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How Did Our Medical Notes Become So Useless?

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Re: How Did Our Medical Notes Become So Useless?

#51

Post by Scoundreller »

sxg wrote: post #40
Thriptic wrote: post #12

This EHR data problem is something I've pondered for a bit. One "simple" solution is to have departmental standardization of note format with thoughtful inclusion of what fields are typically pertinent. This doesn't solve the problem of care transitions but it might help standardize review in a hospital context. The other thing that I've been pondering is something resembling a formalized data structure and language…

Many departments do standardize their note formats. The problem is that the note is directly connected to billing, and the billing requirements are absurd. I'm a medical student, and I recently visited my PCP for a medication refill. I have no significant medical history whatsoever, and the visit took no more than 15 minutes as expected. A month later, I was given a bill for $330 stating my hospital visit was level 4…

Why did a visit to your PCP get billed as a hospital visit?

And which acuity scale was this? Usually the higher the number, the less acute you are.

Re: How Did Our Medical Notes Become So Useless?

#52

Post by davycro »

samsolomon wrote: post #43

I've done a good bit of thinking about medical note taking. To me it's a little odd that hospitals are the ones who keep this information. I'd think that the records should belong to patients—it's about them after all. And that the patients would provide access to doctors or hospitals. Right now I've got a personal medical journal that has things like: * Sickness - Date Range and Notes * Flu Shots - Date * Injuries -…

Notes intended for patients would have a different form than notes intended for doctors. Unfortunately medical records achieve neither. My notes are bloated with information needed to bill the maximum amount from the center of Medicare services, which ultimately hurts all parties.

The bloat obscures critical information from other doctors. Patients are unable to read a meaningful account of their care, and are charged more for worse services.

Re: How Did Our Medical Notes Become So Useless?

#53

Post by mikekchar »

DanielBMarkham wrote: post #6

My Primary Care Physician is unable to speak coherent sentences. I'm half-joking, of course. The guy is top-rated, elected head of the state association. He's widely-regarded as a combination of both brilliant with diagnostics and good with people. He just can't complete a sentence when we meet. Why? Because he's got some pad he carries around that takes up all of his attention span. He comes into the room, sits down…

Maybe not relevant for you, but one thing that has helped me with my doctor is that the first thing I do when I go in is sum up what happened in our previous couple of visits. My doctor doesn't have enough time to prep for my visit. I mean, he should, but he doesn't (been there, done that). So I give him the executive summary to speed things up. I visit my doctor a lot, so he now trusts me to give him accurate and useful information.

Re: How Did Our Medical Notes Become So Useless?

#54

Post by sxg »

limeblack wrote: post #32
jermaustin1 wrote: post #30

Earlier quoted context omitted.

That's amazing. I guess, in the US, we only started tracking patients recently. I had to call and have my old records faxed from my old GP in Texas to one in New Jersey, and then again from that GP to my NEWER one in New York. Earliest record was from when I was 7, since neither my mother or I remember who my pediatrician was before then.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of depression may be the thing that tips your doctor toward getting an MRI of the brain to rule out a brain tumor, for example.

Re: How Did Our Medical Notes Become So Useless?

#55

Post by davycro »

dvtrn wrote: post #19
rhcom2 wrote: post #10

Earlier quoted context omitted.

In the US you're legally entitled to your medical records too but every time I've done it the response is always defensive, ie "why do you need them", "send me the doctors information and I'll fax it to them myself".

every time I've done it the response is always defensive, ie "why do you need them" I was asked this once after requesting mine. I flatly said "I don't", and waited. The person on the other end of the line was clearly thrown off by this, probably expecting something they could dish out a canned response to, hoping I'd give up. It was obvious from their voice they were scrambling for what to say to that. A bit of rigm…

I encourage patients to read or listen to me dictate my note about them during our exam. Often they catch something that I had misinterpreted.

Re: How Did Our Medical Notes Become So Useless?

#56

Post by ars »

goldcd wrote: post #5

In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent). Now knew this theoretically happened, but was quite bemused to see it happen in practice. I rescued a rat from the silken-jaws of my pseudo-homicidal cat, and the ungrateful rodent bit through half of my finger - I thought it would be sensible to have a check…

The US is trying to do this as well. The very famous HIPAA is actually about that, and not as much about the privacy provisions that made it famous.

Implementation of this goal though ..... not as successful. Mostly because those who make the electronic record systems don't understand the field well. See: https://news.ycombinator.com/item?id=18781264

Re: How Did Our Medical Notes Become So Useless?

#57

Post by ceejayoz »

jolmg wrote: post #33
aschneid wrote: post #25

Earlier quoted context omitted.

At Kaiser, you just have to walk into any member services office and request. It doesn't happen right then, but I believe in a few days you get a thumb drive with all of your records on them. However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you.

> However, the law allows the doctors to redact certain portions in your copy that they feel could be harmful to you. Like what?

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance...

Scroll down to "Information Excluded from the Right of Access", particularly the bit about psychotherapy notes.

Also see "Reviewable grounds for denial (45 CFR 164.524(a)(3))", which includes things like "The access requested is reasonably likely to endanger the life or physical safety of the individual or another person" or "The access requested is reasonably likely to cause substantial harm to a person (other than a health care provider) referenced in the PHI".

https://www.hhs.gov/hipaa/for-professionals/faq/2046/under-w...

> Another limited ground for denial exists if a licensed health care professional determines in the exercise of professional judgment that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person. For example, a covered entity may deny a suicidal patient access to information that a provider determines in his professional judgment is reasonably likely to lead the patient to take her own life.

Re: How Did Our Medical Notes Become So Useless?

#58

Post by Scoundreller »

ivraatiems wrote: post #2

I strongly agree that EMRs are making this problem worse, not better. And doctors seem to hate quite ubiquitously the extra amount of documentation they have to do. While there is a lot of evidence in some areas that EMRs have improved quality of care and patients' lives, I don't think this is one of them.

I’ll shoot: what extra documentation has to be done on an EMR that isn’t necessary on paper?

Has the “standard” been to document X, Y and Z, but providers felt (rightly or wrongly) that documenting those things is unnecessary, so they didn’t, but now they have to and it’s easily auditable?

Is the problem the medium or the implementation?

Re: How Did Our Medical Notes Become So Useless?

#60

Post by ams6110 »

dvtrn wrote: post #19
rhcom2 wrote: post #10

Earlier quoted context omitted.

In the US you're legally entitled to your medical records too but every time I've done it the response is always defensive, ie "why do you need them", "send me the doctors information and I'll fax it to them myself".

every time I've done it the response is always defensive, ie "why do you need them" I was asked this once after requesting mine. I flatly said "I don't", and waited. The person on the other end of the line was clearly thrown off by this, probably expecting something they could dish out a canned response to, hoping I'd give up. It was obvious from their voice they were scrambling for what to say to that. A bit of rigm…

Side question, would the "right to be forgotten" also entitle you to call your doctor and demand that all your medical records be destroyed?
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