As far as medical health records go, we're kind of trapped in a weird state of transition that can be confusing, frustrating, and even dangerous for patients.
Many doctor's officers and hospitals still use traditional paper files, or a mix of paper and electronic files, while fewer than 10 percent have transitioned into the world of electronic health records. But that number is likely to grow sharply over the next three years because of the American Recovery and Reinvestment Act of 2009. The stimulus package provides incentives for physician practices and hospitals to convert to electronic health-record systems that fit government criteria by 2014.
"Electronic health records incentives decrease over time, so the earlier doctors implement them, the more incentive money they earn," says electronic health records expert Paul Tang, MD, an internist and vice president and chief innovation and technology officer for the Palo Alto Medical Foundation in California. "After 2014, there's actually a penalty if you haven't implemented."
Currently, some health systems already use electronic health records to pull up patient history and lab results. However, these records don't contain patient information from other healthcare systems or specialists, and other institutions can't access the information. As doctors sign onto the government plan, though, all of your doctors, no matter what hospital or specialist you're seeing, will be able to pull up all of your health information in order to make the most informed decision on your care.
Many of the electronic health-records systems that meet the government criteria will feature an integrated personal health-record component, making it easier for patients themselves to access their records and lab results, and even to communicate with doctors and nurses online. "The integrated version is like a patient's view of their electronic health record," says Dr. Tang. "That probably, in my opinion, has the greatest value to consumers." However, those systems should not be confused with commercially available electronic personal-care records that allow consumers to enter their own information online. Such records aren't protected by privacy laws, Tang warns.
Nadereh Pourat, PhD, associate professor of health services at the UCLA School of Public Health and the director of research planning at the UCLA Center for Health Policy Research, says universal health-record systems could also be a great resource for researchers.
"There's a great potential for studying the data at a population level and understanding what needs to be done," she says. "Greater societal benefits could come from electronic health records."
Electronic health records could save your life in extreme cases, or at the very least help your doctor make smarter choices in treating you. They should make your life easier, too: No more dragging a list of medications and past drug interactions to the physician's office every time you see a new doctor (and hoping you didn't forget something), or relying on one doctor's office staff to send or fax everything to another. And with universal electronic records in place, emergency room physicians will be able to quickly pull up a patient's medical conditions, medication lists, allergy information, previous lab studies, and history of adverse medication side effects, if any, which can help E.R. docs make more pinpointed decisions. Currently, emergency room doctors have to make critical decisions with limited patient information in order to save a person.
Pourat also points out that smaller doctor's offices and patients of primary-care providers will also benefit through cost savings and more face time. "Doctors will be able to immediately enter their notes right there. This saves time because doctors typically spend several hours a day redoing work by re-entering notes from patients' charts," she explains.
Until we get through this transitional period, here's what you need to know about electronic health records.
- Be very wary of commercial personal-health records. Some health-related websites and other commercial sources offer personal health-record-keeping services, allowing users to sign up and to upload their own health information and medical records. These records are not protected by privacy laws, as healthcare records are, so unless you read the fine print when signing up, you don't know who will see your personal information. Dr. Tang says that while insurance companies may not make decisions on coverage based on individual commercial health plans, they could aggregate information and use the information to deny coverage in the future to patients like you. (Note that this is different from online tools that help you log or track your workouts, weight-loss plan, and other healthy lifestyle efforts.)
Plus, these commercial systems rely on patients' uploading their own information. Forgetting to type in certain medications or lab results could results in dangerous drug interactions or repeated lab work.
For now, says Dr. Tang, it's best for patients to keep private copies of their own lab results, medications, symptoms, diagnoses, and allergy information, whether that means keeping everything in a filing cabinet in your home office or using a stand-alone computer program that stores the details on your home computer. Make sure every doctor you visit sees the most up-to-date information.
- Look for an integrated practice. Start asking your doctors if they plan to adopt an integrated electronic health-records system, which would help them manage your health more effectively, and allow you to access your records online, including receiving test results much faster.
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