If you've ever switched doctors, then you've probably endured the brain-racking process of trying to remember the names and dates of your last vaccinations, illnesses, medications and medical procedures.
You might have even wondered whether a record of your medical history should exist so past and future doctors would be able to quickly see pertinent facts about your health.
Well, electronic health records (EHRs) could be a solution to this problem.
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EHRs are still relatively new in doctors' offices: According to a December report by the Centers for Disease Control, more than a quarter of doctors are still using paper, and most doctors who are using EHRs are relatively new at it—two years ago, only a third of doctors used EHRs. And adopting them is different from really taking advantage of them: Only one in six doctors is using them to a significant extent, even though doing so makes a physician eligible for a $44,000 bonus (spread out over five years) from the federal government.
Whether or not your doctors are currently using them, you should know more about how best to use them for your own personal health, because they are likely to be adopted by more physicians. By 2015, doctors not using EHRs will be subject to penalties.
Before you get excited about the day when you won't have to remember your health history, we have to warn you that many EHRs don't yet communicate with each other, so, at the moment, we're still stuck with having to inform new doctors of our medical histories.
We'll give you the rundown on the potential benefits of EHRs, how they work right now and what you should do in the meantime to organize your personal health record.
The Push to Create Electronic Health Records
While EHRs could make it unnecessary for you to remember all the important information in your medical history, they also promise a whole host of other benefits—many of them that could improve your treatment and, by extension, your health. They could:
- Make it easier for different health care providers to coordinate care, thereby increasing the continuity of your care no matter which doctor or facility you are visiting and improving physician decision-making—especially in emergency situations
- Help prevent medical errors and the duplication of treatments and procedures
- Cut administrative costs and clerical errors
- Help collect standardized data that could be used in research for medical techniques, technologies and drugs
- Give patients and their families more complete information that can help inform their health decisions
- Warn doctors and patients of potentially dangerous drug interactions
- Ensure that pharmacists provide the proper dosage of a drug that was prescribed
Indeed, studies of some health care providers that have adopted EHRs already show not only these benefits but also cost savings. For instance, researchers at the Center for IT Leadership found that the Department of Veterans Affairs, which was an early adopter of EHRs, found that the savings just from preventing adverse drug reactions totaled $4.64 billion.
For all these reasons, the government has introduced some incentives to speed the adoption of EHRs by doctors. Its biggest initiative, Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs, offers eligible physicians $44,000 under the Medicare program or $63,750 under the Medicaid program, over five years, if they demonstrate "meaningful use" of EHR technology. (The differences between the programs are mostly administrative and affect physicians more than consumers.) Physicians can prove "meaningful use" in ways that range from using the EHR to engage patients and their families to electronically prescribing medication.
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Are EHRs Fulfilling Their Promise?
Despite the government push to develop EHRs, they are still mostly an emerging technology in a field that has been slow to go electronic. Dr. Stacie Carney, an internal medicine physician at Greenfield Health in Portland, Ore., says, "As recently as a few years ago, most medical records were kept on paper. When I started clinical training at UCSF in 2002 in the Bay Area—home to Silicon Valley—I was shocked that providers hand-wrote all communication and orders."
And here's the thing: if the holy grail of EHRs is systems that talk to each other, well, EHRs are a long way from that. A PriceWaterhouseCoopers report on medicine said of hospitals and health care practices trying to adopt EHRs: "Many have difficulty connecting information sources within their own walls, much less sharing it with other organizations."
Kaiser uses Epic EHRs. However, if a Kaiser patient goes to an ER in another health system, his or her record would not be immediately available, even if that hospital had Epic.
To see how this plays out in just one city such as Portland, where Dr. Carney practices, she says, "Several large health care systems in our area have adopted the Epic medical record system. For example, a patient at Kaiser Permanente (an early adopter of EHRs), has one Epic electronic record that follows them whether they are in a Kaiser primary care clinic, specialty visit or hospital anywhere in the area. Kaiser does a great job of using EHRs to improve patient care, and this works well as long as the patient gets all of their care at Kaiser. However, if that patient is brought to an ER owned by another health system in the area, his or her record would not be immediately available—even if that hospital had the Epic system running."
Dr. Carney says that sometimes hospitals in different systems agree to share some parts of patients’ records, such as test results, through a common EHR such as Epic, but this is the exception rather than the rule.
But because of how fragmented EHRs are, digitized records can easily become paper again. "If that Kaiser patient switched to a different insurance carrier, and then came to see me for primary care," says Dr. Carney, "my office would fax a paper request for records to Kaiser, which would then print the patient’s record and fax it to my office, where I would review it on paper and then have it scanned as a file in our office’s EHR."
Surprisingly, while it would save money in the overall health care system if the EHRs at different health care chains talked to each other, the way the system is currently set up, no one has a financial incentive to recoup that savings. For instance, let's take the case of a Kaiser patient in Portland who is brought to a different Portland hospital. Even if Kaiser has already done a lab test on that patient, it's in the other hospital's interest to repeat the lab test—or to be ignorant of whether or not the test had been done—so that the second hospital could perform the test and get paid for it. Another barrier to communication is the Health Insurance Portability and Accountability Act, commonly known as HIPAA, which requires institutions to get patient approval for their records to be shared with other health care providers.
A recent article in the Journal of the American Medical Association, "Putting Health IT on the Path to Success," took the whole health information technology sector to task for the deficiencies of current EHR systems: "According to the Office of the National Coordinator for [Health Information Technology], in 32 states more than 90% of hospitals have not even exchanged a single patient record," it said.
The article then contended that, because health information technology has not increased communication between health care providers, EHRs are not helping to prevent duplicate tests and medical errors—and that means that EHRs are not fulfilling their promise to reduce costs. "[Avoiding costly medical mistakes] requires comprehensive records for each patient, not just clinician or organization-level EHRs," it said. The article also said that current health IT systems are simply replicating paper processes for clinicians and health care organizations to get patient records instead of creating a single unified record accessible to any institution.
How to Handle Your Personal Health Record
As you can see, EHRs still have a way to go before they bring us their possible benefits. For that reason, here are a few tips to manage your health record, no matter what type of system your health care provider follows:
Take advantage of your patient portal.
As more health care providers adopt EHRs, you'll also start to see some of them inviting you to access your "patient portal," which is your window onto your EHR. This secure web site will allow you to email your health care provider or see your recent lab results.
If your health care provider offers you a patient portal, make sure to get a username and password to access it. Then remember to follow up and look at test results or any other communication from your doctor through it. If it allows you to send messages to your doctor, then do so when you need it.
Track your own medical history on the computer.
If you don't have a patient portal or if you go to more than one doctor, keep a document of your own medical history and bring it to your doctors' visits. Here's what it should contain:
- a list of medications that you have taken in the past and are currently taking
- current medical issues that you're dealing with and current treatments
- a list of allergies to medications
- significant events in your medical history such as surgeries, hospital visits
- a list of doctors you see
- your last vaccinations and dates
- the date of your last colonoscopy
- the date of your last blood test
- for women, the date of your last Pap smear
Already, we are reaping some benefits of EHRs. Out of 1.5 billion prescriptions a year, 600 million are being prescribed electronically. Considering that 20 years ago, the Institute of Medicine calculated that 7,000 Americans a year were dying of preventable paper prescription errors, the e-prescriptions are most likely saving lives. But the full promise of EHRs remains to be fulfilled. So, during this time of transition, maintain your own record, and when your doctor goes electronic, be sure to keep up with the changes.