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July 20, 2007


I just called UCI Medical Center where most of my health records are stored to see if I could get a copy to take back to DC and transfer to my doctor there. No humans answer the phone, of course, I have to leave a message and wait for a future call back. I am informed, though, that getting the records will entail a $15 "clerical fee" and a per page fee, which, given how many pages can be in records, could prove substantial. Additionally, the request will take 10-14 days to process, and then an undetermined number more to mail.

You're telling me this wouldn't be a thousand times easier and better if the doctor's office couldn't simply click "forward?"

July 20, 2007 | Permalink


See if you can get them to send them to the doctor directly, which may be free.

Posted by: Nicholas Beaudrot | Jul 20, 2007 2:00:07 PM

My own view would be that UCI should not have possession of these records at all.

It would be far better, for reasons of privacy as well as standardization and efficiency, if medical records were (electronically) in the hands of specialized medical record libraries. In an ideal scheme, those Libraries could provide those records in actionable form to any provider needing them, when properly authorized by the patient.

Posted by: Bruce Wilder | Jul 20, 2007 2:00:08 PM

Unless you have some rare disease that has only been treated successfully in 15 people worldwide during the past decade.....fugeddaboutit. If you're anywhere near normal, the only thing that might be of any interest in your medical records would be some laboratory error.

OTOH, you should have/make a record of your childhood immunizations and treat that, with updates, like safe deposit box stuff. Believe it, if you call up and ask ten years later they will be like "Duhh??? How would we know?"

Pretty much the worst of both gulags- anything you might actually want to know has been lost or mislaid (or so they say) but if you apply for insurance it all comes back to haunt you- true or not.

Posted by: serial catowner | Jul 20, 2007 2:07:41 PM

Please see DM's 1:36 PM comment in the previous thread. Have you ever held personal executive-level responsibility for a large-scale business information system implementation? Have you ever worked as in-house employee, consultant, or functional manager on such an implementation? Ever developed any large-scale software or been a salesrep for a large-scale software vendor? Have you ever read a glowing trade press or Wall Street Journal article or vendor puff-piece about such a project that you have been personally involved in at a high level? How is Phar-Mor doing these days and why?

As I person who has done this kind of work for almost 20 years now I have to say your faith in the software industry and the human race's knowledge of how to implement extremely complex information management systems is touching - and misplaced.


Posted by: Cranky Observer | Jul 20, 2007 2:14:14 PM

I'm with Cranky. Ezra, go back and read the comments from today's EMR post. This isn't like an email.

Serial Catowner has got it completely right. You are your medical records library. Get paper copies of everything as incidents occur - this will take some persistence (but the law says you are entitled to your records). Lab reports, diagnostic tests. Copy all your prescriptions as received. You will really be glad you kept all of this, literally for decades.

If you wait till later, you will find either the obstacles you've just found, or no record at all.

Posted by: JimPortlandOR | Jul 20, 2007 2:44:40 PM

Part of the problem in the US is that there is no real culture of medical records, even on paper. In some other countries, long term records are seen as an important tool for helping the practitioner understand the patient and most of these started out with paper and are groping forward towards electronic systems.

The US system never encouraged paper records for all sorts of reasons, both to do with the insurance system and the cultural bias towards technological testing over observational diagnosis.

Without the culture of records, where is the room for people to appreciate the power of an electronic record?

Posted by: Meh | Jul 20, 2007 2:48:08 PM

I remember, as a nurse, getting a patient who had been seen for like 30 years by one of our docs. I thought "Oh boy, this will be interesting" as I dived for the medical history. Not. 30 years of one-line notes by the doc. The best one, however, has stuck with me- "Patient presents in his usual state of ill-health..."

OTOH, one morning, around 1 AM, I met a resident hauling a three-foot stack of medical records down the hall. They were for one person, one of our rich morphine addicts who regularly checked in with "pancreatic pain". The doc was required to review the entire medical history before rounds in the morning. His comment- "Why me, O Lord, why me?"

Posted by: serial catowner | Jul 20, 2007 2:54:36 PM

serial catowner...

priceless comments!!

Posted by: jacqueline | Jul 20, 2007 5:58:13 PM

Ezra, I love ya, but *please*, for all our sakes, just stop with gross oversimplification of EMRs. If you really want to talk about them, then let's talk about th real thing, including HIPAA regulations (especially those regarding PHI), data standards (getting everybody to agree to use the same data formats for all EMRs), privacy issues (like just forwarding sensitive personal health care info via email) and transition costs (ie. - even if your doctor started using an EMR today, do you think that suddenly everything ever entered in your historical medical record would suddenly be available in it?), and not this abstract magical creature you keep describing.

Posted by: Rickenharp | Jul 20, 2007 6:00:31 PM

It don't think Ezra claimed it would be easy to implement.

Posted by: MarkT | Jul 21, 2007 10:37:37 AM

I just had an interesting thing happen, medical records-wise. I've known I have Hashimoto's thyroiditis for years, but I've been "stable" in terms of my thyroid function for all this time.

I recently obtained a copy of my medical records for the past several years and simply plugged the values for thyroid hormone into excel and made a simple graph... hey-presto, I've actually progressed to thyroid failure now (thyroid hormone levels have dropped in the last 4-6 months after being exactly the same for 3+ years) and I'm the first one to find it because I made a simple excel chart... Sigh. Making medical records electronic and portable is a very good goal (that will help over-burdened doctors with patient care and spotting problems early), even if it is thorny to implement.

P.S. The nay-sayers that believe it would be too difficult to implement from an IT standpoint should look at data-sharing in the chemical sciences... everyone has a proprietary database (usually searchable by chemical structure as well as keywords).. but nearly everyone also agrees on a common, text-based method of importing/exporting data and it works fairly well for us ... this wouldn't be a whole lot harder from a programming point of view (and if one were to do this open-source, with government-hired programmers to oversee it, it would be pretty cheap). It WOULD be hard to overcome inertia though... but last time I checked, inertia wasn't a reason to not do something that makes sense.

Posted by: BlazingDragon | Jul 21, 2007 8:13:55 PM

"A good wit will make use of anything: I will turn diseases to commodity." -- Henry IV, Part 2, Act I, scene 2

Posted by: Yan D. Kamecki | Jul 21, 2007 10:10:51 PM

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