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A National Database on Advanced Directives? Great Idea.

Posted on December 5, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

An oldish post from the Healthcare Blog had me thinking about EMRs, advance directives and national patient IDs this week. John Maa, assistant professor of surgery at UCSF, writes about a case early in his career where:
– an 85 year old woman called 911, and was brought into the ER around noon with severe abdominal pain. She was delirious and could provide her medical history
– attempts to contact her family and friends were unsuccessful
– she had some serious problems that needed immediate attention, and two surgeons documented the need for her to be taken to the operating room for “life threatening emergency situation”. She underwent a six-hour surgery, was intubated, her kidneys were recovering.
– Her children arrived at about 10 pm, and asked for withdrawal of support. Amid all the back-and-forth, and threats of legal action etc, the hospital went with the family’s wishes and withdrew support. The woman died soon after.

For Maa, this was a formative experience of sorts, happening in his second month of internship. He says he still thinks about the case.

The ethics of the situation notwithstanding (and there’s more in Maa’s post that I’m not going into), from an EMR/EHR perspective – a unique patient ID that identifies each patient and an EMR that captured the woman’s advanced directive would have really helped. As commenter John Ballard states in the discussion following Maa’s post:

“One more illustration underscoring the importance of comprehensive advance directives, properly executed and easily accessible. Why such a document is not routinely a part of medical records is an ongoing mystery to me.

Advance directives — properly executed — should be required by all insurance plans as well as Medicare/Medicaid for beneficiaries. They should expire and be subject to renewal every five years to allow for changes in the person’s health, medical advances or discoveries and changes of opinion (not to mention the passing of designated agents)”

Another commenter says “What we need is a federal mandate for advance directives and a federally run advance directive database that can be accessed from any computer.” Indeed.

Who Owns Patient Data?

Posted on September 26, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Recently, on The Healthcare Blog, there was a really interesting post by Dr. Marya Silberberg about why patient lab data should be liberated. She recommends lab results be sent to patients at the same time that they’re sent to doctors. Dr. Silberberg does an admirable job of looking at the patient data issue from both sides. From the patient’s perspective, it is really not that hard to understand. If you’ve ever transferred your (paper) records from one doctor to another, or you’ve spent a month or more waiting for your doctor’s office to call you with their interpretation of lab test results, you’ve known the pain. It’s your data, about your body, your health, and you really have no way to access it if you have something of a grinch gatekeeping the records at your doctor’s office.

I’m no doctor, but I get you too. There are way too many paranoid, entitled people in the world, and chances are they’re your patients. Handing patients their lab records is the best way to make sure your office is inundated with callers demanding to talk to the doctor right now, and many of them will just be non-emergency calls.

Having said that, I wasn’t a huge fan of commenter Dr Mike’s response to the post:

“If I ordered the test, the results should be returned to me first, if you ordered the test, the results can come to you. So go order your own lab tests and then you won’t have to wait for me to get through that mountain of paper on my desk. Not sure your insurer will want to play along as you play doctor though

Part of the problem is that patients don’t understand that I am not on retainer for them. In the good ol’ days the docs cared for their friends and neighbor’s and community, and had a personal and financial interest in each individual. But today I don’t have a contract with you, I have one with your insurer, and together the two of us have pretty much locked you out of the decision process, and you have allowed this to happen.”


Whoa, them’s fighting words. Patient data access doesn’t have to be an adversarial experience. If you, the doctor, are spending an inordinate amount of time explaining lab results to patients, it’s only fair you be compensated for your consultancy in some way. And you, the patient, must stop thinking of access to patient data as a zero-cost right you can exercise. A tiered insurance plan offering could very well take care of phone-consultancy and patient-lab-reporting costs. If I or a loved one had a condition that required me to look over lab reports and such, I would happily pay a few dollars extra a month for that privilege. And for all the concerns about how the average user can’t understand what the lab results say, it’s surely not impossible in this day and age that lab reports sent to non-medical recipients be in human readable form.

Check out the post here.