番茄社区

This terrible pandemic has revealed to us yet another gaping hole in the armor that is our healthcare system.

The lack of universal availability of medical records across the spectrum of healthcare settings where patients are seen is now a clearly visible flaw that needs fixing.

From the lack of the ability for us to see that our patients have been vaccinated against COVID-19 at another site, to the unavailability of medical records from other institutions, to the unavailability of something as simple as a patient's results -- such as a COVID-19 viral swab that they had done in the community -- this need for universal access and interoperability is once again topping the priority list.

All This to Get a Test Result?

Just recently, a patient of mine sent me a message through the portal saying that they had developed some symptoms over the weekend and gone to a local testing site, and they had received a screening swab that was positive for COVID-19. Due to some underlying health conditions which left them at significantly high risk for poor outcomes, we jointly decided that an infusion of monoclonal antibodies would be a good option to try to keep them safe, healthy, and at home.

Unfortunately, since none of their results were available online, this necessitated several trips by the patient's family members to the testing site to get a printout of the result -- including an extra trip back with a signed form to release the result to the patient's son -- which they then had to take to a local FedEx facility to fax to my email, so that I could scan it into our electronic medical record. Once it was there, our incredible team providing monoclonal antibody infusions was able to see it, and once they had this hard evidence, they could proceed with setting up the infusion under the emergency use authorization program.

Another example happened to a patient of mine just the other day, someone who has been incredibly sick and sheltering in place through the pandemic with their family upstate, and we -- myself and multiple subspecialists -- have been managing their health conditions from afar via telehealth and video visits. The availability of this care being provided has been incredibly appreciated by the patient and their family, and made it easier to get care while avoiding trips to doctors in the city, where risk from exposure to multiple others has increased over the past year.

Due to some recent health changes, we are being required to escalate their level of care, and have been working to transition to another healthcare setting. Unfortunately, the location where the patient was being moved required a recent physical examination; a recent set of blood tests, including serologies; recent TB and drug screenings; and recent functional assessments, all of which would have required an in-person visit.

Getting it on the Record

We tried to explain to this facility that the patient had not left home in over a year, and has certainly not been into the city to see us. In fact, the last in-person office visit was over a year and a half ago. Our records should have been enough for them to see this and understand, and work with us to do the right thing for the patient. But paper faxed forms needed to be filled out with stale and likely less-than-useful clinical information. Better would have been working across a live care platform, where all the necessary items could have been updated, and useful assessments made in real time.

Every morning, as I've written about before, we in primary care receive multiple portal messages from patients, gleefully informing us that they've received their COVID-19 vaccines, and requesting that we update this information into their health maintenance section, under their immunization records.

Considering how careful the federal government has been with tracking these vaccines on their way out into the community -- including where they are allocated to and who gets them -- those of us on the front lines thought it would have been really smart for them to connect to the information systems that report this data back into the electronic health records that we're all using, as has been done in the past for flu vaccines and shingles vaccines that our patients have always received in the community.

Just the other day, a patient who I referred to a specialist at another hospital told me they needed labs and notes from our recent office visit faxed over to the specialist's office so they could assess them, even though I know for a fact that they can see our records across the shared system (although the person who told the patient to get the labs and notes may not have been aware of that).

On our end, as it stands now, we can only get records from certain health systems when the patient is physically present with us in the office, and they have signed a piece of paper that we printed out that they give consent to let me look at those records today. Wouldn't it be great if patients were able to tell all the systems that had their healthcare records in them that we could see them, since they want us to?

This Can Be Better

I find it strange that, sitting in my pajamas at 11:59 p..m. on the day before taxes are due, I can file my tax forms with the federal government by clicking on a box and signing my name with my fingertip. Wouldn't it be great if we had a way that patients, from their end of the portal, could get a similar box where they consented for me to see the records that we were talking about, that I desperately needed to further their healthcare along right at that moment, without them having to come into the office and sign a piece of paper?

One of the consequences of the pandemic has been increased availability of patients' medical records for them to review, enforced through an act of Congress that has provided them with the right to see all of their records whenever they want to. Why can't this go the other way, with them able to let me see whatever they want me to see, whenever they wanted to? This has huge potential to improve the health of our patients moving forward, in situations that stretch far beyond the pandemic healthcare emergency, and just make a great deal of common sense for all.

To keep the information flowing to where it needs to be, when it needs to be there.

Let's bring it all together.

, of Weill Cornell Internal Medicine Associates and weekly blogger for 番茄社区, follows what's going on in the world of primary care medicine from the perspective of his own practice.

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