American health care’s underlying condition
Navigating the American health-care system can be frustrating in the best of times. During periods of crises, such as the ongoing COVID-19 pandemic, it can feel downright overwhelming.
The reasons for this are numerous, but the current system of medical documentation is partly to blame. While documentation has its benefits, it is marred by a fundamental problem.
Your medical records may not be there for you when you need them the most.
The electronic health records (EHR) of different hospitals remain largely disconnected and unable to communicate, preventing timely flow of important information between providers. Additionally, our referral-based and specialty-driven health-care system is such that patients will interact with numerous hospitals and EHRs throughout their lifetime. This means that your full medical records are hidden away like inaccessible puzzle pieces and scattered piecemeal throughout the country.
The unfortunate reality is that health-care providers in America have to make critical decisions based on incomplete information. And it shows. People may receive unnecessary testing, wrong diagnoses and sometimes even the incorrect treatment much more than we would like to collectively admit.
While we certainly gain valuable information by talking directly with patients, especially with regards to their recent history, obtaining an accurate longterm history is challenging. Most patients do not have formal medical training and are not wellversed on the care that they have received over the decades.
When my colleagues and I ask patients if they have had any surgeries in the past, we always check for scars on their bodies. There have been several instances of patients stating that they have never had a surgery, but a quick scan of their abdomen reveals multiple surgical scars. Likewise, patients will often forget their diagnosed diseases or daily medication regimen.
Take this current dysfunctional system and now add a world-wide pandemic on top of it. It becomes abundantly clear that deeply challenging times are ahead of us.
If we extrapolate based on the experiences in other heavily-affected countries, it is likely that tens of thousands of patients, if not many more, will enter American hospitals in the coming weeks to months with COVID-19. A significant portion will inevitably go to hospitals where they have never received care.
This will create a triaging and logistical nightmare.
Who has sufficiently enough co-morbid conditions to warrant an admission? Who will be asked to recover from home?
Yes, we can send out requests for health-care records to various hospitals where our patients have received care. Such requests usually take place over the fax machine. Records may be faxed back anywhere from within a few hours to a few days. Imagine trying to triage a patient with suspected COVID-19 and having to wait hours to days to get back important medical information.
We will effectively have a situation where the virus is traveling with much more ease than the medical information needed to combat it.
So, what can be done about this?
It is important that patients create an up-to-date portfolio of their health-care records as soon as possible. This is often referred to as a personal health record. Studies have shown that PHRs can improve patient outcomes.
Now is the time to learn about your own medical history, inside and out. Know all of your chronic medical conditions. Learn which medications you take and why. Ask your healthcare provider for help. Being able to provide documents and an accurate history to a hospital during the COVID-19 pandemic will ensure that you are triaged, diagnosed and treated promptly.
Health-care providers and administrators must also work with their hospitals’ medical records departments to streamline the transfer of information from one hospital to another. This has to be done with existing privacy laws in mind, but with the understanding that delays in information flow can have dire consequences during a pandemic.
Faraz is a resident physician in the department of surgery at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School, and an incoming MBA candidate at Harvard Business School.