(No Ratings Yet)

 Loading ...

Do patients own their medical records?  Do doctors?  Hospitals?  Insurance companies?  Area 51?  Sanjay Gupta?

You hear this question put out there often, although not necessarily as plainly as that.  People want to “keep my medical records online.”  Google and Microsoft are trying to become a big player in the “Personal Health Record” industry with products that will allow individuals to keep their own records.

But are those really the patients’ medical records?

My office is about to make certain parts of people’s records available to them online in a secure setting.  That way they can view their medication lists, make changes to it, and request refills.  They can look at their last cholesterol or mammogram and know when the next one is due.  This would be great for us and our patients, giving them information they haven’t had in the past.  But we have no intent on making the entire record readilly available to our patients.  There is still some information that I don’t want my  patients reading.  What if someone comes into the office with a child and I have some suspicions about the family situation.  I certainly want to make note of that for the simple fact that I will need a reminder when the patient returns (or if one of the other providers in my practice sees them).  But I certainly don’t want the patients having access to this.

This is also complicated by other facts.  For instance, we started recently putting immunizations directly into the Georgia immunization registry (called “GRITS” by the way), and the question came up as to whether we still needed to put everything into our charts.  Yes, we will document we gave a certain immunization, but do we have to say which leg it was given in, which lot number, which nurse did it?  This information is already being put into the registry, so then is this registry partly ours to use as records?

It’s a really complex subject because there is medical information on a patient in a huge number of places.  Not only do I (as a PCP) have a record on the patient, but so does the hospital, pharmacy, insurance company, specialist, lab, and radiology group.  Who owns that information?  Is there such a thing as information “ownership?”  Lawyers could probably answer this better than me (with words like “heretofore,” “forbearance,” and “adjudicate” – all of which make it off-limits to anyone with ADD), but here are some of my thoughts on the issue:

1. The term “the patient’s medical record” is meaningless.  There are a large number of records, just like a person has accounts in many banks.  The idea that somewhere there is an over-arching comprehensive record is false.
2. Medical records are tools.  I use a patient’s medical record to know what I am doing on them.  Since I see people intermittently, sometimes with six months, a year, or more between appointments, I have to have some way to remember what is going on when they come in.  One of the main reasons we started using electronic records is so we could have rapid access to that information.  I am way too disorganized to do it with paper.
3. The idea of “owning data” is probably wrong.  A better way to think of it is “have the right to access data.”  When we first implemented EMR, one hospital was afraid to interface with our system because we would “take their information from their system.”  A high-up executive in a very large hospital system actually told me this.  But when I am the ordering physician, aren’t I part “owner” of the data?  Does the patient “own” it?  You see how the idea of ownership falls flat.
4. Much of the medical record is there for financial reasons.  If I could, I would reduce the size of my notes by 75-90% by getting rid of useless stuff.  That stuff is not there for me.  It is not there for the patient.  It is there so I can show I did enough work to charge what I did.  Doctors are paid by documentation, not by work.  EMR has made the ability to put more useless information much more accessible.  Does that mean EMR causes me to over-document?  No, it is the rules set by the government which make me over-document.  I just want to get paid for what I did and EMR lets me easily over-document so I can.
5. Another bunch of information is there to protect against lawsuit.  This cuts both ways; increased information is put there to cover your tail, but it also sets you up for more scrutiny.  If I put mammograms into the record that the GYN ordered and they are abnormal, I am at risk of lawsuit if I don’t follow-up on that information.  The easier it is to put information in the record, the easier it is to miss stuff and pay for it later.
6. Most of the record is now irrelevant.  I don’t care if someone had stitches when they were eight.  I don’t care what someone’s serum chloride level was in 2004.  In general, I rarely refer to information that is over 1 year old, and almost never look at information that is over 5 years old.  It is important to keep past histories up to date – the generalities may be important, but the details are meaningless.
7. Different parties will have interest in different information.  I don’t care what brand of stent the patient got in his coronaries, but the cardiologist does.  I don’t care which generic they got, but the pharmacy will.  The same goes for patients; there is only limited information that is relevant to them.
8. Persuant to the claimant forthwith that heretofore is called “client X,” the adjudicated compliance is groovy.

Do patients need to have access to their medical records?  Not all of them.  Somehow there needs to be a way to parse out what is important and what is not.  The Internet has proven to me that more information is not always better.  We don’t need more information, we need the right information when it is needed.

Be prepared to have to adjudicate a lot more information on this subject.  You’ll be hearing a lot more.

Related posts:

1. How to Computerize Medicine No, I am not talking about having pills with little...
2. Decentralizing EMR Run in terror, all you who hate (not “hat” –...
3. A Destination Our office has been on Electronic Medical Records (EMR) for...
4. The Sweet Spot I have heard a lot of talk about ownership of...
5. How Much is Too Much? Yesterday’s post generated a heated discussion on Twitter (and in...

Related posts brought to you by Yet Another Related Posts Plugin.