More Medical Records Trouble

I wrote here about the impossible task clinicians face in attempting to review records of prior treatment of a patient. Two actual cases illustrate further problems.

Case #1: A patient I treated for depression ends up in the local emergency room after a suicide attempt. I contact the hospital, which recently converted to the Epic brand electronic record (EMR), to obtain a copy of the record. The first record I receive contains no documentation of evaluation of the patient by ER staff. I contact the medical records department and explain the problem. They send exactly the same incomplete record again. Only after the third attempt do I see documentation of evaluation by ER staff, but how can I confirm that I now have a complete record? I cannot.

In essence the hospital has tacitly implied that each set of records is complete, a misrepresentation at best, partly a result of the challenge of converting a digital record to pages.

Case #2: A psychologist and myself must conduct an independent examination of a worker for a local employer. We need to review the treatment record. One physician provides printed records and a bill for over $600 for copying the chart, probably at the maximum rate allowed by statute. We put our heads together to address the logistical problem of sharing one copy of the records in order to minimize expenditure by our client the employer.

Digital records (EMR) can obviate the cost-per-page problem, since, in a best case scenario, we might access the record directly on the Web. However, in order to do justice to a record review the reviewer must first attain competence in use of that particular application. Competence in using Epic will not translate into competence in using Practice Fusion or others. Furthermore, the ease of using copy-paste, templates, checklists and boilerplate encourage bloat. Marked increase in the quantity of records means more time for review, and dramatic increase in cost to the client.

Health care providers need to prepare completely before implementing digital records. EMR vendors must implement technology to allow view only access when directed by the patient, and legislators must bring applicable statutes in line with current reality.

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