Reflections on ONC’s Report based on over 10 years of experience
First of all, let me say that I agree with the ONC’s report conclusion that patients should have easy access to their medical records. Having a patient be well informed can assist clinicians in providing the best possible care and treatment for the patients. As the report indicates, “patients and caregivers who do have access to their data can better coordinate their health care, prevent repeat or unnecessary tests and procedures, and have greater control over their health and well-being.”
However, after spending over 10 years providing medical record retrieval, organization and clinically relevant extracts to the top medical centers across the nation, I have learned a few things that may provide additional perspectives around the record request process. These reflections come from our experience working and talking to doctors, department administrators, patients and their caregivers, nurse navigators and many others involved in the record request process:
1) FOCUS on the patient experience. Studies show that hospitals with higher patient experience scores tend to have higher clinical quality and higher margins. But the question remains, when does “the patient experience” start? We have explored in past articles that perhaps the patient experience starts even before the patient sets up one foot in the doctor’s office or medical facility. We have shared how patients are frustrated by the amount of pre-work required to get healthcare.
Like the ‘Darrell Mosley’ persona in the ONC report, patients are burdened with administrative tasks in a very difficult moment of their lives. Yet, it is at this time that complete records from multiple institutions are needed as fast as possible to provide timely treatment.
Similar to the ‘Melissa and Ava Crawford’ persona, one of our customer service representatives, Donna Rodriguez, talked to a patient’s relative that had to spend a week gathering records, not for herself, but rather for her mother prior to the first appointment. This was time consuming and she actually wanted to spend the time with her mother who had been diagnosed with an aggressive form of cancer instead of spending time on the phone.
The bottom line is that the facilities that can remove the burden from the patient and their caregivers, will enhance the patient experience right from the start.
2) UNDERSTAND the clinical and financial impact of the health record aggregation process. Focusing on the impact of the overall patient experience leads me to the next point, the health record aggregation process alone has shown to impact clinical operations and consequently, financial outcomes. Facilities that received complete, intelligently organized medical records in hours or a few days, were able to reduce the time from referral or first call to appointment by over 60%. Which means that the patients were more likely to book an appointment and keep the appointment with the facility that could see them first. In other words, facilities experience an increase in booked first appointments and a reduction in cancelled appointments due to the absence of records.
The bottom line is that every additional patient captured can add substantial life-time value to the medical facility.
3) ORGANIZE the record to tell the relevant medical story. Lastly, it is not just sufficient to get all the medical records or to get them in a timely manner. In fact, in some cases, getting all the medical records can add more information than needed causing clinicians to spend time managing the record instead of the patient. Medical records for complex cases can exceed 1000 pages. There is no way a clinician is going to read or process this data. Therefore, extracting the salient points, indexing them in relevant categories in the chronological order that the clinician requires is critical to help the clinician come up with a treatment plan prior to the patient’s first appointment. This not only reduces the amount of time a clinician spends reviewing records by at least 30% but it also enhances the patient experience. Instead of repeating the medical history, the patient now gets a course of action right from the start. It also ensures important information that the patient may not remember, or is buried in the complex medical record, is easily discoverable by the clinician, thus improving patient care.
Patients want to know that their healthcare team knows who they are, why they are seeking care and if they are not satisfied with their experience, they are willing to abandon the state-of-the-art, high tech provider in order to get that experience.
The bottom line is that providing an organized medical record enhances both clinician and patient satisfaction.
While the ONC reports on real issues today, there is a lot that can be done now to improve health record access. We are also continuing to push for all the improvement areas noted in the ONC report to make this process less painful, less time-consuming, and very importantly, more useful to clinicians so they can provide the best possible care to their patients.