new york times article on access to medical records

Electronic medical records (EMRs) hold great promise for improving the practice of evidence based medicine by facilitating communication between members of the health care team. The most profound influence of EMRs may lie in their ability to encourage clients' involvement in their own pets care.

new york times article on access to medical records

Postby malernee » Tue May 11, 2004 9:40 am

THE CONSUMER
How Patients Can Use the New Access to Their Medical Records
By MARY DUENWALD

Published: May 11, 2004


t one time, polite people never asked to look at their own medical records. To do so would indicate a lack of trust in your physician. Besides, doctors were so resistant to the practice that getting hold of your records could require a subpoena.

But that way of thinking is a relic of old-fashioned medicine, as out of date as the house call and the black medical bag.




Since last April, federal law has required that doctors, clinics and hospitals provide patients with access to their records on demand. As it turns out, many people want to see them, and if you know what you are looking for, medical records can be easy to decipher. Reading them can also be a good way to become more involved in your own medical care.

Doctors once suspected that patients who wanted to see their own charts were distrustful or, worse, planning to sue, said George J. Annas, chairman of the health law, bioethics and human rights department at Boston University School of Public Health. And some doctors argued that patients lacked the expertise to understand their own charts.

"They'd say, you can't possibly understand because it's written in medical language," Mr. Annas said. "You won't know that S.O.B. stands for shortness of breath."

But in this era of consumer medicine and increasing safeguards on personal privacy, Mr. Annas said, "it is considered a basic privacy principle that if anybody has personal information about you, you should have access to that information, too."

The new federal rules, part of the Health Insurance Portability and Accountability Act, or Hipaa, give patients the right to inspect and copy all their records. Parents are also entitled to their children's medical records.

An exception is made for notes from psychotherapy, which are thought to be especially sensitive or likely to be misinterpreted as critical of the patient. With a doctor's permission, patients can view therapy records in the doctor's presence.

Access to medical records will soon be very easy for anyone with a personal computer, as hospitals and clinics switch to electronic record-keeping. But even with paper records, obtaining access is easy. Patients need merely telephone their doctor's office or a hospital's records office and ask, said Carol Ann Quinsey, a professional practice manager for the American Health Information Management Association, a professional organization.

Typically, the office manager or the records administrator will schedule an appointment for the patient to come in and examine the records. Once there, the patient may be asked to sign a form authorizing the release of the records.

Or the patient can send a written request to have the records photocopied and sent by mail. The doctor's office or hospital may charge a fee for photocopying and postage.

Ideally, when looking through the file, the patient should be able to ask a doctor or other informed medical professional questions about anything that seems confusing or hard to understand.

Deciphering handwriting is another challenge, insurmountable in some cases.

"It isn't just that the patients can't read it," Mr. Annas said. "Sometimes, nobody can."

What pieces of the record are most interesting and important?

The ones that a patient might need to provide to future physicians, said Dr. Jinnet B. Fowles, vice president of research for the Park Nicollet Institute, a health research center in Minneapolis. Those might include the dates of immunizations and regular screenings like mammograms, P.S.A. tests and cholesterol checks; the dates of any surgeries and the hospitals where they were performed; a record of all allergies; accounts of any serious medical illnesses; and descriptions of current medical problems and medications.

Dr. Fowles found that reviewing her own records gave her a starkly realistic view of how her weight had increased over the years and how her blood pressure and blood sugar numbers had "moved in the wrong direction." The revelation inspired her to lose 30 pounds.

Patients may want to photocopy the pertinent pages and save them in a file, said Ms. Quinsey of the information management association. Or they may want to transfer the key details to a health history record form. (Her group offers such a form on its Web site at www.myphr.com/maintaining /index.asp.) Some patients may want to carry a partial record of their medical profile with them at all times.

"I'm allergic to penicillin, sulfa and tetracycline," Ms. Quinsey said. "All those drugs are essentially deadly to me, so I keep that information on a piece of paper that stays in my billfold."

People who suffer from chronic conditions like diabetes or high blood pressure are advised to keep that information with them also, Ms. Quinsey said.

It is important to check for inaccuracies: misfiled pages from another patient's chart, for example, or incorrect notations about allergies or medications.

Sometimes, Ms. Quinsey said, a patient disagrees with a doctor's description of a medical situation: "A patient will say, `I didn't say that I'd had five drinks and crashed my car.' "

If the doctor will not change the chart, patients are entitled to write down their versions of the events and attach them to the record.

Contrary to patients' expectations, the doctors' notations are typically not all that interesting, Ms. Quinsey said. "If they think there's gossip in their chart, they are usually disappointed," she said. "Most doctors don't write comments like `She was very short-tempered,' or `She was really nasty to me.' "

Naturally, the trend toward greater openness with patients has discouraged doctors from jotting down ill-considered comments. "They are encouraged to stick to the facts and not characterize patients as `fat' or `shabbily dressed,' " Mr. Annas said.
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