Reason Behind the Project

Whether as a patient or healthcare provider, most people have noticed a shift towards keeping medical records electronically. You also may have noticed there are dozens of systems for doing this, and that not very many of them are compatible.

There is an effort underway to standardize electronic medical records, with the goal of making records transferrable between states, hospital systems, and insurers. This would make it possible, in theory, to easily obtain records for a patient from California who passes out on the golf course while on vacation in Florida.

However, this standardization effort is moving very, very slowly. Depending on who you ask, it may be between three and ten years before any practicable degree of standardization is in effect. For a very ill or geriatric patient, this is literally a lifetime.

A few of the obstacles involved in making EHRs standard are the protection of privacy, cost to providers who must change standards, and how to best transfer information from paper records. Imagine your worst day standing in line at the Department of Motor Vehicles, and then multiply this by fifty, and you have some idea how difficult this coordination effort really is.

As it stands right now, without access to electronic records, when I as a provider admit someone into a hospital system for the first time, I am dependent on the patient and their family to provide me with their history, a list of medications, etc. If the patient is not competent to give history and the family is not available, we call nursing homes, family doctors, etc. We usually figure on being able to get less than half the full history, and having less than half of that be up to date and correct. Not an ideal situation: best case, we are able to use contextual clues to give the person the help they need and maybe only end up doing a few unneccessary lab tests. Worst case, the time that is wasted results in permanent injury or death.

A few weeks ago, while admitting a delerious geriatric patient into the hospital from the ER in the middle of the night, I found myself on the phone with the nursing home cook, who was the only person available to read me the information from the patient's medical file. As this person read me the list of medications, having to spell every word as she went down the list, it occurred to me that there must be some "happy medium"that could be used between now and the time when universally accessible electronic medical records become a fact.

I began to wonder what could be used as a "patch" in the mean time. In an age where computer memory, i.e. USB flash drives, are cheap, durable, and portable, would it make more sense for patients to carry a copy of their own records rather than wait years for providers to catch up?

A few hospital systems are issuing experimental "smart cards" to patients that will contain medical records, track appointments and billing, etc. These are very good programs, but if your provider is not participating, you cannot participate.

In doing research online, I found about a dozen companies that provided individual, subscription-based versions of these systems on the kind of USB memory device people can carry on key chains or in their purses. All of these products have their own strengths and weaknesses and are reasonably good solutions to the problem at hand. However, one thing they all have in common is the need for the patient to assemble and enter their records into the system, or have someone do this on their behalf. Keeping the information on the chip up to date is also the responsibility of the patient. To my way of thinking, it is a little silly to pay for this service if you are doing all the work yourself anyway, right?

This blog contains information on putting one of these records together for yourself or a loved one, at a very low cost (you can get a USB chip for about ten dollars at your local office supply store.)