Archive for the ‘medical records’ Category

Caremark, Prescriptions and Personal Information

September 1, 2010 · Filed Under e-patient stories, general, medical records, policy issues · 2 Comments

A friend of mine, Ms. S., recently had an unsettling experience with a company called Caremark (the parent company of pharmacy CVS), whom she fills her prescriptions through. She was reordering a prescription refill she buys through the mail, and needed to pay for it. She tried logging onto their website to pay, as I’m sure thousands of people do everyday, but because her order was “In process,” it wouldn’t let her pay for it.

Caremark called her this morning. The conversation went something like this…

Caremark: “Hi, this is ****** from Caremark. I’m calling about a recent order. Can I get you to verify your name, date of birth and mailing address?”

Ms. S: “I’m sorry, but how do I know you’re from Caremark? You called me.”

Should Patients Read Doctor’s Notes? Wrong Question.

August 17, 2010 · Filed Under general, medical records, policy issues · 14 Comments

When you have a doctor’s appointment, and she makes some notes and later formalizes them for your medical record, would you like read them? There’s been debate over the years about whether patients should read the notes that doctors write about them and their health issues — in academic circles, in a great Seinfeld episode where Elaine’s dermatologist won’t let her see what he wrote about her, and more recently in a New York Times piece that discusses the promising OpenNotes project. I think this is the wrong question. Instead, you should walk into your doctor’s office with a video camera or tape recorder. More on that in a moment.

The discussion about doctor’s notes might seem silly, since for many years we’ve had the right to go the medical records department and get copies of our records. So all we’re talking about here is making that more convenient, for example, by letting you log into your online account and see the notes there. However, this is much more than convenience, it is a cultural statement: we, the doctors, should sincerely invite you to read our impressions, our thought processes, our decisions; and learn from them, even question them. While this is a powerful statement, we’ve gotten distracted by this artifact, the doctor’s note.

Instead we should focus on the communication it represents. The goal is not to sneak into the doctor’s inner thoughts and see what he’s really thinking about me, rather it is to gain a deeper understanding of my health and add a channel of communication from the doctor whose precious minutes just aren’t enough. (By the way, to those who fear doctors will no longer be able to write what they *really* think, I have two comments. First, patients can already request copies of their records, so be thoughtful in your notes! Second, I would consider supporting a separate area for comments that the doctor sincerely feels are in the patient’s best interest not to see and are only for other clinicians, similar to what’s done today for mental health records.)

What we should be focusing on here are the best ways for the patient to understand and remember the doctor’s guidance, including the Q&A that typically happens during the visit. The doctor’s note hardly addresses this. It’s designed for the doctor to communicate to other clinicians who will later care for the patient, and in practice it’s increasingly full of not-so-useful information included for billing purposes. Sometimes the doctor will create a separate note explaining the plan to the patient, especially if his EMR auto-generates a template for this. But this is uncommon, and it provides only a brief summary of the outcome of the discussion.

I encourage loved ones to take a tape recorder or video camera to their doctor’s appointments, especially ones where new or critical issues will be discussed like whether or not to have surgery or how aggressive to be in treating a cancer. Most of us have experienced how little one actually remembers when fear or stress levels are high. Being able to review the conversation again later can make a huge difference in understanding and better decision making.

As a doctor, does it make me nervous when someone wants to record our conversation? Yes. Because it holds me even more accountable to communicating clearly and taking good care of my patients.

(This post was cross-posted on Huffington Post.)

Reflections after a specialist visit without OpenNotes

August 8, 2010 · Filed Under Why PM, e-pts resources, medical records, policy issues, pt/doc co-care · 21 Comments

Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.

Here’s the story. Read more

“Give Us Our Dammed Data” – Regina Holliday

August 2, 2010 · Filed Under key people, medical records · 1 Comment

17 health-care authors painted by Regina Holliday

Regina Holliday's painting, "Give Us Our Dammed Data" (Photo by Cindy Throop)

17 authors with weapons in hand stare down upon the viewer. The three panel painting measures 60 inches by 144 inches. It is a very large painting, and yet it is crowded with those who have been hurt and those who have suffered. Every one of them is an author. Nearly everyone in the painting took the hurt and outrage they felt about a dysfunctional medical system and channeled that into a book. That book is their shield and their pen is a spear.

(Read Regina Holliday’s complete post, “Give Us Our Dammed Data” about her show at Clinovations in Washington, DC)

Why Mark Boguski joined the Society for Participatory Medicine

July 25, 2010 · Filed Under Why I joined, Why PM, general, medical records, net-friendly docs, positive patterns, reforming hc · 3 Comments

Next in our series, Mark Boguski, MD, PhD is both a personal and a corporate member, as co-founder with Dr. Alan Littleford of ResoundingHealth. If you’d like to submit your own reason, write to me. (This is not an “invitation only” series – that wouldn’t be like us! When a member submits, we put it in the queue.)

Why did I join the Society for Participatory Medicine? Because of its potential as a catalyst for epochal change in our healthcare ecosystem. Read more

Dear White House: The Personal Data Challenge

July 20, 2010 · Filed Under e-pts resources, medical records, policy issues, positive patterns, pt/doc co-care, reforming hc · 18 Comments

Gary Wolf of Wired has posted a whizbang write-up that came out of a whirlwind one-hour 12-way Skype chat about personal health data. Sound frenetic? It was. (I participated. It was, well, 12-way.)

I can’t imagine how to model what happened, except to say that it was wired.

It grew out of a request from the people at the Community Health Data Initiative, which (as we reported here last month) is opening vast amounts of HHS data for innovators to get at. (And innovators are doing so, fast, as that post describes.) Here’s how Gary started his write-up: Read more

CMS slides from the Meaningful Use rules announcement

July 19, 2010 · Filed Under medical records, policy issues, reforming hc · 3 Comments

At last Tuesday’s announcement of the Meaningful Use rules, many people asked for the slides. After going through clearances, they arrived today. ~~Click for 44 page PDF (649k).~~ Correction 12:19pm ET 7/19: the PDF has been replaced with a PowerPoint, which we uploaded to Slideshare:

Chilmark: “Where is the consumer in HIEs?”

July 1, 2010 · Filed Under found on the net, medical records, policy issues, trends & principles · 1 Comment

As we adopt new technology NOW is the time to think strategically: “As I make my next move, where do I end up? How am I positioned for the next step?” Patients have a lot at stake in adoption of Health Information Exchanges (HIEs). Chilmark Research has posted a good summary of how we patients (you, your mother) are not well supported yet by most HIE vendors: “Not a pretty picture.” Well worth a read.

Hm: Because of viewing my visit notes, I did something better.

June 30, 2010 · Filed Under Why PM, medical records, policy issues, pt/doc co-care · 19 Comments

Earlier this month I wrote that the OpenNotes project had kicked off. It’s important – if you haven’t read about it, please click that link.

My primary physician and I are participating, but candidly I didn’t expect to get much out of it: as I told a friend, “I’m not sick!”

Yet, the very first time I used it, I noticed something from my visit that I’d already forgotten. And that made me realize I’m not as observant / “adherent” / engaged as I thought.

Here’s what happened. Read more

OpenNotes background information: WIHI webcast and Ted Eytan post

June 15, 2010 · Filed Under found on the net, medical records, policy issues, reforming hc, trends & principles · 7 Comments

It’s bonanza time for people intrigued with the OpenNotes project, which we mentioned Saturday. While looking for something else tonight, I ran across this, about OpenNotes, from December: “Concern that sharing information with patients may cause sustained psychological distress is probably unfounded.”

It cross-posts a great piece by Ted Eytan MD and cites a December 17 WIHI episode (webcast by the Institute for Healthcare Improvement; MP3 audio here). If you have an interest in patient access issues, you must read Ted’s post and see the linked documents. One is from NEJM, “Giving the patient his medical record” – from 1973. The other article cites evidence from Denmark that fears about patient access did not materialize; that paper is from 1991.

Who says this industry is slow to change? :–)

But we have made progress: the 1973 paper reports that in 41 states you could only see your record through litigation!

Wonderful thinking in Ted’s post, and sobering background reading. Consider it in your thinking.

A project of the