Health Tech

The Drive To Standardize Records: Progress or Chaos?

By MERLE BUSHKIN

I recently asked my Primary Care Physician’s Medical Records Department for copies of my records covering the last eight months during which I had four office visits, five blood draws, and nine brief email exchanges. I should add that my PCP uses one of the two most popular EMR systems.

To my astonishment, I received 274 pages of digital records (PDFs).  I’ve heard of “record bloat” but this was an explosion!

When I analyzed their contents, I found that 59 pages were legitimate documents containing “original” information and data.  22 Pages were Office Notes — or what are often called Progress Notes —applicable to my four visits; 14 were reports of my five blood draws; 23 included my nine email exchanges. In short, they were “normal” — what you’d expect from the number of contacts I had with my doctor and his lab.

But the remaining 212 pages shocked me. They were totally unexpected and, in my opinion, completely unnecessary! They were a slicing, dicing and recasting of the contents of the basic 59 pages! They included 82 pages of “Ambulatory Visit Instructions” (which I was never given), and 62 pages listing my immunizations, meds, problems, procedures, orders, and past medical, social and family histories — all of which are covered in my providers’ Office Notes!

I believe these recast notes result from the effort to standardize medical records so doctors and other care providers can exchange patient records — you know, using FHIR, HL7, APIs, CDAs, CCDAs, etc. 

But is this massive explosion of records and the resulting confusion and chaos really necessary to achieve interoperability? Moreover, all this repetition and recasting of data and bloat doesn’t ensure that the standardized information being sought is available because the provider often enters it in the wrong data field!

What scares me about all this is that either the people who conjured up this system aren’t aware of these problems or they don’t care which would be even worse!

A Texan would say that these bloated systems “are all hat and no cattle!” Others would say “they confuse motion for progress.” I say this solution is far worse than the problem, and that we need a different approach and system. One that is simpler, more comprehensive, easier to use, cheaper and meets everyone’s needs.

I suggest we take a page from search engines like Google, Yahoo and Bing and focus on managing disparate records rather than trying to share standardize data stored in silos — an approach we know doesn’t work. 

We do that today and everyone can benefit mightily! So let’s stop creating chaos and wasting time, talent, and money!

Merle Bushkin is Founder & CEO of Health Record Corporation, creator of MedKaz®, the patient-focused personal health record you carry in your pocket. 

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  1. The point of all those pages has nothing to do with your physician, nor with yourself.

    It is simply done to maximize billing. Frequent provider “education” now takes place to wring every last penny out of an “encounter”, and, from the willingness of health systems to spend mid-to-high seven figures to install these products, I presume the return on investment is rather good.

    When I read my notes written ten years ago – brief, to the point, hopefully insightful, but always easily understood and easy to follow – I want to weep.

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