Where is my medical information?

Many of us have had the maddening experience of going to see a doctor and being told that your medical information is "not in our system". But, things are gradually improving now that we are experiencing post COVID care. In fact, during a recent visit, I wasn't handed one clipboard. I completed the pre-exam information online using the patient portal and the information was imported into the EMR. I also received the results of some blood tests about 30 minutes after the blood was drawn, which, by the way, was drawn by the MA in the office instead of my having to go to the lab and have a phlebotomist do it.

Things are changing rapidly with the likes of Apple getting into the game.

The digital front door isn’t just unlocked; it’s opening wide, and healthcare organizations that want to remain competitive need to figure out how to make it an entrance to a wholly connected patient journey.

“This is an industry that has long been considered a technology laggard of sorts over the years,” Mutaz Shegewi, IDC Health Insights research director, told?PatientEngagementHIT?in an interview. “Healthcare has always been slow to adopt cutting-edge technology and to keep up with its peers in the other industries.”

But in recent years, mounting pressures have changed that. The rise in chronic illness, the aging of the Baby Boomer population, and the shift to value-based care have pushed many organizations to rethink the way patients engage with their care and assess the role that health IT plays in that.

Many will not have a similar experience.

The reasons are many:

1. Electronic medical records and other sources of data are not interoperable
2. The information is buried
3. The person seeing you did not take the time to review what records are available
4. Someone sent information that is not compatible with the receiver's system e.g. a CT scan disc that cannot be read on the legacy IT system
5. There was a referral leak because the sender, the receiver, the patient or a third party intermediary, like an insurance company, got in the way or did not do their job

So, what's a patient to do? Here are some tips:

1. Take personal responsibility for storing and managing your health information
2. Do not assume that the person you are about to see will have your information in the record, particularly if you are going from one part of the US system of systems to another, like from a VA hospital to a for profit or not for profit private system or an urgent care center or ambulatory surgery center to a private practice.
3. Do not assume that the person seeing you will have reviewed your information prior to your visit, particularly if they are an employed physician working in the same hospital system that employs the sending healthcare provider.
4. Be sure you sign a release of medical information and get copies. Bring critical information, like operative notes and discharge summaries to your visit. Dispute unseemly charges for making copies. In most instances, there are only a few pieces of critical information required to make a diagnosis or therapeutic decision as part of an initial or follow up visit. You won't need the contents of your entire last visit.
5. If possible, have someone accompany you to the visit to take notes
6. Check to be sure the information in the record is correct and bring attention to errors. Some are minor. Others are not...like do you still have your right leg
7. Be sure you have an accurate medication list and discuss whether you still need to take them or make adjustments
8. In these days of digital health hype, there are still many doctors who don't have or use them. Most have a fax machine and here's why they still use them. Be proactive and ask the sender to fax information to the receiver prior to your visit
9. Do not send medical information over insecure networks. Black market eCare is pervasive.
10. If people are not responsive, if possible, find someone else to take care of you.
11. One thing you be sure of receiving, though, is your bill for medical services. Be sure to examine it closely and dipute any charges. Here are some tips how to do it. Be particularly aware of hospital "technical fees" (a charge for using the building and all that free valet parking) v professsional fees (what the person who saw you, doctor or not, is charging you). Charges are based on E/M codes submitted (evaluation and management fees) that are often wrong and either overstated or understated.Insist on getting an explanation of benefits that states the E/M code submitted. In addition, contest bills for "free" Medicare annual health evaluation visits even if there is no out of pocket charge to you. You are , in fact, paying for those visits as a taxpayer.

Medical tourism/medical travel presents its own set of challenges. Here are the 7Cs to follow if you are leaving home for care.

The unfortunate reality is that, when it comes to medical information transfer, there is busted trust and impregnable information silos.

Remember too that much of your medical information is not in EMRs. Remember that visit to the accupuncturist? What about your shingles shot at CVS and those unstructured posts and pictures on Facebook?

Be your own best advocate and remember that your medical information is an asset. Protect and monetize it.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SoPEOfficial and Co-editor of Digital Health Entrepreneurship