Wednesday, August 12, 2015

Electronic Health Records

Okay, the image is unrelated to the topic, - all aboard Amtrak!

When I was growing up, the country doctor (who was actually a graduate of a top Medical School in California and had moved the very rural mid-west to be the only doctor in miles as a mission trip for his church and choose to stay) kept medical records on 5 by 7 file cards.  His handwritten notes where all there was, the story of each patient's life, he was there when I was born, he was there when my great grandmother died. The challenge was when anyone needed to read his notes, and his notes are long gone - he retired in about 1980, his replacement committed suicide a few short year's later and the practice never reopened.  The records of my early years are long gone. When I was recently asked if I had been vaccinated for measles, I didn't know and there are no records to check (the blood test showed that I am immune - either vaccinated or I had the measles as a child.)

I started with a new doctor in May and was astounded to see that her office is still using all paper records.  What a mess. I went to fill a prescription a couple of weeks ago, handwritten of course from the office that still keeps paper files, and the prescription was unclear.  The drugs name was incomplete, it could have been one of two different drugs.  They had to call, the doctors office transferred the call a dedicate voice mail box. Because I was waiting the pharmacist called doctors office back and was told, you will have to wait for a response from voice mail, we handle "all of those at the end of the day."  Let me give you a hint, if you have so many questions on the handwritten prescriptions that you have to have a special voice mail box, maybe it is time to move to electronic prescribing. Two advantages, no handwriting issues, and a good electronic prescribing system won't let you enter an unclear drug name. Would I change doctors of the lack of electronic prescribing, I have thought about it.

The hospital and medical group that I spent much of May inside of uses a comprehensive electronic medical records system.  My experience has been good.  I started with a new physical therapy provider recently, the second or third time I saw him he remarked that he had reviewed the discharge notes (sent to him electronically) and was astounded by how much progress I have made in six weeks. He had also seen the most recent images of my spine - information that is very helpful in him knowing how hard he can push on what spots. This kind of portability and transparency is the advantage of electronic health records.

Now every time I was moved to a different part of the system, they would run through 30-60 minutes of questions.  Most were repeats of what I had answered before, sometimes just hours before.  They needed medical history, and frankly I hadn't seen a doc in a couple of decades so there was not much of a history.  One night, I was moved from post anesthesia  recovery to a room after midnight, and she starts in with 45 minutes of questions.  About 10 minutes into it she asks "are you sexually active? - With women or men?" I was a bit surprised, no one had asked those question, and no one did again afterward.  I commented "well that is a new question."  She said it is in the list of medical history questions, most people are too embarrassed to ask so they either guess or skip the questions. I wanted to see how awake you are. My response, was "I will have to think about how honest of an answer I want to give," to which she said, "that tells me a lot about your mind and ability to reason, good answer!"  I did answer her question, with probably to much information.  Undoubtedly recorded forever in the electronic health records.


  1. fire ANY MD who won't use a computer! I fired my primary MD a few years back when he would keep my waiting for 60 minutes plus. nopenopenope! plus he was still on paper!

    my current primary MD is computerized, she is originally from sri lanka, and she is a knitter (like me). there is no guess work when it comes to prescriptions, blood tests, or medical history.

  2. I went from a solo practicing quack who went to jail and almost killed me to a group practice afiiliate with Geisinger Medical(the big player in this region) with an electronic footprint. I have an account on their website and can see any test results, email my dr. directly, pay my copays, etc. and do whatever needs to be done without having to call the office and sit on hold for 30 mins. or more.

    The quack had all our medical records stored in his garage when he went to jail and all records have since disappeared(though we think the Feds have them as he was suspected of criminal activities and they are considering charging him for various crimes). So all my kids immunizations from 2000 until 2013 are gone.....good thing I kept my own records of that! ;-)

  3. My solo doctor FINALLY moved to electronic records. Made my tirade about coding my yearly physical/script renewal incorrectly fight a lot easier. So far, no new BILLS!

    I like it!

    Peace <3

  4. Oh what a tender subject. I am currently going from the 'old' EHR to the 'new" and I have to confess the notes are more detailed, readable, and - gasp - useful. Trouble is sharing them. However if I were to die a colleague could readily pick up any file and proceed. Patients transferring to other docs get good notes.