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BLOG: Can your patients access their medical chart?
The hot topic of discussion in health care reform this winter revolves around patient access to their medical information.
One of the founding tenets of patient-centered primary care is patient education and providing patients with their personal information and the tools they need to take better care of themselves. Because we are now routinely taking vital signs as part of a comprehensive eye exam as well as providing wellness OCT tests, the data in our charts is valuable to the overall health of our patients.
With a growing number of optometrists using electronic health records and attempting to meet the standards for the Merit-based Incentive Payment System (MIPS), providing our patients with access to their medical information should be widespread practice. However, when speaking to my colleagues, this is a rare occurrence.
We are not alone. In a retrospective review from the National Hospital Data conducted by Sunny C. Lin and associates, only 10% of patients with access used it to obtain their health data.
Hospitals are also not alone in failing to provide usable access for patients to their health data. In one of the featured Health Affairs Blogs by Christine Bechtel and colleagues, she points out that most providers have resisted the movement to make patient health data readily accessible. Providers claim that patients will not be able to understand their health records or that data security will be compromised. For optometrists, there is a fear that a patient could get their glasses or contact lens Rx and use it to get optical goods from other retail or online resources.
However, patients have high interest in obtaining their medical data. In a survey contracted by the National Partnership for Women and Families, an overwhelming majority said that they would use and value their health data to improve their health. While the survey indicated that there was some concern about the privacy of their protected health information, they felt that the benefit of access to their medical data outweighed the risks. People are very accustomed to conducting shopping, banking and other financial transactions online, yet health care and related data access in still limited.
So where is the disconnect? First, after much hype about patient-centered health care, the meaningful use standard for providing patients access to their medical data was extremely low. Having to provide access to one single patient to meet the measure was just a nuisance. The patient portal may have been operational but not promoted or used other than for the one demo required for MIPS.
The second problem is related to the economics of the traditional fee-for-service payment system that remains dominant in health care in general, and almost exclusive in eye care. This and the retail hardware aspect of optometry that rewards us to shelter information creates a barrier to open access of our medical records.
There are a number of things that we can do to bridge this gap and help our patients leverage their own clinical data to improve their health. You may need to run against the grain, but you can distinguish your practice by closing this gap in care.
First, you need to complete your evolution from primary eye care to primary health care. You need to be sure to collect vital signs and conduct a comprehensive health history on all of your patients.
Second is to list all appropriate diagnosis codes and management plans in the health record. Your medical record is not complete unless you list the systemic diagnoses that can lead to vision loss.
The last suggestion will bring it all together, and it is to open your patient portal and promote it to your patients as part of your doctoring at the end of the encounter. Your patients will appreciate it and be more comfortable with you as a member of their primary care team.
References:
Bechtel C, et al. Health Affairs. 2019;doi:10.1377/hblog20200108.82072.
Lin SC, et al. Health Affairs. 2019;doi:org/10.1377/hlthaff.2018.05437.
National Partnership for Women and Families. Engaging patients and families: How consumers value and use health IT. Posted December 2014. Accessed January 20, 2020.