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Patients can now access all their health records digitally

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Re: Patients can now access all their health records digitally

#101

Post by adolph »

Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

Along with radiography and similar there is genomic information that is similarly difficult to move around and read.

Re: Patients can now access all their health records digitally

#102

Post by adolph »

batty_alex wrote: post #94
Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

I work on a PACS system. The problem isn’t DICOM, it’s big ass EHRs that don’t need to cooperate with anyone but themselves. Also, we’ve always had to allow exports in .iso/.zip with a viewer for the image data - going back to 2008. This is mostly forcing the big EHRs to stop playing games with patient data Calling DICOM ancient is funny, the whole industry has basically been dragging their feet adopting it. FHIR wil…

Some say ancient, others call it mature

Re: Patients can now access all their health records digitally

#103

Post by QuercusMax »

batty_alex wrote: post #94
Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

I work on a PACS system. The problem isn’t DICOM, it’s big ass EHRs that don’t need to cooperate with anyone but themselves. Also, we’ve always had to allow exports in .iso/.zip with a viewer for the image data - going back to 2008. This is mostly forcing the big EHRs to stop playing games with patient data Calling DICOM ancient is funny, the whole industry has basically been dragging their feet adopting it. FHIR wil…

Last time I seriously worked on interoperability between pacs systems in 2014, there were new products being put on the market from major vendors like GE that didn't support Unicode in dicom.

And when I worked on radiation therapy systems, we ran into limitations with fixed-length fields being insufficient for the number of points in a region of interest, unless you use an encoding that doesn't indicate types. (4 bytes - either 2 for data type and 2 for length, or 4 for length with no data type listed).

It's from the 80s and shows.

Re: Patients can now access all their health records digitally

#104

Post by QuercusMax »

lostlogin wrote: post #76
Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

> But we still aren't very close to being able to see X-rays on our phones. Patients can and clinicians can too with the likes of Intelerad’s offerings - but there are many others. New Zealand has a fragmented system but it’s all slowly improving and depending on when and where your imaging was done, you can access it. Far nastier than DICOM and it’s foibles is HL7 format. The RIS side of things is a cluster fuck and…

I worked on a system to do this back in 2008 - we won an Apple Design award for it and I got a free 30-inch cinema display. This was mind blowing 14 years ago, but now it's not that exciting.

Hl7 tho.... That is crazy stuff.

Re: Patients can now access all their health records digitally

#105

Post by obloid »

petilon wrote: post #98
obloid wrote: post #36

Earlier quoted context omitted.

Not sure where you got the idea that there are "quotas" doctors have to meet for ordering diagnostic tests. I can't speak for other countries but in the US this is not the case.

You can't speak for other countries, but you can for all of the US? Then explain these articles: "Doctors Under Pressure to Meet Quotas and Fill Hospital Beds" [1]. "Once hospitals have made such a huge investment, experts like Dr. Zietman say, doctors will be under pressure to guide patients toward proton therapy when a less costly alternative might suffice." [2] "While payments vary widely, doctors often collect $5…

Article 1 is about certain for profit hospitals setting quotas on the number of patients doctors admitted to the hospital, and giving kickbacks to doctors for ordering tests (which is illegal).

Article 2 is addressing a cancer treatment, not diagnostic tests. And has one quote by a doctor concerned about oncologists being pressured to use proton therapy. No mention of quotas.

Article 3 is about the proliferation of advanced diagnostic imaging (MRI, CT, etc) in private clinics and the concerns about over utilization of these diagnostic tests as well as potential conflicts of interest with doctors having a financial stake in the tests they're ordering. These are both real problems in the US medical system. However, no mention of US hospitals placing quotas on diagnostic tests ordered by doctors on their staff.

Is it possible these types of quotas have occurred? Sure. But is this typical practice in the US? No.

Re: Patients can now access all their health records digitally

#106

Post by petilon »

obloid wrote: post #105
petilon wrote: post #98

Earlier quoted context omitted.

You can't speak for other countries, but you can for all of the US? Then explain these articles: "Doctors Under Pressure to Meet Quotas and Fill Hospital Beds" [1]. "Once hospitals have made such a huge investment, experts like Dr. Zietman say, doctors will be under pressure to guide patients toward proton therapy when a less costly alternative might suffice." [2] "While payments vary widely, doctors often collect $5…

Article 1 is about certain for profit hospitals setting quotas on the number of patients doctors admitted to the hospital, and giving kickbacks to doctors for ordering tests (which is illegal). Article 2 is addressing a cancer treatment, not diagnostic tests. And has one quote by a doctor concerned about oncologists being pressured to use proton therapy. No mention of quotas. Article 3 is about the proliferation of a…

> But is this typical practice in the US? No

Your experience is different from mine. Ordering unnecessary tests is typical practice in my experience. And doctors are quick to reject tests done at another hospital, as if tests done at another hospital are untrustworthy.

Any time a US hospital has expensive equipment, doctors working at the hospital are under pressure to keep it running. You can find any number of articles on this topic if you're willing to spend a few minutes googling.

Re: Patients can now access all their health records digitally

#107

Post by codexjourneys »

cycomanic wrote: post #89
Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

The doctors notes are sometimes actually a problem. We are in Sweden where they are open to patients and I know doctors who received complaints because of their notes (e.g. because they made the patient anxious). They were pretty harmless ones, like "this should be monitored". So to avoid complaints doctors start to not write notes into the official notes, which makes things worse.

This is a good point. If doctors start writing sanitized notes or leaving things out, it would be net negative. US patients can get their full medical records by requesting them from the office, and the notes are in there, but most patients do that only if leaving the practice or if the doctor retires.

I requested and received my medical file from a doctor who passed away. I enjoyed reading through it but was glad I didn't see those notes in real-time. I wouldn't have wanted to go to my next appointment wondering, "I think I'm doing okay, but is he going to write that I'm less compliant than the last time?"

Re: Patients can now access all their health records digitally

#108

Post by ceejayoz »

parineum wrote: post #96
sethammons wrote: post #60

Earlier quoted context omitted.

"Patient feels nausea when seeing the color yellow; I have proscribed a placebo to gauge the effect." Not something a doc would want the patient to know.

Doctors shouldn't be performing experiments.

Kid has asthma? Experiment with an inhaler. Switch to a different one if it's not effective.

Recurrent skin infection? Experiment with antibiotics to find one it's not resistant to.

Patient on a ventilator? Getting them off will require experimenting with vent settings and periods of having them off the vent.

Re: Patients can now access all their health records digitally

#109

Post by JoshMandel »

StanislavPetrov wrote: post #80
StanislavPetrov wrote: post #43

Earlier quoted context omitted.

Because patients should have the right to decide whether and where their confidential medical data is stored.

Astounding to me that anyone is downvoting this sentiment. I would love to hear some sort of rationale from anyone who believes that individuals shouldn't have the right to control who has access to their own private medical information and who stores it.

Not the down voter, but if you look through guidance from the malpractice insurance industry (e.g., https://www.thedoctors.com/articles/medical-and-dental-recor...) you will see that defense against potential malpractice claims is a key driver of retention practices. Introducing a right to be forgotten in healthcare would presumably require concomitant reform of the medical malpractice landscape.

I'm not arguing against the sentiment (and indeed I think patients should have a much stronger ability to audit and control how their records are shared, including the ability to opt out of sharing) -- but when it comes to records retention by the originating organization, it's important to evaluate these practices in the broader context.

Re: Patients can now access all their health records digitally

#110

Post by obloid »

petilon wrote: post #106
obloid wrote: post #105

Earlier quoted context omitted.

Article 1 is about certain for profit hospitals setting quotas on the number of patients doctors admitted to the hospital, and giving kickbacks to doctors for ordering tests (which is illegal). Article 2 is addressing a cancer treatment, not diagnostic tests. And has one quote by a doctor concerned about oncologists being pressured to use proton therapy. No mention of quotas. Article 3 is about the proliferation of a…

> But is this typical practice in the US? No Your experience is different from mine. Ordering unnecessary tests is typical practice in my experience. And doctors are quick to reject tests done at another hospital, as if tests done at another hospital are untrustworthy. Any time a US hospital has expensive equipment, doctors working at the hospital are under pressure to keep it running. You can find any number of arti…

It's definitely the case that many unnecessary tests are ordered. That is a different issue from quotas, which is specifically what I was addressing.

Anyway, I will concede that my personal experience practicing medicine is not necessarily representative of the practice of medicine in all areas of the country.

edit: grammar

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