E is for EHRs – #AtoZChallenge 2018
As the advent of electronic health records (EHRs) or electronic medical records (EMRs) as they are also sometimes called have essentially replaced traditional charting as well as traditional means of communication it has created the potential for a new void in effective communication between the provider and patient.
First and foremost you only get to see on the patient portal what the provider or health system wants you to be able to see. Unlike previous ways of viewing your chart, you now get snippets of the information contained in your chart prepared the way your provider and the EMR software designers have decided will best suit you, which is not always what serves your best interest. Some examples of challenges observed in the electronic age of medical records can consist of any number of the following examples.
The medication list in your chart is not accurate despite you providing them with a current list at each and every appointment. I’ve also noticed diagnoses on my list of illnesses that are grossly inaccurate. Ass it turns out the way the local health system provisioned the software for their providers they do not have the ability (called privileges in the IT world) to be able to delete an entry. In other words, once they press enter on an item like a diagnosis, it’s there to stay unless you are lucky enough to win the battle to get it removed, which trust me when I tell you it is not easy to do.
In previous eras when you were referred to a specialist, once you saw that physician they would dictate a letter to your primary care doctor first thanking them for the referral, then detailing the findings of their examination, results of any studies ordered and closing with their plan for your treatment. This traditionally kept your family physician informed as to what everyone involved in your care were doing so that a) your physician could make appropriate care and treatment decisions, and b) hopefully no details ‘slipped through the cracks’.
However with the institution of electronic health records, or electronic medical records as some regions call them, in nearly all aspects of healthcare in the present day it is very easy for things to seem as if each specialty physician is operating in a silo with none of the traditional coordination of care that the primary care physician used to be entrusted with. Gone are the routine of phone calls between physicians, and there is no longer a need to correspond via paper documents amongst different physicians. The point is that when specialists don’t communicate or take the time to investigate other physicians interactions with the patient, you as the patient often suffer from incomplete care based on incomplete information.
With EHRs replacing paper charts, the consulting physician will simply dictate a note describing his findings and plan for treatment in what’s typically known as a free text field in your EHR. As a result, unless the primary care physician specifically looks to see if there are any new entries from other doctors or advanced care practitioners you may have seen since you were last there, they may not even know you saw someone else. I am told that some EHR software systems can be programmed to notify the physician of new entries, but I’ve also heard that such alerts are often disabled though it is unclear if that is by default, or by the facility that is responsible for implementing the record management system.
Another example worthy of mention is when I was referred to a renowned teaching hospital for a specialist consult. While there the physician arranged for me to have some specialized tests done to rule in or out a suspected lifelong illness with major and potentially devastating health consequences. When I inquired as to how I would find out the results I was told they would be posted on the hospital systems mandated patient health portal and not to call the office for them.
Several weeks went by, with still no results or mention of the tests were visible on the patient portal. Eventually, against their prior instructions, I called the office and was advised that they could not locate the test results if it wasn’t in the portal but that they were sure that if they were abnormal or positive the doctor would have seen it and called me. I politely asked how he would have seen them if even they can’t find the test to give me the results. It is now nearly a year and a half later and I still can’t seem to get results of these tests.
This is the same hospital system that in their welcome letter to me informed me that it was required that all their patients download their mobile app for managing their health records and that this policy was strictly enforced. It went so far as to say that any patient who was not registered via the mobile app would not be seen. Further, when I arrived and went to the counter to check in, I was told that is not how it’s done. I must check in on the app and have a seat to wait for my name to be called.
What if I didn’t own a smartphone and was still using an older style flip phone? What if I couldn’t even afford an old out of date flip phone on a prepaid plan? While smartphones and smart devices have become the overwhelming norm, I know of plenty of people who have flip phones either by choice or because that’s all they can afford. After all, what’s a mobile phone for in the original sense of the device? It’s to call somebody. When did not having one determine someone to be unworthy of the best care possible?
Returning to the discussion at hand, the burden of ensuring that any and all pertinent information from any consults etcetera are properly relayed to your PCP now falls more heavily on the patient than ever before. This will be discussed in greater detail later this month in a separate post but you are now, more than ever, expected to be your own best advocate in your care. You must be diligent in ensuring that each of your physicians knows what the other is doing and not assume that they know without first making sure yourself that they do. You can’t rely on results being mailed to your provider at which point he will review them when they come across his desks and chart them appropriately.
One benefit to them, when the feature either works or is supported by the staff and the software, is the ability to quickly and easily request routine medication refills to be sent to your preferred pharmacy. Some EHR systems even permit you to communicate via email with the doctor’s office, though often with staff, not directly with the physician themself.
What are your experiences with electronic health records? Have you experienced any challenges with the new methods of communication?