Managing Patient Expectations: Providing Portable Medical Records

I outlined the 10 most fundamental changes in patient expectations in January, and am providing some added insight, strategies and tactics to manage each on a weekly basis. Each article is derived from an educational presentation I do for hospitals and physicians.

This article refers to patient expectation number nine: the impression that medical records are portable. To illustrate how pervasive expectations are, even among professionals, I have a recent personal experience to share.

Thanks to a distracted driver crashing into the back of my car in morning traffic a few weeks ago, I found myself needing medical care and was surprised at being required to fill out two sets of forms (each seven pages in length) for two different functions in two offices within the same practice. And I have been seen there within the past two years. The burden of retrieving records for comparison fell on me, my doctor’s staff, and the staff of two other providers. The reason, records are on paper, and paper files have to be found, faxed, copied, punched, collated, and re-filed.

Of the three providers involved, all have the technology to produce electronic health records (EHR). One uses it, two do not. In all, the better part of an hour was spent by all parties, and that does not include drive time. The practice that uses EHR had my records including complex imaging in less than two minutes – including the phone request.

Each paper-based provider admitted that their real difficulty is in the time and energy required to convert from paper to EHR, all of which is complicated by staff and physician resistance.
Rather than investing 100 or so hours over a few months to make the transition, they continue to carry a full-time employee year after year not to.

Privacy issues are also often cited, and they are less of a concern than one might think. Patient billing information is already digital because payers require it. Those records contain enough information to not only steal an identity, but become that person. Adding medical records, which are not particularly appealing targets for hackers, adds little risk.

This failure in using existing technology to communicate among providers has other negative effects that should concern all of us. For example, a December analysis by the Center for Studying Health System Change found that one-third of adult patients discharged from a hospital do not see a physician within 30 days of their release. Records are not coordinated between hospitals and physicians to track patients at high risk of readmission because many are locked in paper. EHR systems could far more easily tag at risk patients and flag their doctors and patients. This is a systemic failure with real consequences. About 8 percent of discharged adults were re-hospitalized during the study period, while 33 percent were readmitted within a year, partly because there is resistance to invest the time to convert from paper to digital.

So, at the very least, baby steps are recommended:

• Add fillable PDF forms that can be completed digitally and the information automatically populated into your EHR system. Put them on your website. E-mail them to patients. Put them on IPads and tablets in your office. Make them mobile smartphone compatible. Encrypt everything not on paper.

• Bite the bullet and invest in training physicians and staff to use the functions. Require compliance — federal and insurance regulations soon will.

• Use voice recognition technology or in-room stations to update patient records.

• Use the medical record transfer capability (PDF format) to electronically transfer records to referring physicians.

• Favor referring physicians who use the same technology.

Then, reap the benefits:

• Once patients experience this technology, providers without it appear backward.

• Real technology = Perceived superiority.

• Those who invest in change profit from the efficiency.

• Faster claims, less duplication = improved cash flow.

Of course, there is a lot more to it, but not as much as many may think.

Nonetheless, it’s time for most providers to embrace technology that will provide a fuller health picture for referred patients that will improve quality of care while reducing costs.

Find out more about James Doulgeris and our other Practice Notes bloggers.