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.

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Is there an app for that?

It amazes me the amount of apps or (applications) that are available for phones these days.  I recently heard on the news that only 40 % of Americans still use a land line.  So the use of a cell phone as a standard means of communication is in full swing for most of us. So with that many people using cell phones it is no wonder that more people are demanding apps for tracking things that are important to them. If you are dieting, there is an app to track your progress, if you want to track your exercise routine there is an app for that.  Too bad there is not one app that does it all for tracking health care information or personal health information. I would like to see an app that tracks all my medical information and stores it all in one place.  There are many barriers to this project but slowly the barriers of capturing, storing and sharing health care information are deminishing as new technology becomes available.

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

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?

Domestic Violence Victims Need to Track Health Information

In Oklahoma the number of domestic violence reports has risen by 31% from 1994 to 2003 years according to the 2003 Uniform Crime Report. I know about domestic violence in Oklahoma. I am a survivor. I was involved in an abusive relationship for over 17 years. I was married to a man who started out with mentally abusing me. It was a slow process but over time it led to physical abuse. I ended up in a women’s shelter with my two teenage children. It has been over 10 years now since this relationship ended in divorce. I am remarried but the scars of domestic violence are there forever. Generations have been touched by this awful problem. Women need to be made aware of the resources that are available to them.

One particular spring morning, my husband and I had a heated argument that got out of control, I tried to leave and he reached for everything in my purse. He took the keys to my car, my money and my children’s social security cards along with mine. He even took things like my insurance card and my credit cards. He knew exactly how to play the fighting game. I dialed 911 for help. We were living in rural America at the time so I had two sheriffs respond to the call which is about like having Andy Taylor and Barney 5 off of the Mayberry show, show up at your door step. They questioned my husband and me separately and I told the officers that I wanted to leave. The police officers told me that they did not determine property and ownership so they would not tell my husband to let me have my car. My husband would not let me have the keys to my car so I elected to leave with the officers. They took me to the police station and I filled out paper work. A lady police officer seen me crying and asked if I was okay and I told her about the abuse. She told me to get out while I still could. She was the only one that showed any compassion. Since this time in my life, I have read about domestic violence and the increasing numbers and I have studied it thoroughly. I have read about the men who violate women and how it can began so innocently. It can happen to all walks of life. You don’t have to be a minority or poor, it can happen to anyone. In thinking back I think to myself, oh my goodness how did my husband know to do these things to me and take all those things from me. I didn’t realize at the time how much I was going to need money, my important documents and my medical information along with my children’s information. Today, I am a big advocate of making sure that everyone women knows that she has the right to have access to her medical information and her children’s medical information. Each women has the right to review their medical information and to have a copy made of her medical records or those of her children.

Every women needs to have a personalized protection plan and in that plan she needs to make sure that she takes or gets out with all her important documents. Take all your important documents and this includes medical information. I have found a great website about making a protection plan. It is http://www.DVIS.org they have a section under the heading of domestic violence called the safety plan. Please take a moment and read this if you have a friend or someone you know is dealing with the issue of domestic violence. It can truly save a life.

I have developed a product to assist everyone with tracking their health care information. It is called the Health Care Tracker. The Health Care Tracker is a way to monitor or track your health information along with your children’s health care information. You can keep the health care tracker on a key chain or in your purse. The Health Care Tracker holds easy to use and easy to complete professional health care forms. Any physician’s office or emergency room can use them. To learn more, you can visit my website at http://www.healthcaretracker.org

Reflecting back over my past, I wished I would have known these things about domestic violence. Domestic violence is about power and control. It is not your fault. If I can help one woman or several women by sharing my story and sharing how important it is to have a personalized safety plan than maybe just maybe the numbers will decrease. The power is really up to you. It starts with you taking care of yourself. Take responsibility for yourself.

How to track your health care information

How to start tracking your health care information

I have just finished telling you the various reasons that is so important to keep track of your health care information so now I feel the need to share with you how to go about doing it. It is not complicated at all. Some of you are probably tracking your own health care information and you do not even realize it.

Think about it, you are probably using a calendar to track your doctor and dentist appointments. Some of you are probably checking your insulin level, if you are a diabetic and some of you are probably watching or monitoring the bathroom scale because of your New Years resolution to lose weight. I have come up with six easy steps that I feel will make it easier to track your health care information.

#1. Complete health care forms. We are the ones that supply the physicians with information so this information needs to be accurate. We sit in the lobby and fill out the forms for the doctors and we really need to be doing this for ourselves as well. We really need to be doing this at home so that we can accurately gather infromation to make sure the forms are as accurate as they can be. Ask for a copy of the health care forms from your provider after you have completed them. This can save you time in the long run.

#2. Collect your health care information. We all need to be collecting our health care information from every hospital and physician that we have visited. Now you can do this for the last three visits to get a good start.

#3 Organize your health care information. Pull your information out of the shoe boxes and file cabinets and organize it. It is recommended to put things in chronological order. Place a divider in a three ring binder for each family member to separate the information. Knowing what is in your record can possibly save you from having duplicate or unnecessary test. Tracking your health care information and organizing it can save you money.

#4 Protect your health care information. Make sure that your information is not lying around so that it can be seen. A safe deposit box is a good idea or a fire proof box. If you are already putting your health care information on a computer make sure it is secure with a password, and virus protected. Back up your information.

#5 Retrieve your information. The one thing about health care information is that we need access to it when we are going to our physicians, sending the kids to camp, while traveling or even in the event of emergency. We need to really be thinking about how we can retrieve it when we need it. The only way to do this is to have access to your health care information at all times. That is why I am recommending that you keep your health care information on a USB drive or flash drive so that you can have access to it and give access to it when you need too. The Health Care Tracker, a valuable tool for tracking health care information can assist you if you have a chronic illness, while traveling or even in the event of emergency. Being able to retrieve your health care information in an emergency can possibly save your life.

#6 Update it. Our health care information has to be updated routinely. If you are given new medicines then you need to add them to your list or your forms. If we have a drug that we are sensitive to now and that we have never had any problems with we need to let our doctors know. It really is up to us to keep track and update our health care information. Tracking our health care needs to be viewed as a process not just as a one time activity.