By Kirk Saunders and Hamish MacDonald
Eric Topol, MD, recently penned an editorial on Medscape entitled “Why Are Doctors and Hospitals the Owners of Patient Records?”. He asks provocatively, “…isn’t it high time for rightful ownership to belong to the consumer? After all, the patient paid for the visit, procedure, lab test, scan, or hospitalization. It’s his or her body. …Shouldn’t the current setup be flipped? The patient is the one who should be granting access to doctors and hospitals.”
Primary Care Physicians (PCPs) really want to do the right thing – they are good professionals who want to practice good medicine and treat more than a patient’s symptoms. However, due to the requirements and restrictions of the reimbursement system on their practice, they often cannot do much more than throw drugs at symptoms.
Meaningful Use payments for EMR utilization will drive even more standardization and checklist-style medicine, further reducing the amount of time even the most patient-focused PCP can spend with their patients. To achieve Meaningful Use reimbursements, PCPs must now interact with patients through the patient communications part of their patient portal. This often leads to low-value doctor-patient communication, with the patient asking questions that would be better answered by lower-cost resource, e.g. unbiased/no advertising health literacy online sources.
By the time they complete patient visits, write up chart notes and take care of administrative tasks, PCPs average a 16.8 hour day. All the trends in healthcare today are leading to more inefficiency, lower quality practice, and the threat of lower payments for doctors. PCPs have little time in the current system, to entertain any outside data about patients unless it’s obvious that introducing the new data can make the Doctor more efficient.
Clinical notes are primarily written for other clinicians and are not a patient friendly means of communication. Because of this, sharing the clinical notes with patients increases confusion between doctor and patient. To minimize this looming problem, there need to be other ways to educate and coach patients which does NOT involve a clinician, except where absolutely necessary. Considering the health literacy of the average patient, low value questions pose a big challenge. What is needed are patient-owned tools that include health literacy, as well as, coaching and advocacy capabilities.
Until PCPs have more time to incorporate other resources, and can operate in very different reimbursement models than available today, it would be beneficial to change the way health records are communicated. It is our understanding that doctors would appreciate a concise, meaningful, multi-page printout with patient summary information that can be incorporated into diagnosis of the patient’s condition and treatment plan. This may be the primary clinical access point of Patient Owned Health Records (POHRs) for the near future. The quality of communication between doctor and patient would also improve dramatically as a result.
Even if patients had complete ownership and access to every clinical record, without health literacy and coaching, this could potentially overwhelm the current practice model. It would reduce the ability of the key medical service providers to do what the system desperately needs them to do; to spend most of their time diagnosing and treating patients in a way the maximizes the opportunity for the best health outcomes for the patient. Part of the job for POHRs is to make sure patients are ready to take on the responsibilities of their data ownership and are properly prepared to get the greatest benefit possible from a heavily burdened healthcare system.
BOTTOM LINE – Doctors practice medicine today as efficiently as they are able within the constraints of the current reimbursement system. Empowering the patient without training patients to effectively and efficiently utilize doctors’ services, and the healthcare system as a whole, will not lead to happy outcomes for either the patient or the doctor.
Our challenge to doctors is to add to this discussion; how can Patient Owned Health Records best help facilitate the transition from doctor-centered sick care to patient-centered well care?