If you are reading this, you are likely engaged in an initiative to drive healthcare innovation forward. However, it's quite possible you have run into some challenges around how to handle the information that is required to get a full picture of a patient’s health and history. Without effective ways of managing health information, patients are unable to access the care that they need. So, how can we manage patient health information in an efficient way?
Why is it so hard to get a complete set of patient records in a timely manner?
From conversations with hospitals and providers throughout the United States and around the world, many have communicated a priority for fixing how we handle medical records (or at least improve it).
In a world of instant access, it can be hard to believe that something as seemingly viable as sending a medical record (such as an x-ray, or even a signed release form) to a doctor that needs to see it can be so challenging. These challenges can, in many cases, delay a patients’ treatment. Yet that happens today, and not just in the United States.
A survey from Consumer Connectivity Insights found that more than half of people around the world knew someone whose care was delayed due to information not being shared between healthcare professionals. In a commentary for WBUR, Dr. Pranay Sinha, an infectious disease fellow, described inaccessible records at several hospitals within the state as being “tantalizingly out of reach, frustrating the care of our patients.”
Recently, we’ve heard from certain medical imaging facilities that they quote fulfillment of medical record requests in up to 30 business days. That can mean a month and a half, not including mailing times if they are being mailed on CDs, before a patient has access to vital medical records.
It is clear that something needs to change.
Taking new scans can cost you more money.
When records are incomplete, or if a CD can’t be read, providers often decide just to retake the tests or scans rather than go back to find the originals. However, this is not a sustainable solution to the problem. Beyond the delays in care it can cause, medical imaging is expensive.
In California, one hospital administrator told us that freeing up scanner space is financially important for major hospitals that receive patient transfers from the surrounding areas, especially for emergent cases. There are imaging backups at these facilities, to the point where non-emergent scans can only happen between 10 pm - 5 am due to the emergent requirements during the day. Receiving these records electronically and immediately would prevent the need for re-imaging in many situations.
Is there a better way to collect a set of patient records?
There are three rules we, and our clients, adhere to when we look for new and better ways to collect patient records.
I. Be the patient’s advocate
Ultimately, we all need to center the patient in their own care. This means being the patient’s advocate in the collection of their records – NOT cutting them entirely out of the process. Requests that are done on behalf of the patient are fulfilled at a faster rate than those by third parties.
In order to do this, be sure to explain the record collection process to the patient, and have them sign electronic medical record release forms that authorize you as the organization acting on their behalf.
Of course, not all patients have printers and scanners, so to avoid creating yet another point of delayed care, make this process as easy as possible for the patient. Purview’s second opinion software includes electronic medical record release forms, but even simply using a third party signature software such as DocuSign can reduce pain points for the patient and make it easy for them to partner with you in their care.
Tip: If you already subscribe to Adobe Acrobat, you can have patients “fill and sign” prepared PDFs.
Keep in mind that if using this workaround, the patient will have to sign a separate form for each facility in possession of necessary records. If a patient has seen a number of providers, utilizing a purpose-built record collection software can be the better choice.
II. Keep it relevant
Medical record requests that lack specificity result in a dump of a patient’s entire medical history into one place. While that may not seem like a bad thing, patients often have decades of medical history, most of which is not relevant to the care the patient is seeking at that time. It is essential to set a standard for the required records that are sufficient based on the specialty and type of care the patient needs. To create these standards, it can be useful to outline all the different types of consults you provide for patients and ask your physicians what records they look for in each of those.
As an example, one hospital we work with asks for the following information when giving a second opinion for cholangiocarcinoma:
- MRI and Cat Scan images and results
- Labs for the past 3 months including pathology results
- Clinic visit notes from physicians for the period of the condition
As you can see, this is slimmed down significantly from a patient’s entire medical history. Receiving years of labs and pathology results is not only irrelevant in this case, but can cause confusion or frustration for physicians because it is difficult to identify the recent and relevant records.
Once you know what records you need, lay that out in the medical record request process. Not only will that enable you to get strictly relevant records, but it will reduce the number of records that need to be located and sent by the provider you are requesting from. This will simplify things from all angles.
III. Avoid paper and mail
As we discussed earlier, manual printing, signing, and scanning of records can create delays in care. We are likely preaching to the choir here, however, it is worth saying as many times as necessary – electronic solutions are available. There is no need for burning and mailing CDs or having to physically sign documents. Find a vendor that prioritizes a frictionless process for you, your patients, and your physicians.
How can collected records be organized clearly?
Lastly, without an appropriate organization of records, all the effort put into collecting records efficiently can be wasted. If a physician can’t easily find the pieces of the patient history they are looking for, care can (again) be delayed. Making the process easy and clear for the physician is essential.
Organize collected records based on your guidelines created for the specific care the patient needs (as discussed above). These guidelines can make up the template for your record organization. Then, make sure each record is labeled clearly with the type of record and the date it was taken. In some cases, a set of patient records may be uploaded as one document. These need to be separated so the physician doesn’t need to sort through many pages to find the tests and records they need to consult.
“It is helpful if documents are labeled as specifically as possible, and not combined into larger PDFs,” said one physician providing second opinion consults at a top oncology hospital in the United States, “it makes it much easier to miss data if items are not labeled properly.”
Lastly, make sure to communicate to the physician what you would like them to answer. If the patient or their referring physician has specific questions, be sure to convey those. As the same physician said:
“It is important from the questions or cases to understand why someone wants a second opinion. Do they just want confirmation that they are doing the right treatment, or do feel a change is needed? If they have questions about specific treatments or clinical trials, that can be helpful to focus the opinion.”
Hopefully, if you have read this far you now have some tools and strategies that can help you better organize and manage your patient cases. Of course, all providers (and patients) have different specific requirements, and some of these strategies and tools may need to be adjusted to be the most effective. If you are looking for more information, please reach out, we are happy to help!