10 Things Medical Records Won't Tell You!

The Wall Street Journal published an article last week on the 10 things medical records won't tell you.  I have condensed the list, so you get the idea...

1. COST: The price tag is HUGE!
2. SHARING IMPORTANT CLINICAL INFORMATION between providers is a myth.  Even high-price tag enterprise level systems do not do this well, or cannot, especially between different hospitals and doctors.
3. DOCTORS HATE IT in general and pretty consistently, especially if forced to use it by their hospital, the government, or partners.
4. DOCTORS HAVE LESS TIME to spend with patients...because they have to fiddle with machines.
5. PRIVACY physicians may employ strangers such as scribes to manage there cumbersome EHR into the previously sacred and secure doctor-patient relationship.
6. ERRORS MAGNIFIED mistakes are easier to make; just hit the wrong key, or have a voice recognition system hear "no chest pain" instead of "known chest pain".
7. INFORMATION OVERLOAD TMI- too much information...sometimes, in fact most of the time, we just don't need or want to read "War & Peace" on every patient, and only a section of the total is needed in any clinical situation.  But the EHR commonly gives it all. No one, especially not clinicians, have the time to read it.
8. IDENTITY THEFT EHR's contain much of your demographic information--social security, payment, address, phone, work schedule, etc.  They are therefore a fertile ground for the thieves that prey on such things.
9. YOU BECOME A MARKETING STATISTIC your information will be marketed and sold e.g. to pharmaceutical companies, insurance companies, etc.
10. BIG BROTHER IS WATCHING the government can and will track the events that occur in medical interactions through EHRs.  The requirements and criteria for this sort of tracking are already in place.

Choose an Electronic Health Record that has thoroughly considered these complaints and actively deals with them.  Complaint #10- government policies and incentives is the biggest driver in turning to EHR.

Rethinking Office Personnal

Rapid change is occurring to the world of medicine and its varied practitioners.  These practitioners run varied practices, but all have the similar goal of providing quality health care.  The trick is figuring out how to change your processes to reflect the new nature of health care.

Traditional practices have office managers, receptionists, medical assistants, nurses, technicians, and the various providers.  As technology and new rules come into play, these various roles will need to be adjusted.

All the employees of the business will have to be able to multitask, be cross-trained, and most of all pleasant.

The receptionist will be a self-logging user-friendly computer terminal similar to the airlines where the consumer logs in with drivers license, credit card, insurance card and eventually their own personal barcode.  The computer will access eligibility, account balances, and create a spread sheet of what the patient is covered for, their referral list (specialists, lab, x-ray, and needed age-appropriate wellness screens.  The computer will ask pertinent information of the patient pertaining to the chief complaint and motivation for visit.

The intake specialist will review the data, while the vital. sign machine records the blood pressure, etc.  They will order obvious tests (blood, ekg etc. per protocol) and queue the patient to the appropriate provider according to triage protocols.


The provider (Physician, Nurse Practitioner, Physician Assistant) will assess the patient, determine a plan, institute a protocol if needed, and/or make a disposition.  Their personal data technician will create a document that reflects the transaction and document the orders.  The provider may want to input some data through voice-activated technology.  The nurse, medical assistant, and technicians process the orders.  The data technician advises the providers about alerts, core measures, etc. that the Electronic Health Record has given a notification for.

After the patient is given their instructions and medical education by the provider or their surrogate, the social worker interviews the patient.  They deal with the most difficult part of the transaction.  They advise the patient within their social situation how to access their prescriptions, follow-up care, and devise a real-time follow-up plan to keep the patient from floundering in confusion.

The billing specialist analyzes the visit and informs the patient of the costs and options.  With modern billing technology, most practices will be able to do their own billing.

With the social worker monitoring the care in real-time, this should lead to consistent, cost efficient outcomes.  The provider with this type of cross-trained medical staff can hopefully concentrate on practicing "Medicine" and not business, liability, and endless outside pressures.  This environment will lead to success and job satisfaction for all parts of the team.

Number Needed to Treat

Wikipedia states the number needed to treat (NNT) is an epidemiological measure used in assessing the effectiveness of a health care intervention, typically a treatment with medication.  The NNT is the average number of patients who need to be treated to prevent one additional bad outcome (i.e. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial).  It is defined as the inverse of the absolute risk reduction.  It was described in 1988.  The ideal NNT is 1, where everyone improves with treatment and no one improves with control.  The higher the NNT, the less effective is the treatment.

Recently, the American Heart Association and American College of Cardiology gave out new guidelines on the preventing atherosclerotic cardiovascular risk in adults.  These guidelines suggest the most "Americans" being on statin cholesterol lowering drugs.  This has created some controversy.

NOT being an expert, I cannot tell you whether these are ideal suggestions, but as a consumer there is a question to be asked.  How many people need to take these medications for life to make it a valuable endeavor?

All medications include cost, side effects, and compliance by the patient.

Conclusion- ask your provider and/or pharmacist for all chronic medications, what is the number needed to treat to obtain benefit from these ongoing therapies.  Once you know the number, work with your provider to assess your risk and need for any and all medications.

How Medical Consumers Can Get More “Bang for the Buck”

One of the more interesting interactions between patient and provider occurs when the patient is asked, “What is the problem?”  The patient responds with “You’re the doctor,” or “You’ve got my records.”

This scenario highlights the opportunity the consumer has to achieve their goals in a quick, efficient, and potentially inexpensive way.

What can the patient bring to the interview to help the provider “GET IT RIGHT” the first time.

1. Express your motivation for your visit. Such as:
• I'm worried about a "stroke" or a "heart attack"
• I need a work excuse
• I'm out of meds
• My spouse/relative made me come
• I need a routine check-up
• My concern "runs in the family"
2. Provide a list of medications – best kept in wallet
3. Provide a list of allergies
4. Provide a list of past medical history and surgeries
5. Share what has worked for you in a similar situation
6. Don’t be afraid to say… “After Googling my symptoms, I got concerned about X…”
7. Share your expectations
8. Write a list of questions you have
9. Be straightforward with your goals -- it saves a lot of time and money
10. Reserve the right to say NO THANK You—I just wanted an educated opinion not a lot of tests and consultants.

All that said - and going back to our brief introduction of “you’re the doctor” -  what if you really don’t know.  That is, perhaps something is indeed bothering you, something is not right, but you cannot put your finger on it. 

Don’t be embarrassed.  

Doctor’s love these sorts of challenges, but they need to work alongside you to be effective at discerning the issues.  Just say it that way.  “Something is bothering me, something is wrong Doc, but I cannot put my finger on it.”  Then, you and the doctor can work together to figure it out.  And both of you feel like you have a partner in the discovery process.