In response to a reader's letter Elimination of duplicate tests warrants EHR cost":
A. Scott Holmes' impression that duplicate tests can be avoided by using EMRs is wishful thinking. The principal hurdle to successful electronic medical record implementation with sound data sharing is HIPAA (as it is interpreted today). HIPAA needs to be scrapped first and we need to start treating patients like responsible human beings capable of handling their privacy issues. Today, if one doctor orders a laboratory test from one of the national labs like LabCorp, there is no way for the patient to allow another doctor to view this information online. Labs do not e-mail the results to patients. Labs do not allow other doctors (including those who are in their database) to access online lab results unless the labs were ordered by the same physician. Labs do not allow online access of results to patients. Imagine the agony of a sick patient seeing multiple physicians or landing in an emergency department in shock or pain! We have one full-time staff just requesting records from different places. This is disgusting. This is just one example of simple issues that have not been fixed by the EMR industry. These kinds of hurdles are the norm in the healthcare industry. HIPAA has been a convenient excuse for poor quality EMR software and user interface.
What we need is better document management with the patient as the principal custodian of records. Every patient leaving a doctor's office should have their entire medical record in a universally readable format. In my office we have implemented this policy. All our 17,000 patients have access to their records. After any significant event (labs, X-rays, procedures, discharge from hospital), we send the entire record as a secure chronological PDF document to the patient, either as an e-mail attachment or as a protected PDF file on a USB drive (patient pays for USB drive). This is a protected file and only the patient can open the record with their password for any other caregiver to view the contents.
We have ditched HL-7 interface protocol to a superior protocol for all medical records software we use in our office. The software we use has to generate a PDF output that is filed chronologically in the patient's master-file. We wrote most of the software that runs our office because we found vendors unwilling to listen to us. We have thousands of satisfied patients to prove this patient-centric approach really works.
Narayanachar Murali, M.D.Gastroenterology Associates of OrangeburgDigestive Endoscopy CenterOrangeburg, S.C. To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.