Transparent Medical Records And The P+P Relationship

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In the New England Journal Of Medicine last week, an article about increasing transparency in medical records caught my attention. It was a good idea. And a frightening one. At this era of EHR use, patients are generally excluded from the documentation process. We prefer to request documents directly from other providers or institutions and hesitate in showing patients their data, results and visitation notes without filter. The medical record has become a safe place to communicate our thought process and even our judgements about patients without fear of ‘being overheard’ by the patient and their families directly. In various situations, this non-verbal dialogue allows for a special type of communication between providers without the need for being politically correct or filtering our true assessments on the subject matter.

By the same token, as so much time is spent on documentation the utility and accuracy of our documents would be better served by efforts to make a patient’s records accessible to the patient themselves. It serves several great purposes which would enhance the patient+physician (p+p) relationship:

1. Increase medical literacy for patients: verbal explanations and written ones can have very different effects on patients. Often the verbal explanations come in a rush without full context. Giving the patient access to their record will allow them to have better sense of what is going on and the means to learn about their health process.

 

2. Patient engagement: In reality this will put more responsibility on patients — some of whom are unwilling to take responsibility for their health. Several times a day I ask a patient about their medical history and they don’t know or say ‘go look in the computer’. Patients both have a right and responsibility to know their own medical problems in order to receive the best directed care. Closed medical records make this harder for patients to know their diagnoses or to bring along records to another provider if a change is made.

 

3. Cost reduction: I believe that in the setting of justifying particular (and often unnecessary) tests, less of these tests will be ordered if open documentation allows patients to follow why a workup is being initiated. Armed with their own prior tests they may be able to seek multiple opinions about further workup. Physicians will be required to document the necessity of a costly image or lab.

 

4. It’s what patients want: The surveys in the NEJM article note that an overwhelming portion of patients were interested in having documents available. They also indicated they liked that records were available even if they did not personally utilize the resource. The openness creates a different dynamic that will only be beneficial to improving healthcare quality in the long run.

 

5. Design reconsiderations: With both the healthcare provider and the patient in mind, EHRs and the interface to distribute particular documents will need to be reconsidered. Given the need to make it more universally approachable, this will likely improve usability and user friendliness across the board.

Photo Credit: Oliver Regelmann

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