"Give control of electronic health records back to patients"

[Byrne]

An interesting opinion article by Stephen Strauss of CBC. Some of you out there may have read it (was posted on March 18): http://www.cbc.ca/health/story/2010/03/16/f-vp-strauss-electronic-health-records.html

 

I was reading through the comments section of the article and came across one post that I thought was noteworthy:

 

If we all had universal electronic patient records within our province, we could consult ANY available doctor or nurse practitioner. There would be no need to have an individual Family doctor, but you could always do so if you wished.

 

Given that, one would be less likely to present at ERs with non-emergency conditions - a constant cost and logistic headache for public hospitals.

 

Anyone suffering an accident or sudden onset of disease in any part of their province would have their entire medical history at the immediate disposal of the treating medical and nursing staff, no matter where they happened to be. Connect the EHR of all provinces through a common gateway, and the entire history of a senior from Glace Bay who collapsed on a trip to Prince Rupert would immediately be available to aid their treatment. (How long would that take now?)

 

Pharmacists, paramedics and physiotherapists could all have limited views of a client's EHR. This could be used to control over prescribing, or dosage errors for example.

 

EHRs recorded over a long enough period with adequate basic data might be used to remotely identify those at risk of certain classes of disease. Imagine receiving a letter from Medicare advising you that you were projected to be at elevated risk for Type 2 diabetes, and requesting you consult a doctor to arrange a prescribed battery of tests.

 

Could we not save money by offering these kind of people coupons to attend exercise programs or dietary consultations? Could we offer tax rewards for those who achieve specific outcomes within a given time frame?

 

We can manage both banking services and income tax reporting securely via the internet. I don't see why we cannot do the same with EHRs.

 

EHRs are a vital step in reforming Canadian public health care.

 

Does anyone here disagree with the above comment (i.e. that patients should not have access to their health records)?

 

Just figured I would spark some discussion because I see this as an important issue moving forward.

[Jochi1543]

Does anyone here disagree with the above comment (i.e. that patients should not have access to their health records)?

 

I would be extremely concerned about patients changing the facts in their record. Imagine how many reasons there would be to change them - trying to manipulate families, messing with WCB, trying to feed an addiction to medications, etc. And then who'd be responsible in the end? Undoubtedly, the medical staff.

[future_doc]

Having access is a fundamental right, essentially confirmed by the Supreme Court of Canada. Access has nothing to do with a separate issue being raised, i.e., fraudulant changes. Obviously, when given access, a patient will have no right to make entries!

[astrogirl]

In addition to the important concern Jochi has brought up, I see a couple of other issues with that comment. I completely disagree that giving patients access to electronic health records would eliminate the need for people to have individual family doctors. As a patient with a chronic illness, my family doctor is really important in helping me manage it. Jumping from doctor to doctor would still be a nightmare, even if they could easily access my records - a new doctor would still need to take the time to go through my history and probably ask a lot of questions to understand what's been happening. Continuity in healthcare providers is really important. I also don't see how giving people access to their medical records would have any effect on people going to the ER for non-emergency reasons. If anything it might increase it, because they could take lists of symptoms from their medical histories, type them into an online symptom-checker, and convince themselves that they have all sorts of life-threatening conditions.

 

Most people have limited to no medical knowledge other than what they've read on the internet, which may or may not be wildly inaccurate. Giving them access to their medical records isn't going to do much for them. I agree that a province-wide electronic health record would make it easier when people have to switch family doctors, see a new specialist, go to a new pharmacy, or go to an emergency room. But it's not going to eliminate the need to have a specific family doctor or cut down on non-emergencies in ER's.

 

And regarding people at high risk for certain disease - if you have a good family doctor, they will see those warning signs and recommend tests and lifestyle changes. I don't see a huge problem with giving people access to their records, as long as the issues that Jochi brought up are addressed, but I don't think it's going to solve any problems. And can't you already ask to see your chart in most places anyway?

[erogers239]

We bank online, we shop online so much of our life involves electronic record keeping yet there is a constant fear (including manipulation, security, access etc) that it is not a viable option in health care.

 

If I can make two suggestions to why I think could be a huge asset in medical care. First of all, much of our current record keeping is done by dictation, using notes taken during the appointment and often dictating at the end of the day. This means that records are very inconsistent and leave room for not capturing or remembering everything that needs to be seen. This becomes a huge problem for a lot of specialty doctors that see 3 patients every 15 minutes etc,. Tablet electronic record keeping is slowly being integrated in clinic, allowing for more consistent real time record keeping and ensuring everything is captured appropriately during the appointment.

 

Secondly if the record keeping system in Ontario becomes a set database that a patient (and emergency proxy for ex) has a code and all physicians can access, then rapid access to these records can happen. For example, a rural town experiences an emergency situation where physicians do not have the expertise to handle the situation, with patient permission to release the records an expert at a larger institution can be very rapidly consulted and draw up all of their medical history without time delay of faxing etc., and be able to give their opinion in the next step of care, improving multidisciplinary care in even the most remote of areas.

 

As for the "security argument" if we can protect our money effectively online then surely we can develop a system that can protect records (as so many hospitals already do with electronic data on their systems), so to me this argument is a little faulty. And surely systems can be developed so that once a piece of information is put into a patients health history it is permanent and can't be changed by any physician or patient after the fact.

 

Bottom line, a patient has the absolute right to see their records and determine who will see their records through release. Electronic record keeping would not infringe on this, and likely will actually take out a lot of potential issues of people who do not need to see a patient chart (ex a clinic secretary who brings the current file to the room, this would no longer be the case).

[T. Funke]

We bank online, we shop online so much of our life involves electronic record keeping yet there is a constant fear (including manipulation, security, access etc) that it is not a viable option in health care.

 

If I can make two suggestions to why I think could be a huge asset in medical care. First of all, much of our current record keeping is done by dictation, using notes taken during the appointment and often dictating at the end of the day. This means that records are very inconsistent and leave room for not capturing or remembering everything that needs to be seen. This becomes a huge problem for a lot of specialty doctors that see 3 patients every 15 minutes etc,. Tablet electronic record keeping is slowly being integrated in clinic, allowing for more consistent real time record keeping and ensuring everything is captured appropriately during the appointment.

 

Secondly if the record keeping system in Ontario becomes a set database that a patient (and emergency proxy for ex) has a code and all physicians can access, then rapid access to these records can happen. For example, a rural town experiences an emergency situation where physicians do not have the expertise to handle the situation, with patient permission to release the records an expert at a larger institution can be very rapidly consulted and draw up all of their medical history without time delay of faxing etc., and be able to give their opinion in the next step of care, improving multidisciplinary care in even the most remote of areas.

 

As for the "security argument" if we can protect our money effectively online then surely we can develop a system that can protect records (as so many hospitals already do with electronic data on their systems), so to me this argument is a little faulty. And surely systems can be developed so that once a piece of information is put into a patients health history it is permanent and can't be changed by any physician or patient after the fact.

 

Bottom line, a patient has the absolute right to see their records and determine who will see their records through release. Electronic record keeping would not infringe on this, and likely will actually take out a lot of potential issues of people who do not need to see a patient chart (ex a clinic secretary who brings the current file to the room, this would no longer be the case).

 

Exactly. Patients can request paper copies of their health records, why shouldn't they be able to have an electronic copy? I agree permanency of the record is crucial and self-made patient changes would cause mayhem, but would that not be simply resolved by health care practitioners be given a password or code, so that they can make changes and patients can not?

[future_doc]

Exactly. Patients can request paper copies of their health records, why shouldn't they be able to have an electronic copy? I agree permanency of the record is crucial and self-made patient changes would cause mayhem, but would that not be simply resolved by health care practitioners be given a password or code, so that they can make changes and patients can not?

 

Yes. You mean "updates" as nobody should be allowed to make "changes" that are not transparent and fully explained.

[T. Funke]

Thanks F_D. I did mean updates:) Good to catch that now, rather than later!

[ploughboy]

If we all had universal electronic patient records within our province, we could consult ANY available doctor or nurse practitioner. There would be no need to have an individual Family doctor, but you could always do so if you wished.

 

Oh mercy. As if specialist waiting lists weren't long enough already.

 

Joe Random Patient: "I just don't feel right. I can't put a finger on it, I'm just kinda off. I need to see the best cardiologist, gastroenterologist and neurosurgeon in the province to get this sorted out. I think I'll start with the neurosurgeon, since I think this could be a brain tumor caused by my cell phone. I've read about that on the internet, and my friend's brother's ex-wife's cousin almost died from something in his head. Ya, I'm gonna call me a neurosurgeon right now. Maybe he can fill in my odsp form and get me a handicapped parking permit, too..."

[ploughboy]

Oh mercy. As if specialist waiting lists weren't long enough already.

 

Joe Random Patient: "I just don't feel right. I can't put a finger on it, I'm just kinda off. I need to see the best cardiologist, gastroenterologist and neurosurgeon in the province to get this sorted out. I think I'll start with the neurosurgeon, since I think this could be a brain tumor caused by my cell phone. I've read about that on the internet, and my friend's brother's ex-wife's cousin almost died from something in his head. Ya, I'm gonna call me a neurosurgeon right now. Maybe he can fill in my odsp form and get me a handicapped parking permit, too..."

 

That said, I'm all for province or country-wide electronic patient records. I've had far too many conversations with children of my elderly patients (because the patient is demented, or doesn't speak English, or both) who have been well worked up at other hospitals, often a few miles away. The conversation usually goes like this: "Yes doctor, he was in that other hospital for three weeks, and they did some scans and blood tests -- you know the ones, right? It was a big machine, you know? -- but they never really found out what was wrong with him. We just wanted another doctor to take a look at him because he's still weak and dizzy "

 

Right. Ok. Just sign this release of information form and you can sit here blocking this bed for the rest of the day until we get the notes from St. Elsewhere.

 

*sigh*

[Jochi1543]

Oh mercy. As if specialist waiting lists weren't long enough already.

 

Joe Random Patient: "I just don't feel right. I can't put a finger on it, I'm just kinda off. I need to see the best cardiologist, gastroenterologist and neurosurgeon in the province to get this sorted out. I think I'll start with the neurosurgeon, since I think this could be a brain tumor caused by my cell phone. I've read about that on the internet, and my friend's brother's ex-wife's cousin almost died from something in his head. Ya, I'm gonna call me a neurosurgeon right now. Maybe he can fill in my odsp form and get me a handicapped parking permit, too..."

 

Hahahah, I was thinking the same thing, but I knew I could count on you to put it in a much funnier manner.

[runningdoc]

I see some value in it, but I find some of the comments in the article about people having their own banking information + taxes as justification for why it would work a little funny.

[rmorelan]

Just a thought - usually electonic systems give freer access to information by people (who perhaps shouldn't have access) rather than less. Doesn't take long before assistents get access to things (as that really does speed things up), and so on. Seen it professionally many times when I was working as a software engineer.