apparatus of our group. Meditech, which our hospital still uses OTOH sucks raw putty balls. 
Epic is rapidly becoming the gorilla in the room, increasing its share the fastest. And EPIC Everywhere, the communication between different healthcare systems on Epic is making life substantially smoother for those of us who try to coordinate care (“the medical home”).
But yeah, a long way to go.
To everyone commenting that there are many systems and how will they talk to each other: HL7.
At my last job, I specifically worked on the HL7 input and output system for an EMR. The spec is, despite having to handle everything under the sun, not that bad. If an EMRs aren’t handling HL7, I don’t think it should count for keeping the PPACA penalty away.
I was going to ask why there is no standard data format. Good to hear that there is one.
HL7 is not a single standard, there are a number of HL7 standards that evolved over time, and are still evolving. There are many more standards for medical records also. The problem is not a lack of a standard but the plethora of standards available.
**DSeid **-- Epic is pretty, well…epic. It’s a good system; I like what I’ve seen with it.
I think there needs to be a **single **standard for EMR output, like there is for claims systems output. Everyone doesn’t need to use the same EMR company if they can all create an output file in the same language. ANSI should be up for the job of creating a universal output standard – ANSI X12 is the standard for claims data today, and it’s widely understood. However, I imagine that providers really, really don’t want to implement yet another data standard and that it will take years for a standardized dataset to be created.
Well, not terribly effectively. It just makes casual sharing more difficult. Our info is still being shared with the Medical Information Bureau, and other data mining companies, have no fear! :mad:
ETA: – Psychobunny, I agreed that the US needs UHC.
There were deliberate problems built in to the standards making process to create lock-in by the big vendors (for instance GE). Standards were developed by industry task-forces, as pointed out several standards were developed, that have the effect of making it difficult-but not impossible-to share data across software packages. So if a doctor decides to buy a competitor’s product, it is possible but the added cost of data clean-up and validation often makes it a money-losing decision. It is possible to move data though and the law requires that, so no one can accuse the industry of locking out new entrants, just making it cost-prohibitive for the customer to buy the new products. Note that all the vendors benefit from this-they keep their own customers while being able to freely go after new customers. IMHO, this is the one place the Gov’t really let the public down. An honest easy-to-use data format wouldn’t have been that hard to develop. But it wasn’t in the best interest of the big companies who had the lobbying and industry clout. So forever more, everyone except the companies suffer.
I spent eight years of my life writing and supporting medical records systems and interfaces. It is a huge PitA. Not only all the old paper records that have yet to be converted, but (as mentioned) the hundreds of different formats for those that were.
Converting to one format is a massive and expensive effort. And it is not going to be any cheaper or easier whether we have UHC or not.
A lot of practices are not going to meet the deadline, so they will lose some of their Medicare and Medicaid payments (which they generally lose money on anyway), so they will have to jack prices up for those with insurance. Medical record coding is a fairly specialized profession, and as the demand picks up, so will their salaries, which will also add to the cost.
It’s a good idea, but neither simple nor straightforward of achievement.
Regards,
Shodan