Who owns your medical history?

You may think that you own your medical history, but you may be mistaken. New trends in the medical field are changing the way patients medical records are stored and used. This promises to help millions of people each year and improve patient safety, but make sure you know who really owns your health history.

Hospitals and medical care providers are moving away from paper documents to keep patients records and are moving towards electronic records. Electronic medical records (EMRs), also known as electronic health records (EHRs), will allow for faster and more efficient transfers of patient data from the doctor to the pharmacy and to the health insurance company.

This move from paper to electronic has obvious advantages for the hospitals. The storage and retrieval of patient information is much cheaper and faster. The move will help many patients, too. In particular, the electronic transfer of prescriptions from the doctor’s office to the pharmacy promises to dramatically reduce the number of prescribing errors that occur due to misread doctors’ instructions.

We all know and have seen the chicken scratch abbreviated instructions that doctors often write on paper prescriptions. Errors in prescribing and taking medications pose a very serious problem. A 2006 report by the Institute of Medicine estimated that 1.5 million people are injured each year by medical errors including deaths. The cost of these errors is in the billions of dollars each year. Having electronic medical records will help alleviate the problems of misreading hand-written prescriptions. In addition, patient safety can be increased further if the electronic prescribing system can be linked to drug safety databases and personal medical records that could automatically check for a drug’s side effects and potential problems with a patient’s known allergies or other medications they may be taking. All these benefits have created a strong impetus to increase the use of electronic medical record systems. In fact, President Bush stated that he wanted every American to have an electronic medical record by the year 2014.

Electronic medical records are a wonderful advance for handling patients’ medical records, but do have some concerns. One problem is that they are only as good as the person entering in the information, so having a quality control system in place is important. Another large concern is the issue of confidentiality. Knowing who is looking at these electronic medical records can be problematic for patients.

Health and life insurance companies are starting to use these records to access the medical risks that an applicant poses. This in itself makes a lot of business sense, but other companies are in the business of selling medical records. Patient medical information is being packaged and sold to third party companies, such as insurance companies and other interested parties. In fact, if you aren’t careful, your medical information could be sold without your knowledge.

There are government rules for how electronic medical records can be used. The Health Insurance Portability and Accountability Act (HIPAA, pronounced “hip-ah”) sets rules and standards for how electronic medical records can be shared. It contains a Privacy Rule that instructs companies holding your electronic medical records to inform a customer about their policies for sharing electronic medical records. When you sign up for insurance or a health care plan, you should be presented with the company’s policies for sharing information. You may choose not to accept their policy, but your failure to consent could prevent you from getting approved. When signing these forms, pay attention to what their policies are.

For companies that sell medical records, the HIPAA rules require that they protect a patient’s identity. If you feel that your information has been misused, HIPAA protects your right to receive a report on who your information was shared with. If you think it has been improperly shared, you can file a complaint with your provider or insurer, or with the US government if you feel that your concerns are not being addressed.

The move to electronic medical records will save many lives and improve healthcare, but consumers need to pay attention to how their health information is shared, just as they would their financial information.

Google Health: Personal Online Healthcare Accounts Are Here To Stay

Google has a new online feature called Google Health that allows you to enter your medical information in a personal account and track your medications, doctor visits, and prescriptions. Your account provides access to Google’s other tools such as links to relevant information matched to your health records to help you find out more information on the drugs you are taking, the medical conditions you have, and issues you should be aware of such as harmful drug interactions and side effects.

I am very encouraged by this new feature and commend Google for creating this service. I have felt for a long time that this is the natural progression of personalized health care towards an electronic network connecting the patient, health care provider, health insurer, and pharmacy becoming commonplace in the not too distant future.

Just as we seek better jobs now, patients will seek better doctors in the future.
We are living in a time when patients are just beginning to change the nature of their relationships with their doctors. I think this will mimic what has happened with the employee/employer relationship. Years ago, it was typical for an employee to join a company, spend their whole career with that one firm, and retire from the company with a pension. The employees of the past often looked to their employers to control their career and retirement plans. That relationship is dramatically disappearing. Pensions are now rare for new employees and have been replaced with 401(K) plans, placing the responsibility for retirement savings squarely on the shoulders of the employee. Coincident with this change of retirement responsibility, employees are in a “what have you done for me lately?” relationship with their employers when it comes to their careers. Employees are empowering themselves to control their career paths and many are in a perpetual state of job hunting. It is now common for employees to expect to work for several companies, possibly in several different fields, during their careers. I predict that similar changes will occur in the health care arena as patients take on responsibilities for their health care choices that have previously been left to their doctors.

Why, you may ask, shouldn’t patients simply let their doctors control their health care decisions much as past employees let their employers control their careers and retirement? The doctors are the trained experts, so why not treat them as surrogate parental figures and not question their advice. What’s wrong with that?

What’s wrong with that model is that it is not working for most people today as well as it once did. The close family physician who took care of a patient from birth to adulthood has been replaced with unfamiliar specialized practitioners. These specialists are experts in their specific slice of medical practice but only see you for a very short time in your life. Sometimes they only see you once and only for several minutes. It is not uncommon for the patient to be a stranger to the doctor. The ob/gyn doctor who supervised your birth is not the pediatrician treating your ear infection as an infant. The emergency room attendant fixing your broken bone is not the fertility specialist helping you start a family, the cardiologist helping your heart condition, the hematology/oncology specialist doing your blood work, the radiologist looking at your X-rays, the gastroenterologist helping your stomach aches, the podiatrist helping your foot aches, the dermatologist helping your skin rash, etc, etc, etc. As medicine has specialized, so have the doctors. Therefore, they may be more likely to treat your condition more than they are able to treat the whole you. To make matters worse, in order for doctors to make money with the current reimbursement practices, they need to see lots of patients each day. This means less time they have to spend with you.

On a single doctor visit, you may have three or more people talk with you. How often have you gone to the doctor and been shown to the room by one person and have a second person document your problem and medical history with a simple checklist. Then, after a brief consult with the medical assistant, the doctor comes in and quickly examines and tells you what you should do. The doctor briefly gives you some advice, prescribes some medicine, gives you best wishes, and leaves. End of visit.

So what did you do after your visit to the doctor?
Did you research your prescribed medications to see what similar medicines are also available on the market and how they compare to the ones you were prescribed?
Did you see if your medications have side effects or if they would have bad reactions with the other medications you’re taking?
Did you get a second opinion?

If you’re like most people, you probably left the choice of medication to your doctor and didn’t bother to ask another doctor for a second opinion. Hopefully, your doctor told you about possible side effects, but chances are that many of you didn’t specifically ask. When getting your prescription filled, you probably left it up to the pharmacist to determine if there are any concerns with bad reactions your prescription could have with other medications you’re taking. Again, you probably didn’t specifically tell them about your other medications and didn’t ask. Fortunately, many pharmacies are using electronic medical records to track your medications for you to find problems such as these (this will be the topic of another podcast). However, for something as serious as your own health, it would be great to at least double check your medicines… if you had that ability.

What did you do before your visit to the doctor?
Did you investigate your doctor before the visit to find out how well they rank compared to other physicians in your area?
Did you get reviews from other patients about the doctor, their staff, and the hospital or clinic they work for?

Again, the answers are likely “no”. You may have asked your family or friends to recommend a doctor, but you probably have no real idea of how good that doctor, medical staff, or hospital is.

Hopefully these problems will be solved in the future.
As you know, a major problem is that even if you wanted to do a lot of the above research, you couldn’t do it very easily. Fortunately things are starting to change. Sites like WebMD provide a lot of medical and drug information that you can read. However, for doctor, hospital, or even drug rankings, their isn’t much information available to you. It’s much easier to find thousands of movie or music reviews about just about anything you want to see or hear, but this type of rating and review system just isn’t available for most people when it comes to their health care.

Hopefully, this will all change in the future. I foresee that just as you can fill out your personal financial information for your online banking account that allows you to track your financial health, you will be able to fill out an online health account to let you track your physical health. Just as you can manage and track balance transfers, get email notifications of account activity, and apply for new bank accounts online, you will be able to track your doctor’s visits, pharmacy prescription status, and apply online for doctor’s appointments and prescription refills all from your one account. Even better, in the future you may be able to get email notifications of health problems immediately affecting you such as drug recalls, appointment cancellations, or prescriptions that are ready to pick up.

I see a future for social network ratings sites for doctors, hospitals, and drugs just as there are now for everything from restaurants, moving companies, hotels, and cars. Of course these should have some careful monitoring. Perhaps to ensure accurate rating information, some medical ranking sites can be tied to health care reimbursement companies and non-profit community resources that have a vested interest in knowing which doctors are successful in helping their patients and which are not.

So while some people may argue against personal medical record accounts because of security and personal disclosure fears, I think they should be welcomed with open arms. Just as you use your online bank account to help you strengthen your financial health, you should be able to use online medical accounts to help you strengthen your physical health and well-being. The access to information will be empowering for patients as they try to take charge of their own health care decisions.