Solution 2

Another solution might be just to listen to the younger generation’s ideas. Take it from them and switch to an online based program. As medical files are going onto the internet safety,  efficiency and cost effective way must be considered. This program must be technological security (for example, passwords, encryption and firewalls). If the format cannot do this, it is probably not satisfactory and the physician should consider using an alternative system. A system that is looked over by multiple parties and is being taught to the users how to properly use the system. As well as making sure that the physicians using such systems, ensures that each record entry captures the unique aspects of that particular patient encounter. It is a must that the system with it’s confidential records can be expunged or protected by the service provider before entering into a contract for the provision of the service. (Or to use one of the systems that have been recommended by the BC medical service. Physicians also need to be aware that e-mails and web servers are not secure. Physicians should not send personal health information by e-mail without express consent to do so from the patient and that Wireless Internet access causes other security concerns. As sending the information out without permission is against the Canadian Rights and freedoms. Therefore it is imperative that they take the appropriate measures to restrict access and maintain the privacy of patients’ personal health information. As well as getting the patients more influenced and making records that can be accessible in a time of need with the needed information. Never the less the system can not cost too much money as smaller doctors offices can’t afford to spend thousands of dollars on a program. With these things in mind the online adventure will be a battle but it will be a battle for the betterment of all Canadians in the future.

Solution 1

As of this moment the medical files are divided by three terms electronic medical record (EMR), electronic health record (EHR) and personal health record (PHR). This is one way of fixing the problem is just by making everyone switch to this sort of online format.

Let’s look at each of these in a little more detail.

1. Electronic Health Record – a health record under the custodianship of the health system used in support of multiple care settings. The definition of this record was part of the original EHR Solution Blueprint and has withstood the test of time. Learn more in our updated Digital Health Blueprint.This is often described as a patient-centric health record for the sharing of health information.

2. Electronic Medical Record – a record under the custodianship of a health care provider, or providers, that is used in a community physician practice setting. Typical use is by clinicians within a primary care practice or specialist physician.This is often described as a provider-centric or health organization-centric health record of a patient in support of the provider’s interactions or encounters with the patient.

3. Hospital Information System – a record under the custodianship of a health care organization.    It is used in an inpatient setting such as acute care, continuing care and long term care.This is often described as a provider-centric or health organization-centric health record of a patient in support of the provider’s interactions or encounters with the patient. So therefore we can have this all put online where everyone is put on to one system that is divided. This might be a bit confusing until the system has been used for a while.

American Medical Personnel

After talking with a Canadian nurse I decided to ask some questions to an American nurse to see how their medical documents are kept. Their government is trying to make it so all documents are kept online and not on paper so I asked these questions to see if it would be a good option for Canada as well as what it was like with paper…

1) Do you believe that the medical records system is outdated?
Some practices in the US still use paper charts.  Yes I believe this is outdated for many reasons, not the least of which is fire.
A lot of pracitces are moving towards electronic medical records and in fact that is what the government is attempting to force compliance with.  This is a much more up to date and practical way of managing records.
2) What are the major problems with medical records? (If any)
There are several issues with paper charts.  One problem is that alot of handwritting is not legible so it makes it difficult for anyone not familiar with that persons hand writting to decifer.  Another problem is that things can be changed and or papers lost, or even full charts lost.  For legal purposes that is not a good thing for either the patient or the practioner.  Paper records take up alot of space that can be used for other things.  The only pro that I can see with a paper chart is that is it quick and easy.  Everyone is already used to paper charts and in the hospital it is easier to chart by hand than to chart electronically ( It may be easier now but when I was still in the hospital it was cumbersome and a bear to do).  In the doctor’s office a lot of pts hate when the doctor is charting electronically while the pt is in the room and that really is the proper way to do it.  I have been in a doctor’s office with my father in law and the PA or nurse practitioner spends way more time answer questions on the computer than actually working with him.
Electronic charts have their own set of problems ( one of which I described above).  There is a very large learning curve for people to learn to use electronic medical records (EMR) and it is different from company to company. To use and EMR each individual provider must find a company that provides EMR and web based or server based EMRs are often VERY expensive.  They require frequent updates and there is often problems with the updates ( this is part of what Scott does, he has done extensive research on EMRs because he had to get the practice he works for going on one). If the provider is not happy with his EMR system and or the company it is very expensive to get it moved to a different company.  ( we are dealing with that with one of our clients right now) A benefit is that if you have a good EMR then the doctor can just take some type of a mobile device (ipad, phone etc) and log in and have all his patients data at his finger tips when the patinet is in the hospital.  Staff has easy access to medical records to send to other doctors etc as needed as long as the doctor does his notes when he sees the patient.  In some systems patients are given a log in so they can see their medical records and even fill out their initial intake forms on line.
3) What can we do to change the medical records systems to make it more efficient?
From the US stand point I believe that EMRs are way too expensive.  If the government is going to mandate something be used then there should be some cost effective way to do it.  There is a “free” EMR that two of my clients use and it is very cumbersome to use.  My small provider is doing ok with using it as he has the time to play with it but my busy cardiologist really doesn’t do much with it at all.  I don’t have an answer really on how to make it more effective as each one is so different.
4) What do you think about how the united states store their medical record? (on the internet)
See question #2
5) Do you believe that people should be able to see their records free of charge?
I don’t believe that a patient should be able make a doctor’s office ( or hospital) copy their records for free as it costs them in man hours, ink and paper.  If it’s electronic then sure, the patient should have access to their records.
6) Do you believe that having record accessible to every Doctor or hospital is an option?
   Why/ Why not?
Not at this point and I’m really not sure about the future.  We have laws in place in the US governing the release of patient data. I personally do not live the idea of having medical records easily accessable to other providers or hospitals.  I believe that opens people up to too much risk.
7) Do you believe that the way of keeping the medical records is reliable?
Not really sure what I think about this.  Paper charts are definately a thing of the past for us here even though there are still practices using them.  I’m not overly fond of them because it is easy to misplace or loose a chart.  Electronic on the other hand is far from perfect.  For example,  one day the server in Scott’s office failed.  They were doing back ups but the back ups were corrupt and they did not know.  They LOST 6 days of pt visits.  Luckily the doctors were able to recreate the notes but if they hadn’t then those days would just not have been there.  I know things are encrypted but what is to stop someone from hacking into the records especially the ones that are web based? Another example is when a patient is in the hospital, any hospital employee CAN look at their records in the computer.  If they are caught they will get fired but the damage is already done.  I had a boss when I was working in the ER the was hospitalized.  She told me later she was horrified at the number of people that looked at her records that had no business looking at her records.
8) What about just having the major medical conditions available to all medical personnel?

 

Records should ONLY be available to who ever is directly involved in the patient’s present care.  We need to educate patients to start taking some responsibility in their own care.  We have something here in Florida called a file of life.  People write in their medical problems, medication, allergies and if they have a DNR.  Ambulance personell know to look on the fridge for that.  It is small and can even be carried in a purse or wallett.  Instead of opening up a can of worms by allowing complete access, why not try getting the patient involved right from the start.  If they were carring this then any medical person in any state, country or continent would have the immediate access they needed.
From these answers I can see some of the major down falls of the online American medical information system and how we can fix them to better suited Canada.

Young Nurse

When asked these questions about the medical record system a young nurse who wishes to remain unknown states…

Do you believe that the medical records system is outdated? 

“Yes I believe that the medical records system is outdated because it still relies heavily on written documents and storage of records in areas such as hospital basements. In view of all the technological advances and cloud storage that is available now, the system is quite outdated which leads to time lags and compromising of patient care. ”

What are the major problems with medical records? (If any) 

“The major problem with medical records is trying to preserve patient confidentiality by keeping records and patient information off the internet/cloud storage but still provide fast patient care. However, by having medical records not easily available, there are inevitable time lags. For example, lab results from BC Bio are not even accessible by the local hospital. This means that a patient may have to undergo the same blood test again to obtain the same results. This results in increased cost and time that could have been alleviated by simply having fewer restrictions on the sharing of results via the internet. As well, after a patient has been discharged from the hospital, they usually make an appointment with a family doctor. However, unless the doctor has hospital privileges, he will not be able to access the records on the computer and either has to rely on faxed information from the hospital or on the patient themselves. Again, this could result in a loss of information, miscommunication and compromising of patient care.”

What can we do to change the medical records systems to make it more efficient? 

“Currently, Fraser Health uses Meditech, a specific computer program specific to hospitals, to store their limited patient information. While the patient is in the hospital, you can access information from previous admissions to a hospital. However, (I believe) that once the patient has been discharged from the hospital (and therefore the computer system), that information is no longer available. As well, there is limited information sharing between health regions. This means that if a person is admitted to VGH which is under Provincial Health and then later admitted to LMH which is under Fraser Health it is more difficult to access the information. Therefore, the first step would be to make information more easily accessible by having one main computer program that all health authorities in BC (and elsewhere) can access that is password protected to ensure patient confidentiality. There should also be a move towards paperless documentation such as supplying of tablets to medical staff where they can record patient information. This would allow for instant storage to the main computer program and save all the time spent scanning and faxing written documents.”

What do you think about how the united states store their medical record? (on the internet)

I feel that the United States store their medical records in a much more efficient manner than we do. As long as there are many steps taken to ensure that the information is safe and free from hackers (password protected, firewalls) then cloud storage is the way to go. It allows for streamlining of patient care which ultimately will save many hospital dollars, decrease time spent in the hospital and optimize patient care.

Do you believe that people should be able to see their records free of charge? 

“I believe that they should be able to see a summary of what happened while they were in the hospital free of charge, not every specific record. For example, a lot of medical records are worded in medical jargon that could be misconstrued by the patient and medical professionals would be very concerned about liability issues. However, every person has a right to know what happened to them while they were in hospital such as the results of CT/MRI scans and lab work and they shouldn’t have to pay for that.”

Do you believe that having record accessible to every Doctor or hospital is an option? Why/ Why not? 

“I believe that having records accessible to every Doctor or hospital is an option only if they are directly involved in that patients specific care. If every record was accessible to all medical professionals, there would be concerns about lapses in patient confidentiality. For example, a patient has a right to not having every medical professional being able to access the information that shows they have been diagnosed with AIDS. This would be especially true in smaller communities where the chances of patients and medical professionals knowing each other are quite high. I feel that each patients record should be password protected and that password would only be obtained when accepting that patient into their care. ”

Do you believe that the way of keeping the medical records is reliable? 

“No I do not believe that the current way of keeping medical records is reliable, but archaic instead. Because the majority of medical records are still on paper, there is a very high risk of documents going missing as they change hands.”

What about just having the major medical conditions available to all medical personnel? 

“I don’t believe that would be enough information for medical personnel as most patients are able to tell them their major medical conditions upon admission to hospital. Medical personnel need to be able to access the diagnostics to correctly identify where the patient is in their disease to be able to provide proper patient care. For example, it is not enough to know if someone has heart failure. A medical professional would need to know which type of heart failure (right-sided or left-sided) and what stage of heart failure they were in.”

 

With these in mind I wonder what is stoping us as a country form doing exactly what the USA has done as it seems to have worked well for the USA. Next time I will talk to an american medical personnel and see what they think of the american medical system vs that canadian system and about how we can improve our system while still maintaining our constitional rights.