In a recent LinkedIn discussion I started, David Voran offered this powerful perspective:
A doctor’s ability to make good decisions depends on having the right information in the critical path of their day-to-day processes. Have discovered that patients can play a very big role in making this happen. Those patients who have access to their medical records, manage their information (my own internal patients that are nurses or physicians for example) help with the documentation process. They audit the chart 100% of the time and make sure that all of the relevant information that I need to help them with their health is teed up. Over the long haul it’s very easy to take care of these patients at the lowest possible cost.
The patients who can do some of this through the portal … at least monitor their charts and letting us know when there are errors are and that the data is clean, participate in their health, contribute new information that occurs outside the “walls” of our institution are the second least costly patients to provide health care as we can eliminate many office and specialty visits without adversely affecting quality measures.
The costly patients are those who are seeing multiple subspecialists who are not sharing information and don’t have access to their information and don’t want to invest in making sure the right information is presented to the right providers. These patients suffer repeated duplicative tests, have many more office visits than necessary and drive up the cost of care.
My take? What to improve physician performance and decrease cost of care? Open up the record and assign the patient the auditing job and get them engaged.
How do you feel about this perspective? Is it one you share? From my experience, many doctors would disagree with David on this. As with most things, there’s two sides of the coin. On the one side is the patient that’s involved in getting the doctor the right information. Every doctor loves that patient because a patient that withholds information from their doctor is an issue. On the other hand is the involved patient that’s paranoid over things that are a non-issue and make the doctor’s life miserable in the process.
The question I raise is, does access to the records causes more of the good kind of patient or more of the bad kind of patient?
I am for the involvement of patients on the EHR charts for all the reasons that David Voran outlined. The caveat being shared responsibility by all parties. The responsibilities need to be clearly delineated with some sort of safety net for the institution, organization or doctor to be able to have recourse for those patients you mentioned that are zealous or paranoid about the non-issues mentioned. The shared responsibility has to include adherence, compliance or whatever the best lexicon for the meaning. It would need to be transparent on both sides to work, including the good, bad and ugly.
Effective patient involvement requires a lot of patient training and nurturing to get them to the point where their updates are meaningful and do not require the physicians or staff to correct these updates. In the examples cited, all the patients who help make their healthcare cost less, understand the industry and the value. The majority of patients are not at this level.
To make this work, the industry (or individual physicians) would need to start training their patients to take a more active interest in their own health and manage their health information. This is not a trivial process and, in most cases, is not something that will get done.
There are a couple of points of view, mostly in support for having the patinet involved in their data quality maintenance and these are:
1) Information quality and maintenance is a significant process in any new practice, at any level, in any domain. Providers frequently rely on high quality data, which is not the case always. GIGO principle (garbage in, garbage out) is as valuavle in in health care as anywhere else.
2) Healing is a collaborative process that involves multiple stakeholders. Collaboration needs a “collaboration framework” or governance. Giving access to patients to the maintenance of the subset of data they have created is a good governance component (Handy insisted on it – it is called subsidiarity). Subsidiarity, when done right, increases dramatically the effectiveness of a collaborative group.
3) Education of the patient is, imho, one of the usually low recognition healing tools. it has been there since the beginings of health care delivery, but never truly awarded the right role and “compensated” for accodingly (in modern times especially – in the paste, educating was part of the healing practice for which the provider was compensated).
To sum all these notes, in my humble opinion, having patients educated for the purpose of taking ownership of cleaning their info,when done right, is beneficial to the care delivery process and care provider. Success in healing should be made relevant to both patient and provider in all dimensions of reward ( financial, intellectual and societal.
It all hinges in good governance, like anything else.
Looking at this just from the perspective of a patient, my wife and I have only one practice we use where there is a patient portal, and the practice doesn’t even tell patients that the portal exists. We asked, and found it, and checked it out. Our first discovery is that the EPIC portal had absolutely no lab results, something no one could explain. But it did have a couple years of history. And it provided a way to send emails to the doctor with questions, which was very helpful. It was also very easy to use, actually fairly welcoming. But the practice didn’t believe in it – or the EHR itself, though they did take it seriously. And I’m pretty sure that if we found errors in the records that they would want to correct them.
Depending on the EHR/Patient Portal, doctors have the ability to only allow patients access to certain pieces of their medical record, without providing total access. I think this could mitigate the issue of a patient disputing information that a doctor wouldn’t have wanted a patient to see.
I agree – providing patients with access to their medical records benefits both patients and providers alike. With analytics tools emerging that will give patients access to their health data, the opportunity to simplify patient care through engagement is too advantageous to overlook. When patients engage with their health information this way, it becomes “actionable” – they take more ownership of their care. For example, if patients can access their health records and see health patterns on a mobile device, they might make smart choices that could prevent a future health scare and even prevent an unwarranted visit to the doctor, saving both patient and provider time and dollars. The same can result when patients switch physicians, those who are actively engaged with their records will be able to help in the transfer of information to the new physician. — Will Saunders, president, Government Healthcare Solutions, Xerox
Great discussion on patient engagement. It’s not a simple one size fits all solution. What I do see happening is patients are going to get more access to the EHR data. Once the data is electronic it’s that much easier to deliver the data and so in the natural progression of things, patients will get the data. So, I think the key is to best analyze how we prepare patients to receive the data. Are they properly educated? Is the doctor documenting in a way that they’ll be happy sharing the data? These are all real issues.
On the flip side, do the patients care about the data? The answer I think is that they usually don’t until they become a chronic patient. Then, they are a lot.