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Patient EMR Access May Be The Biggest Cultural Shift

Posted on April 15, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As most readers probably know, U.S. doctors are skittish about giving patients full access to their medical records. That fact was underscored by a recent Accenture study, which concluded that 65 percent of doctors think patients should only have limited access, and 4 percent feel patients should have no access.

While I have no proof of this, my gut feeling is that these results aren’t just a snapshot in time, but rather a sign of a stubborn problem that’s not likely to melt away quickly. Though much of the high-level thinking about EMRs counts on building collaborative patient relationships over shared records, that thinking may be flawed.

Why are doctors hanging back from full and free disclosure of electronic health data?

Self-consciousness:  Doctors may say things in records that they’d be a bit embarrassed to reveal. To some extent, this is a problem whether the doc is  using paper or an EMR, but EMRs are trickier for doctors to use, adding to the awkwardness factor if a patient questions their work or feels offended by the commentary.

Poor collaboration skills:  If patients get to see their records, they’re likely to become all e-patient-ish and want to have more control of their care.  Old-school doctors aren’t trained to think this way, nor are they likely to want such a relationship temperamentally.

Low digital comfort generally:  Even among younger physicians, there are those that are naturally wired and those that only use computing devices when they must. I’d argue that when you toss in the generation of doctors who trained 100 percent on paper, you’re looking at a large population of physicians who may never quite be on board with touchy-feely data sharing.

Bottom line, data sharing with patients requires a cultural shift which a surprising number of healthcare pros seem ill-equipped to embrace.  I believe it is this cultural shift — from patient as object of notes to patient as co-creator — which will ultimately pose the biggest obstacles to getting value from EMR investments.

Yes, it’d be nice to think that as doctors get more used to living with EMRs, a large number will loosen up, but I doubt that’s the case. Let’s hope the cynic in me is wrong this time.

What Do Patients Need From EMRs?

Posted on November 14, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As we’ve noted countless times in this space, EMRs aren’t going to get any better unless vendors and doctors communicate freely. But what about catering to the needs of patients.  But given that by Stage 3 of Meaningful Use, EMR data will need to be accessible to and available for comments by patients and caregivers, it’s time patient needs were taken into account.

In that spirit, here’s my list of a few EMR features that might benefit patients and their caregivers. Bear in mind that this is me speaking as a patient and family caregiver, but perhaps that’s a good thing.

Patient data needs

*  Multiple views of the data:  Doctors are used to standardized reports, but patients and their families will still be learning the game.  Patients should be able to do pull data by history, by current status, by lists of drugs, allergies and other key factors affecting current care, as well as by a simple overview similar to patient discharge papers.  It should be possble to pull down these reports into Word, PDF, Excel and other popular formats for re-use.

* Access to contextual data:  Being able to fit data into a larger context is very helpful. As a caregiver, I’d want to know if the pulse ox number my asthmatic son was low relative to other asthma patients, particularly pediatric asthma patients. I’d also want to compare his current number to numbers from the past, preferably in easy-to-read chart form.

* Links to medical information: If I’m reading a report on my care, and I run into medical terminology I don’t recognize, I should be able to pull up a pop-up window and search for the definition of that term. I should also have access to full-length reports on my condition — from validated sources such as WebMD — to give me a broad understanding of my care.

* Ability to comment on data and notes:   While I realize this could become very time-consuming for doctors, it might be worth the trouble to give patients the ability to comment on elements of the data or notes. (A Microsoft Word-style comment function would probably be sufficient.)  To contain the time doctors need to spend, comment functions could be constrained to medical notes and other areas where impressions could be clarified or corrected — rather than the entire EMR data set.

*  Portal:  Portals, of course, are on the way regardless. But I wanted to underscore, as the caregiver to two chronically-ill family members, that accessing data through an organized interface will be a welcome method for skimming key indicators and raising the questions I need to ask doctors.

* Mobile access:  Another obvious one. Patients are as likely to access data on the road as physicians are. Patients need an adequate mobile app which offers a reasonable amount of access to key EMR data on a real-time basis.

Readers, what other types of data access do you think patients and caregivers need to participate effectively in care?