Doctors Office so low tech

This is glib, but the source of truth for your investment situation is the electronic financial system, but the source of truth for your medical situation is you and your body. So there always has to be a way for you/your body to correct the records system meaning it can only become so automated.

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There are a number of reasons is it more complex than it first seems.

If a medical history simply involved a listing of objective facts like surgical procedures/dates or prescriptions/dates that would be easy; indeed, getting a prescription history from your pharmacy is fairly simple and even transferring prescriptions between pharmacies is straightforward for that reason.

But a medical history involves much more. Where does it hurt, how long has it hurt, what makes your symptoms better or worse, how has this impacted your life, how well did prior treatments help, what sort of assistance do you now need at home because of your symptoms, has it gotten worse or better over time, what side effects have you noticed → these are really important considerations that do not neatly fit checkboxes. Indeed, there is a school of thought that encourages “checkbox” type histories (referred to as structured data); those are far inferior to “narrative” or unstructured medical histories.

Transferring records by computer is also complex not only because records can be thousands of pages long but also because a patient has the right to exclude certain types of information from release such as details of psychiatric treatment, sexual assault, or sexually transmitted diseases. The process of vetting records to remove such excluded information cannot be reliably done by computers/AI, particularly as there are subsbstantial penalties for violating such a patient request.

Assuming all that can be resolved, there is the question of how can we make it easy to share medical records while retaining privacy. If we set up a unique national medical identification number there will all sorts of protests about big-brother. If we do not have such an identification number then how can we be sure privacy is being protected in such a database.

An automated, integrated national medical records database would be an awesome piece of infrastructure both for medical treatment and for medical research. But it would also be a unified repository of extremely personal information; if someone were to hack into and steal that database it would be a failure of epic proportions.

So it turns out that implementing a medical records database is a lot more complex than a database of stock certificates.

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And yet, several conuntries have managend it, even under the strict privacy regulations imposed by GDPR. Of course, what helps us, is nationwide, legally mandated healthcare.

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More specifically what helps is national healthcare where the government not only funds healthcare but also owns the health system and employs all of the healthcare workers. So actually no “Interoperability” is needed and no “transfer” of medical records ever occurs; the government simply provides access to the database for all their employees, just like happens within a large private USA health system.

But if you live in one EU country and find yourself needing medical treatment while visiting another country, then you will face similar issues, albeit interoperability may be easier among a couple dozen countries than among 230,000+ individual physician practices in USA.

USA actually does have a large database of records very similar to that used in EU countries: You can find it in the USA Veterans Healthcare System. Though there are many faults with the Veterans Healthcare system in USA, it is in fact a leader in electronic medical records. Soldiers travel all around the globe and their military medical records are efficiently available to their USA military physicicans everywhere. The system is analagous to government-owned healthcare distribution in EU. But when a USA soldier leaves the Service and seeks treatment at private medical facilities in USA, the same issues of obtaining prior medical records arise.

Indeed while the Veterans Healthcare System has a superb medical records system, it is highly optimized for reading records online by their own employees. It’s terrific for that function but if you need to share that information with your private doctor in USA, the printed/exported PDF version of those military records is absolutely awful to read. I wonder how that works in EU; if you get a copy of your records from one government healthcare system in EU sent to another country, is the information in an easily readable format or is it an awful mess like transferring USA Veterans records?

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…only in much smaller and more homogeneous countries than the United States. And that have socialized medicine, too. :slightly_smiling_face:

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OK, this is is a compelling argument. But I would still say that there is still a benefit to have the facts recorded in a uniform and consistent manner. Broken finger 2008, torn meniscus 2010, etc. Then have a conversation around the facts. This is one of the things I like most about my regular doctor. He will sit down with me for a half hour and ask me a bunch of questions and write down notes in my chart. The next year, he pulls out these notes and we review to see if anything has changed or to see if anything new should be added.

Instead of a centralized database, a better solution might be a standard (like epub for ebooks) for electronic records that can be exchanged between doctors when needed. So there isn’t one central repository of all the data, but still making it easy to exchange the information. I know it’s not easy and there are pitfalls along the way, but just about every industry I can think of has benefited greatly from information technology.

A big part of the challenge there isn’t the format of the records (PDF is more than up to the task), but the mechanics of transferring them.

I occasionally get lab tests done from a private lab. That lab lets me download my results as a PDF. My existing medical provider can’t accept those records via email from me, because I’m not part of their secure communications system. If I could get the private lab to set up with the hospital’s system, they could transfer them. But I can’t. I can fax them. I can print them out and physically walk them in, then they scan them. But I can’t send them the most logical, most direct way.

My girlfriend was in the ER once. There had been a scan done of something at her regular doctor, but the ER was in a different network that wasn’t set up with the exact same “secure communications” system - so the regular doctor’s company had to FAX the scans to the ER.

That’s the biggest issue from where I sit - coming up with exchange channels that are both universal and deemed to be secure.

Hilarious that they won’t accept an email because it isn’t a secure communication system, but they will accept a fax, which is probably the most insecure method possible!

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The funny thing to me is that I can’t email them. I mean, I get that they wouldn’t want to email them around if that method isn’t secure - but if I’m the sender, wouldn’t it be me violating my own privacy? :smiley:

You should look at a good electronic records system sometime. The complexity, depth, and flexibility required, not to mention the security issues, would blow you away. I worked for a corporation that developed and sold that sort of software. Fortunately for me, I worked on the medical billing side rather than the clinical side. As complicated as medical billing is in the United States, it is still far simpler than what is demanded of a system that must securely store clinical medical records.

I’ve worked in the financial industry most of my career. The financial world is more complicated than most casual observers think. Stocks are just the tip of the iceberg. There are futures, options, bonds, FX, swaps, the list goes on forever. I do get that a person’s medical history is probably a more complex problem, but we seem so far away from capturing even the most basic information, such as my date of birth and address. Why not start there at least?

We’re talking about much more than “a person’s medical history.” That’s the easy part. Supporting doctors as they try to make an accurate diagnosis, correctly prescribe drugs and other treatments, and develop and track a care plan, just for example, is on an order of magnitude more complicated than your financial world where your clients might lose money and you might get fired. Electronic medical records and and all that goes with them in sophisticated software systems in use today keep patients alive or kill them. The stakes are much higher.

Thanks to whoever started this interesting conversation. When I started my training we were writing on triplicate paper and writing names on a giant “grease board”… in the 90s. This was far after other industries had adopted computer optimizations. We were still waiting for paper records to be delivered from the bowels of hospital’s medical records department.

When everyone was forced to modernize, we adopted the biggest player in the field: EPIC. There’s a saying in hospital IT, “no one gets fired for buying EPIC.” At that time it was so clunky and obviously customized to maximize billing. Interoperability was a future plan. Entering data was so horrible, our first day with it we all spent 3-4 hours extra just entering data into the system. I hated it.

Today, I can pull up records from other hospitals (including those using EHR’s from other vendors). Patients can follow along in realtime through the patient portal apps. Docs and patients can even chat with each other through the app. Judicious and safe use of macros has probably dropped my charting time by about 50-80%.

I agree with everything said above. In some ways, Medicine is the biggest laggard industry of them all. We have a lot of old people with big egos who don’t want to use the latest and greatest technologies. There are also layers of regulations and precautions in place that prevent us from using lay solutions.

It’s not perfect, but it’s gotten so much better.

Though we’re going to ask you the same questions multiple times. It’s annoying but it’s also safer.

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@webwalrus and @jcarucci

A standard for digital exchange of medical records does indeed exist - it is called a CCD or “Continuity of Care Document.” In turn this is part of a larger standard for digital health records known as HL7.

The US govt pushed this hard as part of their “meaningful use” program in 2009 to pay doctors to establish EHR systems.

It turns out that in practice the CCD is not really very useful. A basic medical problem list is somewhat useful in very simple cases such as young patients with straightforward, distinct injuries/illnesses which resolve fairly quickly. But the vast effort of our health care system in terms of both time and money is focused on chronic diseases - often in older people who may have a half-dozen or more combined chronic, progressive conditions. Management of such a patient inevitably needs to be combined with an understanding of their family support and other social determinants of healthcare. That takes narrative writing - not checkboxes or coding in a digital exchange format.

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Another vote against checkboxes, here. There is a LOT of nuance that is lost with checkboxes. One of the key functions of the medical record is to communicate to the future providers. Checkboxes don’t cut it. However they do make the job of the billers & coders = money people easier.

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I used to think that but I believe there is a method to the madness.

With email it is way too easy to accidentally hit Reply All or misspell an email address and very private information goes to many people who should not have the information.

It is a lot harder to do that via fax - and when errors are made with the fax destination typically the number of recipients is not nearly as severe as with email.

Moreover email often is forever - it is very hard to erase it from recipients’ inboxes (even when they are the intended recipient). So if you email your doctor and then his computer is stolen or hacked, someone may now get your private health information.

With fax, once it is done it is done. It does not hang out forever in the recipient’s inbox.

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Not correct. Private medicine also exists and is integrated into the system. Also several “government” entities exist, a lot of the stuff is organized at state level, with different IT systems, so interoperability and transfer were huge issues in the implementation. But solved.

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That’s interesting

Do they solve this by allowing other entities to login to their system, or do they export the health record to others?

Do they export a digital summary similar to CCD or do they export a PDF with the entire record?

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Europe is homogeneous? 447 million people in the European Union, 27 countries, 24 languages. And the eHDSI (eHealth Digital Service Infrastructure) is being implemented for cross-border patient information, prescription, etc.

Thanks god.

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Don’t quote me on the technical details. As far as I know, the “electronic patient act” is a centralized database. So every entity (private, public) pushes information into it. For any access: my smartcard (“health insurance ID”) is needed to unlock access and also a smartcard by that provider. Then they have some read/write access. Every access is logged, so from home with my “digital citizen ID” I can access the system and see who accessed what and when. The physiotherapy i mentioned was due to an accident in another European country and the scans were put into the system. So the physiotherapist could access them in the system. Not sure on the formats.