The Meaningful Use program that was supposed to bring us shareable electronic health records for improved coordination of care, reduced health costs and improved health outcomes is winding down and here I am telling you about my first Electronic Health Record (EHR) that goes back to 2012. Why? The patient’s perspective on any healthcare news is rarely voiced and members of HICUP (BB Brigade acronym for those who are engaged in the business of health care in the USA), are too busy looking out for their own self-interests to tell our side of any story. The government bureaucrats are more worried about program funding and their jobs than they are about having shareable electronic health records that patients can use meaningfully. Because program funds are largely spent and distributed to private healthcare providers and hospitals, they must wind down the program and move on. Whether Meaningful Use has been achieved or not is being swept under the rug. The healthcare providers and hospitals never wanted shareable electronic health records from the start and would just as soon see shareable electronic health records go away and be relieved of the burden that largely benefits their patients. These self-interest messages are loud and prolific. With most of the incentive payments distributed or allotted, there is no reason to deliver anything more. We, the patients, who were supposed to be the primary beneficiaries of Meaningful Use, must now live with the “shareable electronic health records” that the program has given us to date. Let’s take a look at my first Electronic Health Record to get an idea of what the government, the private healthcare providers, and hospitals have delivered. In my next blog post, I will describe the rest of my Electronic Health Records.
My First Electronic Health Record
In the year 2012 I went for my yearly gynecological checkup and was asked if I wanted to sign up for Electronic Health Records (EHRs). Healthcare providers refer to their business-centered online patient access websites as EHR patient portals. I had never heard of them before. I jumped at the chance to finally have an easily accessible and convenient way to collect my personal health records. It had been an absolute nightmare trying to extract health records from my healthcare providers whenever I moved.
When I first logged on, I was very underwhelmed with how little of my personal health records were in my first Electronic Health Record. Most of the information on the portal was the general health history that the doctor asked me about during the checkup (drug allergies, prescriptions he prescribed, immunizations, and preventive care services I had had in the past). During my office visit I was not prepared to summarize my detailed health history (we had never done this before), so the information that ended up on the patient portal was my incomplete recollections. If my doctor had “engaged” me ahead of time, I could have consulted the personal health record I kept at home. My Electronic Health Record did not contain any results (stool, urine, and blood tests), any clinical summary reports, any mammogram results or images or any bone density test results or images.
It looked like my gynecological checkup involved taking my height, weight, and blood pressure and not much more. I inputted these measurements into my personal health record on my home computer even though I can take all these measurements just as easily at home. I had no reason to return to the portal.
During my 2013 annual gynecological checkup no mention of my EHR patient portal was made and no advertisement for it was anywhere to be found in the office. Accessing the portal a couple of months later, I found an incomplete clinical summary report , but it was not in a downloadable file format (like a PDF). I took a screenshot of the report instead for my records. My earlier checkup summaries and all the other results were still not available for me to view, let alone download or transmit to others. I did not use any of the other features (e-prescribing, messaging, and appointment scheduling) because I didn’t need them. In fact, I was no longer using one of the medications, but the EHR patient portal didn’t allow me to make changes.
In 2014 (two years since I had first accessed my first Electronic Health Record), the content I found was no more complete. I signed out without doing anything. I did not access the portal again until June, 2016 so that I could have the latest information for this blog post. I have to admit that I wasn’t expecting the portal to have suddenly sprouted content that delivered Meaningful Use. To my surprise, there was in fact more information. I now found that multiple clinical summary reports from several office visits had found their way to the my Electronic Health Record. One of my visits was given two separate titles (one for the office visit and one for the laboratory tests). Laboratory test results finally after four years! My enthusiasm was short-lived after I downloaded and viewed the files and discovered that the separate PDF files turned out to be the same file with different names. Neither file contained the laboratory (urine, stool, and blood) results.
When I accessed the message center, I was told that communicating with the practice electronically was currently unavailable to me and I was instructed to use the telephone. Very interesting… In the Meaningful Use Final Rule (released in October 2015), patients must have the capability (which I do) to send and receive a secure electronic message with their provider (in 2015). Having the capability and making it inoperable for most of the patients would keep pesky patient questions to a minimum (time is money after all). For 2016, the Meaningful Use requirement calls for at least one patient to send or receive a message. I obviously was not to be the one patient in 2016. How there any healthcare providers who are practicing the spirit and not just the letter of Meaningful Use?
Meaningful Use requirements dictate that I receive a clinical summary of my visit within 3 business days. My incomplete clinical summaries did not appear for YEARS! In 2016, I do not have any test results in my Electronic Health Record even though this is a Stage 1 Meaningful Use requirement. Perhaps my doctor feels confident that erroneously labelled “test results” file will fool an unlikely audit event. This physician received $29,760 (in 2012-3) and $11,760 (in 2014-2015) in incentive payments (94% of the maximum allowed). I still have virtually non-existent shareable electronic health records as defined by my protected health information in my designated record set.
The Bottom Line
Many healthcare providers complain that patients do not want shareable electronic health records. If the untimely content available in the EHR patient portal I described above is at all representative of what they are placing on the portals, then it is a wonder to me that anyone wants them for anything but electronic messaging, setting up appointments, and e-prescribing. Any patient seeking timely shareable electronic health records would have abandoned accessing my first Electronic Health Record long before I did. Timeliness is not measured in YEARS but in days.