Who should track health care information? (Part V. Travelers)

It is February and cold.  Oh how I long to go to Mexico. It would be warm and maybe the achyness in my bones would go away.  I just finished two challenging semesters of Spanish at my local college.  I never took Spanish in high school so this was quite the ordeal at my age. I have  been reflecting on how much time and effort I spent and yet I still feel that there is so much to learn.  The same can be true of the area of healthcare and medicine.  Most people do not really understand medicine.  Medicine is so complex and that is why we all rely on the experts (the doctor) but what about when we travel? How do they know all of our health information?  That is just it, they do not have a record on us or an electronic health record (EHR) I have only been out of the country a few times and most of the time I travel via car and see the sights along the way.  One particular time, I took a cruise with my husband out of the country.  It was our first time. He was not feeling well before we took off.  He had a scratchy throat, achy but was not runny a fever. He thought about stopping by a minor emergency center before boarding but he decided against it.  On day two of our trip he was very sick and needed something for his fever.  He went to visit the ship doctor and was told he had strep throat. The weird part of all this was how unprepared we both were for all of this.

Everyone needs to track their health care information even those that travel for recreation, business, missionary work or athletics.  Stay with me as I continue to blog on this important subject. You can also follow me on twitter.  Please check out my website at positiveresourceconsulting.com

Empowering the patient

I think all patients should monitor their own health care. Do you keep track of your medical records and what is inside them? I do. Why because I feel I know myself better than anyone. It is not that I do not trust but I feel that I need to know what is going on with regards to my  medicine, treatment and options. I would go as far as to say that if you have a chronic problem or serious disease you need to be 100% involved in your healthcare.

I just now re-read my thoughts from when I wrote this post.  I guess at the time I was in a hurry.  I could write for days on this topic.  I have been reviewing some applications (apps) on my iphone and I have noticed while we are making great strides in the area of tracking health information we still have a long way to go.  I have also noticed that when you Google the subject, electronic health records (EHR),a great deal of products pop up.  Some of them new and some of them are old and have been around a long time.  I have used the electronic health record from a coder/biller stand point to an auditors viewpoint.  I have even used many products from a patient perspective.  I have read and studied so many of them as a registered health information technician (RHIT) but I still find them lacking with a very important component.  The patient vantage point is still missing.  It is a critical link to fixing a broken health care system.  I have noticed that for the most part it is still up to the patient to track their health care.  Oh sure, the hospitals and now most clinics and doctors office have an electronic health record but it is for them (health care providers.  They can track everything from your where you are at in the hospital to your medicine to your urine output but still there is a gap that must be filled.   The gap is between the patient and the health care provider.  More education needs to continue and the patient needs to speak up and ask more questions.  The physician and all health care providers need to learn how to communicate with their patients better.   Why do I feel so passionate about this topic because I see it playing out right before my eyes as I go in and out through the health care system.

Here is what I see.  This is just an everyday occurrence, medical errors that is.  I see the patient entering through the ER and then the health care provider decides to admit the patient because they are very ill.  (Ok some serious tracking going on now).  The hospital knows where the patient is at all times and inside the electronic record is all of the patients information from the medication they are given, vital signs to what the patient ate or didn’t eat while in the hospital.  But information in is information out in a lot of cases.  Or like the old saying, “Garbage in is Garbage out.”

Let’s start with a scenario and let’s tale a closer look at where the communication starts.  It starts with the patient.  The patient comes in through the ER or doctors office and starts by sharing with the physician or hospital staff information about their health.  The patient shares information from a financial stand point as well as from a medical stand point.  The patient discloses this information so that he/she can seek quality treatment.  In this scenario, the patient is asked what are you here for today?  A very common question.  The patient describes his/her symptoms and shares what medication they are on all the while the clinician is taking notes.  They usually document it in their computer or electronic health record (EHR).  The patient goes on to tell the provider about their past history and all the surgeries that they have had.  Some physicians have you fill out a questionnaire ahead to save time.  The fact is that communication can even break down before this point if the receptionist is allowed to write down what you are coming in for and the health care provider doesn’t ask the right questions.  Lets say that you describe to the nurse symptoms of a sore throat, sinus headache and drainage running down the back of your throat.  The receptionist makes an error and writes, UTI, which is the abbreviation for Urinary Track Infection.  Next the patient (you) sees the nurse and he/she takes your vitals and ask why are you being seen and you describe the symptoms and he/she then sends you to the lab for a specimen.  The lab asked for you to urinate in a cup.   Most patients would do this.

Now lets change the story to what actually happened to me. At his point with cup in hand for the specimen I went back to the nurse and asked why was I asked to urinate in a cup and she told me they needed it since I was coming for symptoms of a urinary track infection.  I explained, no I wasn’t that I had symptoms of a sinus infection which is usually abbreviated as URI which stands for an Upper Respiratory Infection.  Now, I am not an old person so you cannot blame this on the elderly and I am not an uneducated person so you can not blame it on that.  This was clearly an error of communication that started with a receptionist that did not know what he/she was doing or bad hand writing etc.  The point is the communication is lacking and errors are being made with or without an electronic health record (EHR) and the patient pays the price, the patients insurance company pays the price and ultimately the patient is the one that suffers.

Medical errors happen every day in America.   According to Fierce Health Care Journal, In 2013 it was thought that medical errors leading to death are much higher than previously thought, and may be as high as 400,000 deaths a year, according to a new study in the Journal of Patient Safety.  The new study reveals that each year preventable adverse events (PAEs) lead to the death of 210,000-400,000 patients who seek care at a hospital. Those figures would make medical errors the third leading cause of death behind heart disease and cancer, according to Centers for Disease Control and Prevention statistics.

Barriers to EHR continues

I see every day the barriers of the electronic health record (EHR) that face the health care community.  Tablets are fancy gadgets but I am so concerned that the text is so small and so hard to read.  Errors are made.  Implementation is slow going and a daunted task.   The conversion of the workflow and the training are so critical and yet it is easily misunderstood to how important it is.  Proper training is needed and yet we rely on salespeople to guide the process, a train the trainer approach.  The colleges of today and our educational system is failing us since there is not enough grants to offset offering new and upcoming programs for technicians to be trained on the electronic health record.   Our backs are against the wall, so many of my friends have lost jobs since the government is regulating everything and the physicians are not coming on board like they anticipated.  Let’s face it the real reason for the loss of jobs is the grant money ended.  We are all waiting on the next funded project.  Yes, the electronic health record is here to stay but the barriers are bigger now than ever.

My Mercy

I am now on board with a network whereby I can communicate with my physicians and access my medical information. The portal is called My Mercy. I am finding the website easy to navigate and very informative. My physician answers his emails timely and answers me thoroughly when I have a question. I would like for this network to consider a few up grades to their system. I would like to access my diagnosis and treatment. I think that would be helpful. I cannot remember the date of when I was in for a sore throat last and what he prescribed that worked so for me to have that information would be helpful. I have a few more suggesstions but this is one that sticks out the most. I know they do not realize that I have alot of experience in this sort of thing (Selecting and Implementing EHR’s) Other than that good job. I would rate them a B-

Electronic Health Record Viability

Meaningful use may have different interpretation for patients.

Even though I am a health care consultant concerned with health information management and the transition to the Electronic Health Record. I am also a consumer of health care. I was born with a cleft palate. I have since found out that I probably have a condition called Sticklers syndrome. Once this diagnosis was tossed around and landed in my medical record it has caused some concern with obtaining life insurance at a reasonable rate. Now as of today, I have one physician that has uses this term repeatedly and none of my other physicians that I go to even know what it is. This is very frustrating for me especially since I have a career in health information technology. I checked with some of the agencies out there that capture rare disease information and they report that there are 4 cases in the United States that have Sticklers syndrome. I know this is not accurate because since my diagnosis of this condition my own daughter of 23 has been diagnosed with it. I have already myself found numerous cases with the Stickler foundation where I reviewed some of their cases. What a discrepancy with our reporting system? We have some real issues with how things are recorded and reported in the US and so I am excited to see that this issue might finally be addressed and corrected with utilizing an Electronic Health Record EHR) and thus by reporting to patient registries for quality improvement, public reporting, etc.

The second category of engaging patients and families is long overdue. I think if I have read correctly that the committee is wanting to:

• Provide patients with an electronic copy of or electronic access to clinical information per patient preference
• Provide access to patient specific educational resources
• Provide clinical summaries for patients for each encounter

I think that education is the key here. The American Health Information Management Association (AHIMA) has taken an active role in trying to educate consumers and empower them to take more responsibility for their health care information. More needs to be done in this area. Here again I go back to my own personal experience. I have to track my health information so that I can ensure that I receive good quality care. I believe everyone should have access to their personal health information at all times. I really feel that each physician should give the patient a summary of his/her condition after each encounter. This doesn’t have to be in paper format. It could be sent to a flash drive and every patient would have one with their personal health information on it. Of course training would need to be done on how to use a flash drive. (Believe me there are a lot of people who do not even know about them or how they work) The flash drives today are becoming more sophisticated and technically secure. A person can purchase one with password protections, or biometrics. I feel very secure using a flash drive to carry my information to and from my doctor’s appointments. As a consultant, I am also very involved with training the health care providers about the importance of sharing information with their patients. I am also involved with training different health support groups on how to approach their providers when they need information. Training is the key here.

I hope this gave some insight to my thoughts on the term meaningful use. When you look at the term meaningful use one really has to ask themselves who is the end user. Who is the consumer of this information? To me the answer is -we all are.

To find out more on how I am involved please go to my website. http://www.healthcaretracker.org

The Story behind the Health Care Tracker

My name is Deresa Claybrook and I was born with a birth defect (cleft palate and deformed lip) and as a result of that birth defect I have spent many hours in and out of physician’s offices and clinics as a child. I had a difficult time learning to speak clearly and correctly. As a result of my condition I also have poor vision which required me to wear thick glasses as a child. I also have dental and sinus issues as a result of a small airway and the repair. I can remember being very self conscious of all these facts when I was younger.

At each new doctor’s visit, I can remember my mother telling each physician that I saw all about my medical history. Sharing my medical history over and over again with each new physician and also sharing my current concerns with my physicians is still something that I do today. In fact, we probably all have shared our health care information with a health care provider or two or three at some point. You can probably relate with me because I am sure you know the drill when you go to a new physician and you sit in the waiting room and complete that health care questionnaire. We all know that it is a must needed step but what a time consuming process.

Sharing complete accurate health care information with our health care provider is a very important first step. In fact it is the first step in the health care process. It is very time consuming and a hassle to recall all our health care services and medications while we are waiting in a waiting room but it is one that is essential for quality care.

As I grew older, I realized that I wanted to do something in the medical field but I really did know what exactly. I went down the career path to be a registered nurse but soon found that it was not the right path for me. I later heard about a career whereby I would be responsible for all of the medical records and making sure that what each health care provider did each day along with their staff would be documented and available for years to come. Yes, that is right I became what use to be known as a medical records librarian, today we are called Health Information Management Specialist.

On a personal note, I have been trying to keep track of my own health care information along with my family’s information for years. I am also a mother of two grown children. I also enjoy writing as a past time but that experience in itself really hasn’t prepared me for tracking health care information. For example, in order for me to track my own health care information I have since found out that the hospital where I was born is no longer in existence. Most records were destroyed in a fire. Most of my physicians from my childhood are no longer around. Even as an adult some of my physicians that I have built a good report with are no longer on my insurance plan. This fact in itself has forced me to choose different physicians for my health care. Let’s face it, health care information is a challenge to capture and store.

I decided since I have both the professional and the personal experience of tracking health care information that I would develop a company called Positive Resource Health Care Industry Consultants. (Positive Resource for short) In 2007, I decided to develop a product that is easy to use by both the health care provider and the health care patient/consumer. I decided to call the product the Health Care Tracker. The health care tracker comes with forms and these forms are easy to use and the health care tracker allows you a portable way to use information when you need it most. The health care tracker was developed in 2007 and has been used by thousands and by assisting others with tracking their health care information.

I don’t want to stop there; I want to find out what products really work to track or monitor health care information and make them available to health care organizations and to the public. Health Care organization’s need guidance on selecting and implementing the EHR from an expert, someone who understands records, I want to help with the training and the transition. We all need a good thermometer, blood pressure device in our house but which of these is the right tool for tracking your health care information when you are sick? Do you know? Today, we have the ability to track many different aspects about our healthcare.

I am taking my disability and using it to the best of my ability and helping others. The term for meaningful use has a whole new point. I think everyone should track their health care informmation and have a personal health record. Thank you for allowing me to share with you!

Electronic Health Record and the back side

I am so excited to see so many hospitals, clinics and physicians offices transitioning to the electronic health record (EHR). As a consultant, I definitely see the advantages for the practices on a daily basis. The goal of the electronic health record is to place comprehensive health information at the fingertips of any medical provider who treats that person. Rather than chasing paper records, physicians, nurses and other staff members or even consultants like myself can access the EHR from any department or facility where the patients receive care. The EHR allows physicians and staff members to:
• Document interactions with patients.
• View medical histories and insurance information
• Make referrals
• Order laboratory tests and view test results
• Send electronic prescription requests to pharmacies (reducing the risk that hard-to-read handwriting will lead to medical errors)
• Flag potentially harmful drug interactions

It also provides physicians with “decision support” tools, such as clinical guidelines and checks for drug interactions; and generates printed post-visit summaries for patients, among other benefits.
While these are the advantages to the electronic health record on the front side, there are areas of concern on the back side. As a consultant, who conducts record reviews, I see a lot of waste. Physicians are documenting in a handwritten format and also electronically. I am not sure why they are doing that. Are the physicians still not comfortable with their systems? Is it just that hold habits are hard to break. This is a challenge for me as an auditor I have to scan that information into a data base for review. The problem comes with trying to get from one system to another. Most of the time, I am printing progress notes and other forms from one system out on paper and then scanning to another system for review. At times it feels like I am reinventing the record. This can all better served with a flash drive. The flash drive can really be a great tool. The flash drive can cut down on the re-printing of a record and make it to where two systems can talk to each other.

Just the other day, I was reviewing some past articles on the electronic health record and I come across one that was referencing the original content of what President Bush had envisioned for the Electronic Health Record. This article that I was reading was dated, April 26, 2004. We are now in 2009 five years later. The article read something like this according to a White House document released Monday, the president “believes that innovations in electronic health records and the secure exchange of medical information will help transform healthcare in America.” The briefing memo says Bush envisions “a dramatically changed system” in which patients carry their healthcare information on a keychain and can authorize any physician or clinician to access their full records electronically. Finally the system would serve as a sentinel to alert public health authorities of a possible disease outbreak or bio terror attack. The ultimate goal is to allow medical information to be stored and shared electronically while assuring privacy and security.

I think President Bush was right on target with envisioning a way to carry health care information on a keychain. Even though he was referencing the patients, this concept is great fro a auditor or consultant. I guess I just didn’t think that I would be using the flash drive like that as a health care information management specialist. I am already using a flash drive for my own health care information called the health care tracker but now when I look in my purse or brief case I have several flash drives. The flash drives are encrypted and password protected. The flash drive is definitely the tool for the back side. How do you feel about the fact that the flash drive can be used this way?

PHR growing pains can be fixed.

The personal health record (PHR) is really facing some challenges now as the awareness of the value of the personal health record becomes known to the American public. What good does it do to sit in front of a computer and input medical information about yourself and your family and then have it coupled with data from a billing record when it is not accurate? People are starting to value their health information and billing information more and more. With the awareness of the Google Health products and their involvement, consumers are now more aware of the overall benefits of keeping a personal health record. But don’t be fooled, Google health products has had its share of headaches up to this point. It seems that we have so many choices with these products yet there are no standardizations measures of where the data comes from among any of them, on the clinical side or the administrative (billing) side.

As a consultant, I have seen some of the same issues with the electronic health record (EHR). I have seen where errors in the record constitute errors on the billing record or claim. One thing about the electronic health record (EHR) that is different from the personal health record (PHR) is that during the transitioning process, most consultants recommend that the health care facility or the providers fix their issues before they implement a large EHR system. Most consultants recommend that the issue of duplicate records be eliminated or at least be under control before implementing an EHR. Electronic Health Record systems typically only look at health information when they transition they do not necessarily couple this with billing information. Although most health centers do not review every record that is handed out, there is a formal record process for a hospitalized patient record. The hospital record has several built in steps to ensure that meets quality standards, assembled correctly, coded, billed and maintained properly. The same cleaning process needs to take place with the administrative data if it is going to be incorporated in to the personal health record side. Patients do not know to ask if there billing information is clean or not and they shouldn’t have to. The patient has the right to clean and accurate information on their clinical information and their administrative billing information.

When workflow processes are computerized this does not mean they are automatically accurate. This is the part of the puzzle that needs to be fixed just because we spend millions of dollars to implement the electronic health record or we ask that every patient be responsible for their own health care information by completing a personal health record, does not mean that we will NOT have problems. Garbage in is always equal to garbage out. If this data is not cleaned up in the paper medical record and on the claim or billing side with the insurance carrier, we will be wasting money if it is not standardized in some format. If everyone is not held accountable for their entries into the electronic health record or personal health record then we will be wasting money as well.

How do we fix the growing pains of the PHR? We start with educating the vendors so they are not selling products that are programmed to do more than they should be doing with valuable health care information. There are so many programmers being hired to just make the system work, that the people doing the actual work do not understand that health care information is different in one, how it is used and secondly how it is interpreted. Vendors should work closely with groups such as CCHIT to ensure standardization among personal health records. Vendors should work collaborately with other health care professionals on building a standardization format for the medical record so that it can be used easily with a personal health record. Another important step is to train medical personnel on what to down load on to a thumb drive/CD and what to give to a patient. It begins with education. We now need to switch roles and to train others to take more of an analyst approach to the record. We all need to become quality documentation experts in our own practice. Is there anyone auditing the final process or overseeing the results of the record? This needs to be built in. We cannot afford to sit and wait and become another Mr. DeBronkart who eventually discovered a problem: He found out that some of the information in his Google Health record was drawn from his billing record. His story really could have been a disaster. In the end, he had some good advice for others using a personal health record. He recommends that you check it, to see if it is accurate.

As a consultant, I feel that we are allowing too many hands in the pot. I am very concerned that there are too many people building EHR/PHR systems and they do not have the health information management background needed. I am not only scared for the patients but for the health care practitioners who practice.

Training your Staff on the Electronic Health Record (EHR)

It is a typical busy morning at the clinic. You notice that your staff is busy with their usual duties and functions. You decide to take a minute and instead of going into your office right away you decide to sit in the front waiting room and look around. It is amazing what you see. It is only 9:30 am on a Monday morning and the front waiting room is packed with very ill patients. You watch as your staff pulls their records, greet patients and takes down their information. You also notice there are three receptionists on the phone taking calls and making appointments for future dates. The patients are very restless and fumbling through magazines and tossing and turning in their seats. You think to yourself, how are we going to be able to implement the electronic health record in this type of a busy practice? You know that behind the scenes it is probably more hectic. You have two new medical assistants and you are still one short. The nurses are on the phone making referrals. The coding and billing section is busy dealing with insurance companies that are slow to pay and that won’t return phone calls. You take a big deep breath and decide to go in and face the challenges of the day. Two days ago first thing in the morning after taking off your coat the owner, the main physician informs you that the practice will soon be implementing the electronic health record. The physician also mentions for you not to worry that the vendor would be conducting all the training. You know in your head that the training is not the real issue at hand. You think to yourself, how are we going to stop the train or this case the practice to allow for the training? The physicians want to continue to see their patients. Does this sound like a typical day for you as an office manager at your clinic or practice? Here are some things to think about before implementing the training of electronic health record.

Planning is a very important element. Determine what records will be converted to the electronic format first. Look at what forms you have that you could train on first. Do you have any forms that are standardized? Secondly, look at your staff and their down time? It might not be the best time for training on Monday at 9:30 in the morning. You might want to pick the right time and target group. Look at your overall practice and determine if you want to go live on a certain date with a lighter load. Maybe you know that on Wednesdays your practice only deals with preventive medicine visits. Well women or well child etc. That load might be lighter and easier to implement a electronic record on. You also might want to consider hiring temporary help since you are already short handed and your clinic is busy. Also make the vendor work for you. Ask them what they have done in the past at similar large clinics. How can they streamline the process and make it work effectively?

As an office manager your role is a full one. Communication is a key. Your staff needs to be informed. Find out all the information about who the vendor is and what they will be doing. Yes, it is sad that you didn’t have any input on the selection of the electronic health record but no sense crying over spilt milk, take the bull by the horn and run with it. You have a clinic to run and now an EHR implementation project. Educate or train yourself first. Train yourself on the product, the cost, the implementation time, the training etc. Make yourself an expert. Find out what others are doing in your area. Some large clinics actually hire a project manger so that the office manager can stay focused on running the practice. I wish you the best of luck. For more information please visit http://www.healthcaretracker.org