A shared platform for medical records would make health history less of a mystery, writes Fred N. Pelsman, MD.
This article first appeared December 14, 2017 on Medpage Today.
by Fred N. Pelzman, MD
At this time of year, as the holidays approach, packages begin to arrive at our medical practice.
These often contain gifts, lovely gestures from patients or from other physicians or services we refer to, and include things like a bottle of wine, fresh fruit, and those towers with an assortment of treats in a basket.
We often open these gift baskets up and share them around the office, so there's plenty of caramel popcorn, Godiva chocolates, and other sweet and salty snacks for everyone to share in.
The other day I got a different kind of package, one which is often looked at with both joy and a little bit of trepidation by the recipient.
This offering comes in a large thick mailing pack, with the return address of a physician or hospital system, and contains a huge sheaf of Xeroxed papers.
The dreaded prior medical records.
Whenever a patient comes to us for an initial visit, transferring their care from a prior primary care doctor, or when the patient has been away from our care for a while possibly due to insurance issues, or they have been living out of state, we want to gather their records for the sake of completeness, and to inform us moving forward.
With new patients, one of the requests I make is that they make an effort to get their prior medical records so I can see a little more about their prior healthcare, and perhaps gain insight into the current state of their health.
If a patient was hospitalized elsewhere in an emergency, we want to know what was going on, how they were treated, anything we should know to follow up on or investigate.
Sometimes getting what we wish for is not always the best thing.
Occasionally the package that arrives is several inches thick, and contains badly photocopied old handwritten notes dating back many years, and despite our best investigative efforts, we learn little about the care the patient had, their prior symptoms and treatments, and sometimes we're better off not even looking.
When this package arrives, we are faced with the choice of whether to read it in its entirety, or do a quick skim through, hoping to get a general gestalt about what went on before they came to us, and hoping nothing bad is hidden inside this old chart.
By accepting these medical records, and copying them into our own, we are accepting responsibility for them, and the history contained therein is suddenly ours to reconcile and act upon if necessary.
Sometimes you can get a sense of what the patient's care was like, what their prior physician was like, what they expected, what they wanted done for their health, what was tried and failed.
Occasionally you discover something that explains a finding that you've uncovered, a medical mystery now answered in these crusty old pages.
Several cases that some of my partners have related to me proved the benefit of having access to prior medical records.
One told me about a worrisome liver lesion incidentally picked up on imaging done for another purpose on a patient of his, and later when digging through an old photocopied prior medical record he was able to discover that this lesion was essentially unchanged down to the finest details, the description of its size and morphology, from a CT scan done for another reason by a different provider 10 years earlier.
Another one of my partners has described getting back a lab value on a patient that she was seeing for the first time, suggestive of renal insufficiency. Unfortunately she had no way of knowing at the time whether this was acute or chronic.
However, when the patient brought in their old records, she was able to track back through the years of this patient's care with the different series of providers stretching back quite some time, that this had been in fact a slow and gradual process. The patient's creatinine had, while always remaining within the normal range, slowly been creeping up over years of medical care, right under the noses of multiple doctors. The creatinine had been 0.4, then 0.7, 0.9, 1.1, 1.3, all within the "normal" range, and no one had noticed the gradual rise over many years. It wasn't until suddenly it popped into the abnormal range that attention was paid, but by knowing this had been going on gradually for years she was able to eliminate several causes of acute kidney failure.
My hope is that as we move farther along in the 21st century, our healthcare system and the technology available will catch up with us, and that ultimately we will all be on one shared platform.
A complete blood count in one lab should be the same as a complete blood count in another lab, and a chest x-ray should look the same no matter whose computer you're viewing it on.
All our records should be instantly translatable and transferable, and all of our health history should travel with us.
We will leave it up to the technology gurus to decide what format this takes, what universal standards they adopt, although we know this needs guidance from clinicians actually out there doing the real clinical work.
How we translate all the old material buried in paper charts and previous electronic health records in other offices so that it is instantly accessible and valuable in the way it's presented to the provider sitting in front of the patient today will be informed by these processes.
Right now, when we get a package with old records in the mail, we need to put some time into it, some legwork, some elbow grease, to read through it to see what's in there, what nuggets of wisdom might lie within, what things that can help us take better care of our patients.
Often this is just a lot of the same stuff, the fluff of the electronic medical record and the patient chart, but we need to synthesize it and distill out the things we need to know to take care of our patients moving forward.
One project we are working on, still quite a ways from implementation, will be using several new technologies that will essentially allow us to "read" these prior medical records, no matter what form they come to us in, and find the real value that lies within.
As we continue to develop this, further updates will be available here.
For now, we'll just have to unwrap these like we do all the other gifts we receive in the mail over the holiday season, hoping that we got something good.
Some are ready to use, right out of the package.
But for others, some assembly is required.