Candid Physician: Medical Records and Testing

Would it surprise you if your doctor shares
some of your healthcare system frustrations?

Stop me if you have thought or heard any of these common healthcare complaints.

There are too many medical record systems. It’s too difficult to make sense of information in an after-visit summary. Why does every health care provider request the same blood work? It feels like my doctor spends more time looking at my charts than talking to me. The way patients are billed is confusing.

Those are five of the most common complaints about the healthcare system. Here is the shocking part: your doctor most likely feels the same way you do when it comes to improving your care quality and the inefficiencies in the healthcare system.

On a recent episode of HeartTalk presented by Capital Cardiology Associates, I had a candid conversation with Dr. Connor Healey, a board-certified cardiologist on the challenges healthcare providers face. I was surprised to learn that a physician shares many of the frustrations of his patients. He was also open to sharing his thoughts and feedback on how we can improve the system. Our talk opened with the after-visit summary (AVS), a paper or electronic document, given to patients after an appointment. As one study found, “the AVS is nearly universal in the United State. However, patients infrequently reference or even retain their AVS, suggesting currently designed documents do not meeting patients’ needs.” The main goal of the AVS was to create a basic report of your doctor’s visit, enabling patients to make better lifestyle choices, while also providing transparency in the care orders. Instead of a standard report that could be freely shared between the patient and their providers, “most of these summaries are inadequate and speak to the inefficient system we have,” stated Dr. Healey. “There is too much medical jargon or information that patients don’t understand, like billing or coding.

There are too many medical record systems

It should be noted that one driving factor behind why every healthcare provider in the United States is pushing to provide an AVS is to meet a standard in the Health Information Technology for Economic and Clinical Health (HITECH) Act. This unlocks financial incentives from the Centers for Medicare and Medicaid Services (CMS). The AVS information is also useful for providers and healthcare teams when they are collecting data before a visit or procedure. The AVS is part of the electronic health records (EHR) system outlined in HITECH. “Most patients would know an EHR as a ‘patient portal,'” Dr. Healey pointed out. This component was initially one of the most challenging goals to reach due to the lack of a national medical records system. “More than 50% of affluent countries have a national health records system, according to the World Health Organization (WHO). The United States is not one of them.”

The reason why you must fill out a separate medical records information form at every health provider is due to the fact that there is not an industry-standard EHR. “Number one, there are way too many different EHRs out there. Your primary doctor may use one; we use a different one at Captial Cardiology Associates (CCA), your rheumatologist may use another. None of them are the same as what is used where you receive your hospital care,” added Dr. Healey. According to the National Electronic Health Records Survey of 2017, nearly 9 in 10 (86%) of office-based physicians had adopted an EHR. “None of these systems talk to each other, that is my biggest complaint.”

Blood work and testing

Whether you visit your doctor for your annual physical once a year or have a roster of health care specialist appointments during the year, chances are you have your blood tested. Blood work and testing are two examples of services that could be difficult to understand on an AVS. “What do the results mean,” is a common question asked by patients. The other is, “why do I have to get my blood checked by every doctor?” As we have learned, since most healthcare providers do not have access to the same patient records, this is an inefficiency in the system. Or as Dr. Healey stated, “blood work is probably the number one example of lack of communication between healthcare providers. Ask any patient the number of times they get blood drawn in a year, it’s ridiculous.” In most cases, the tests that are order are the same test. As part of your routine physical, your primary care provider typically checks your kidney functions, electrolytes, vitamin D levels, cholesterol, and other areas depending on your medical history. “When you come to the cardiology office, that’s a lot of what I’m looking at too. I may look at a troponin, which is a blood test for heart damage. I may look at BNP, a blood test that indicates how much MI stretch there is and acts as a surrogate for, ‘hey, do you have too much fluid circulating in your body?’ While most of it is redundant, there are specialty tests that do get ordered, which is why you will need more than one blood test a year. Having said that, there is so much waste on the redundancy of the standard blood tests that the country would save, literally, tens of millions of dollars if we had a better capability of sharing results.”

A better system

As we have transitioned from hand-written notes to electronic records, there are still improvements necessary to upgrade the American healthcare system. A valid point on a Twitter thread stated that EHR’s should be more intuitive. As one doctor tweeted, “As a millennial doc, I still wonder how my older colleagues managed to learn and use. Then read a recent study that EHR is one of the top reasons for physician burnout… and it all makes sense.”

“The goal is to improve the system so that physicians can deliver the highest quality of care at the lowest cost. This starts with a standardized AVS and better connected EMR,” Dr. Healey suggested. Healey visualizes a digital document designed as a standard medical record file, delivering a simple visit summary to the patient, and pertinent information. “Ideally, the solution would be that every patient has a single chart that is unique to them but would accessible by all providers.”

Patient Summary example from Modern Healthcare

A standard patient records system would also improve patient visits. A study released in February of approximately 100 million patient encounters with about 155,000 physicians from 417 health systems, showed that providers spend an average of 16 minutes and 14 seconds per encounter using EHRs. That’s almost a patient visit to review charts, documents, and order tests. Dr. Healey detailed, preparing for a typical patient appointment. “I will get a note that is eight pages long for a single encounter. I have to parse through all of this garbage to find vital signs, physical exam, what was discussed, and the concern or reason why I am seeing this patient. And that’s just one visit! I’m also getting messages from their oncologist, their lung doctor, and in some ways, this is more time consuming that when we used paper charts where we had more control of things.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates