Posts Tagged medical records

Good & Bad Patient Portals — improving communication

patientportalA good patient portal is wonderful; a bad patient portal is a waste of time.  A recent post by Dr. Yul Ejnes suggested portals may not be patient centered and don’t get much use.

An alternative view is that all patient portals NOT are the same.  Some have great features and are supported by the providers offering them.  Other portals are not much more than advertising — generally something a patient does not revisit.  Sadly, many businesses have the latter type of portal — no wonder people don’t flock to medical portals.

Check out your health care provider’s portal.  If it does not really provide a benefit then TELL THE PROVIDER, complain, and say other providers do a better job.

Admittedly, a poorly functioning provider office will likely have a poorly functioning portal.  Just because the portal lets you send a message to the nurse or provider is no guarantee the response will be helpful.

Large vertically integrated health systems or ACOs have the best chance of a good patient portal.  The portal needs monitoring and rules for providers — rules that require questions to be answered the same day.  And, that the portal will display lab results within 48 hours, regardless of whether the provider has or has not seen the results.  Responses from nurses need to be monitored for accuracy and timeliness — the lazy but profitable response to just make an appointment is not adequate.  Integration of pharmacy functions is essential.

Here is a checklist of possible portal features — how does your provider’s portal stack up?

  • Responses to online requests take less than 24 hours
  • Ask a medical question
  • Ask medication related question
  • Make a follow up appointment
  • Make a same day urgent care appointment
  • Get refills on a chronic medication
  • Get a message from your provider about test results
  • Report drug side effects or drug allergies
  • Send a picture of a skin rash.
  • Diabetics can send blood sugar results
  • Asthmatics can send peak-flow measurements
  • Look at your list of medical diagnoses both active and inactive
  • See a list of current medications and the diagnosis for which they are prescribed
  • Links to drug information about the drugs on the medication list
  • Review the providers notes
  • Review any test, x-ray or consultation report
  • Your provider can send questions to specialists and forward the response to you
  • You can print your lab, pathology and x-ray reports
  • See your most recent medical summary including past medical history, social history, family history, medications list allergies — and be able to print the report if needed for consultations or to take on trips.
  • Request a summary of billing and payment information  — including when bills are sent to insurance and when payment is received.
  • Pay your bills on-line
  • Links to reliable on-line information sources about tests, treatments, drugs, immunizations and diseases.  Include a symptom checker — a computerized diagnosis based on symptoms — something to discuss with your doctor.
  • Provider office provides training to use the portal.

A provider might say:  “I’m not paid for running a portal or answering questions”.  That is very true for many providers in the US health care system.  But, in systems without fee-for-service billing then portals are a huge driver of efficiency.  If a patient’s questions or problems can be resolved via the portal so much the better for both the provider and the patient.  The handwriting is on the wall — fee for service is going to go away — the efficiency of portals will be a strong driving force.

 

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Creeping Spread of Electronic Health Records

snailDelinquent, delayed and diverted the electronic health records in the US are missing.   According to the Washington Post two Presidents set 2014 as the target for all medical records to be electronic — so has American medicine hit the target?

According to a study by the Robert Woods Johnson Foundation US healthcare has been very slow to adopt the technology.  RWJF reports 50% of office practices have a “basic” system and 59% of hospitals have at least a “basic” system (25% of hospitals have a comprehensive system).  To give perspective, a “basic” system contains medical reports and medication lists but no physician notes.

Barriers stand in the way of progress:

  1. Medical data is a very valuable business asset.  EHR companies are threatened if such data could be easily transferred to a competitor.
  2. Fear of losing control.  Doctors and hospitals don’t want their data to be too available to insurance companies or regulators.  Quality problems could be easily exposed.
  3. Self-determination.  Health care entities want to make their own systems — the CEO would rather manage than cooperate.
  4. Lack of governmental action.  Doctors and hospitals are licensed by States — just putting the license at risk is all that is needed to make EHRs mandatory.
  5. High cost of building an EHR.  Every office practice and hospital needs a financial system.  But, really, only one EHR is needed in a State or perhaps only one in the entire US.  Hundreds of EHRs across the country is a waste of money — they all do the same thing, and they can’t “talk” to each other.
  6. Failure to embrace a “cloud” computing solution for a large scale EHR.

Ask your doctor:

  1. Please show me my chest x-ray on the computer screen in the office exam room.
  2. Please electronically send all my records to a specialist across town.
  3. Please show me a record of all the prescriptions I had filled this past year and which pharmacies filled them and how much they cost.  (surely you can trust your doctor with that small bit of financial information).
  4. Can I send you a secure email and expect a response?
  5. Can you securely send me the results of my tests?
  6. Can you easily look up the discharge instructions from my recent hospitalization on your office computer?
  7. Do all the doctors and hospitals and pharmacies in town share the same medical record system — why not?  It would be very good from a patient standpoint.

NO answers exemplify the current data problem.  The US has a far better tax system than a medical record system and a far better post office than a medical record system.  Contrary to the story in the Washington Post this is NOT OK.

 

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