Health Record Portability – Part 3 Problems Abound

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One of the challenges of managing your health information is that it comes in so many forms and formats.  It is not hard to find examples where the ball gets dropped.  Here are a few examples that I recently encountered that demonstrate this challenge.

Recently, my uncle who lives in a remote part of Pennsylvania had a heart attack.  Because the local hospital could not perform the required procedure, he was flown to a larger hospital.  There he had a cardiac catheterization and stents were placed in the arteries that supply blood to his heart (coronary arteries).  A day or two later when he was stable, he was taken by ambulance to the first hospital.  We had been told by the cardiologist who placed the stents that 2 were placed.  When we got to the first hospital after he was sent back there, the doctor who had reviewed his record from the second hospital said that he couldn’t find any documentation that any stents were placed.  The next day when my uncle’s local cardiologist looked at the record, he said that he found documentation of only 1 stent being placed.  It wasn’t until I was helping get things ready for his discharge home that I found 2 wallet cards, one for each stent, that were among the discharge papers from the second hospital mixed in the plastic bag that was sent with him.  These cards specify the kind of stent, its size & location in the arteries of the heart.  It would make better sense if this information would be in a more prominent place in the hospital chart so any doctor can easily find it!

Another example happened to me personally.  I recently saw an orthopedic surgeon about persistent pain in my knee for several months.  X-rays showed some arthritis but nothing very significant.  After another month, I noticed that one spot on the knee was especially tender.  Thinking that it could be a torn meniscus, the surgeon ordered an MRI.  A few days after the test, he called & told me, other than the arthritis, it was normal.  Well, because of continued pain that limited my activities, I saw a rheumatologist to whom I had the records from the orthopedic surgeon sent.  After a few minutes, the rheumatologist asked if I knew the result of the MRI.  After I told him that I was told it was normal, he showed me the report that indicated I had a small tear in the meniscus and some other abnormalities.  He assured me that surgical repair was unnecessary, but it left me wondering why the surgeon never mentioned it.  I believe he looked at the wrong report.   I wonder how often that happens?  In my case, it didn’t make a difference.  But how often does it?

So, how do you make sure all your important medical information stays “attached” to you and can be easily found?  The health care system should do this, but there are too many moving parts.  As I said in my previous post things are slowly moving in the right direction.  But the question is – What can we do now?

In my next post I’ll present some strategies that may help to ensure health record portability until the health care system catches up to the digital age.

Please share your experiences, ideas and comments.

For Your Health – Dr. Bob

Health Record Portability – Part 2 Some Progress To Report

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In my last post, I outlined the need for Health Record Portability as well as the obstacles to its widespread implementation.  However, there are a few inroads being made.  Here are some of those initiatives.

From the healthcare provider viewpoint, some communities have launched their own Health Information Network (HIN) that enables community physicians, hospitals, labs & other healthcare providers to share their information. You can think of it as a healthcare information utility that supports health information exchange.  This sharing is always dependent upon the consent of the individual patient.  One example with which I am familiar is the East Tennessee Health Information Network (etHIN) in Knoxville, Tennessee.  The hospital systems & physician practices pay a fee to etHIN to be able to share their patients’ health information.  One feature that would have helped me to keep track of my pneumonia vaccine is a Vaccination Gateway that etHIN provides.

But what can you do as a patient, especially if you live in a community without a health information network?  From a non-technological perspective, you can keep paper copies of your medical record.  Usually you’ll want to organize them by practice or medical issue, but if you have some condition that gets monitored by some lab test, you’ll want to group them together.

There is a more modern approach that you may want to consider if your physician’s EMR system supports it.  Microsoft has a free cloud storage application called HealthVault that can help you manage all your electronic medical information in one place.  Once you set up your account, you can ask your physicians (past and present) who use an electronic medical record to send your files to your HealthVault account.  Not all EMRs can provide your records in a format compatible with HealthVault.  It is far from perfect, but it is a beginning.  Hopefully we will see more EMRs that are compatible with HealthVault in the years to come.  You can also upload any records that you have scanned into your computer. A great feature is the ability to create an Emergency Medical Information card that includes your allergies, medications you take, health conditions you have and emergency contact information.  It also has access information so an Emergency Room physician can view your HealthVault record.  It can be folded to fit in your wallet or purse.

Next time I’ll share some examples of situations I’ve encountered where health information sharing just hasn’t worked and, in a later post, some possible ways to prevent these problems.  As always, please share your thoughts and comments.

For Your Health – Dr. Bob

Health Record Portability – Part 1 What Is It & Why Is It Out of Reach?

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It’s been awhile since I last posted. My apologies.  I’ll try to do better.  I thought retirement would give me more time to focus on this blog, but it seems to give me more distractions.  Since my last post, I’ve once again seen some issues with being a patient in our healthcare system that deserve some comment.  This post will talk about one that those of us who have moved around the country face – keeping track of our medical records, in other words, health record portability.  We may have paper records that we carry with us, but the more we have, the harder it is for our new physician to pour through them and incorporate them into the current record.

What brought this topic to my attention was my recent need to find documentation of a pneumonia vaccination that I know I received within the last few years.  Was it done at my doctor in Knoxville or was it done at a pharmacy while I was on vacation in Florida?  I can’t find the record of it within my paper files.

In this digital age, it seems that certain aspects of our healthcare delivery system have not kept up with technology.  Our medical records should be digitally portable.  If you had surgery in Richmond, VA and now moved to Charlotte, NC a lot of that information may not be readily accessible to your new healthcare providers.  What are the current obstacles?

  1. Not all physicians or healthcare providers use an electronic medical record (EMR)
  2. Not all significant healthcare information is contained in the EMR
  3. Not all the EMR systems that are operational can share information
  4. Even where sharing is possible, it’s often not automatic

Next time I’ll talk about some solutions that are on the horizon.  In the meantime, please feel free to share your comments and thoughts.

For Your Health! – Dr. Bob

Creating Your Weight Loss Plan – Part 4 Changing Behaviors & Keeping Resolutions

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With 2016 just a few days away, many of us are thinking about making resolutions for the New Year.  Well, resolutions are really behavior changes.  In the context of a weight loss plan, changing behaviors refers to changing what you have been routinely doing in regard to your eating and exercise routines.  You may also think of behaviors as habits.  Your weight is what it is because of your eating and exercise habits.  While your metabolism plays a significant role, your eating and exercise behaviors are the two areas that you can impact to change your weight.  You will either add new behaviors or substitute new, healthier behaviors for your current less healthy ones.  It is rare to just stop a behavior without replacing it.

Adding Behaviors

New behaviors involve adding something to your current activities, such as an exercise routine.  Often the main challenge is finding the time.  For some, it’s in the morning before the main activities of the day; for others, the evening makes more sense.

As far as exercise, the ultimate goal is spending at least 30 minutes most days of the week doing an activity of moderate intensity.  The more time you spend exercising, the more calories you will burn.  It has been recommended by the American Heart Association that from a cardiovascular health viewpoint, those 30 minutes can be expended all at once or in several blocks of at least 10 minutes each.    It makes sense to start slowly, so 10 minutes three days a week may be the perfect starting point for you.

Substituting Behaviors

These often revolve around eating behaviors.  For instance, instead of drinking sugary beverages, substitute water.  While this may sound simple, it takes planning to make sure you do it.  You’ll probably want to buy fewer sugary beverages and have them less accessible, too.  (Ideally, don’t buy any!)  You may need to put notes in your refrigerator on those sugary drinks that remind you to drink water instead.

As you create your weight loss plan, take some time and identify the behaviors you need to change and which ones you’ll tackle first.  Don’t try to change them all at once.  Make a list and change a few more every week or so.

Don’t forget to check out my website www.insightsforhealth.com where you can set up Health-e Texts to reinforce your new healthier behaviors.  To use some of these you must register as a member, but membership is free!

Your comments are welcome.

For Your Health! – Dr. Bob

Creating Your Weight Loss Plan – Part 3 Milestones & Rewards

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Just as you anticipate and prepare for barriers and obstacles to your weight loss plan, you should build in some rewards for milestones you reach during your journey.

Milestones

Milestones can be thought of as mini-goals that you must attain on your way to your ultimate goal.  If your ultimate goal is a target weight loss of 75 pounds over a 6-month period, then you can set your milestones in terms of process measures and outcome measures towards that goal.

Process Measures

In order to succeed and reach your weight loss goal you need to change habits surrounding your eating and activity (exercise).  These habits, behaviors, processes must change.  For example, you can no longer buy any food just because it tastes good at the grocery.  You must read labels and evaluate your choices.  As far as activity, you need to get on a routine of scheduled exercise.  So a milestone for eating habits may be consistently keeping a food diary or consistently reading food labels at the grocery.  As far as exercise, a milestone could be exercising for at least 30 minutes a day at least 3 days a week for at least a month.  Where possible, you will want to increase certain aspects of your new behavior to set a new milestone for yourself.  This is often done with exercise.  After a month of 30 minutes a day 3 days a week, you may want to increase that to 4 times a week.  But reward yourself as you attain each milestone.

Outcome Measures

These are usually tied to getting to a specific portion of your goal.  So, when trying to lose 75 pounds, your first milestone may be losing 10 pounds.  The next may be 25 pounds.  These milestones help you track your progress and allow you to reward yourself for the work you’ve done.  Changing behaviors isn’t easy!

Rewards

The ideal reward should be tied to the new behaviors you are undertaking.  In the case of weight loss, they certainly shouldn’t be unhealthy or off-limits foods.  So, you may get yourself some new workout clothes or exercise equipment.  For more significant milestones, a weekend getaway might be appropriate but without indulging in foods that are not on your healthy eating plan.  When you hit your ultimate goal, you’ll probably want to treat yourself to some new clothes that fit the new you.

Next time I’ll talk a little more about changing behaviors.

For Your Health! – Dr. Bob