Have Medical History, Will Travel
Every time I consult on a patient I’ve not previously met I have to go through a series of questions to obtain what we call a medical history. On some people, especially the young and healthy ones, this is a very quick process (What medical problems have you had? None. What surgeries have you had? None). In older, chronically ill individuals it is a bit more laborious (What medical problems have you had? How much time you got, Doc?).
When I provide a cardiology opinion on a patient’s condition I need to take into account all the pertinent information I can obtain. Such information includes occupation, heritable illnesses, and recent non-cardiac symptoms. For the purpose of the medical record (and to satisfy increasingly finicky insurance companies) I have to include a lot of material that is not particularly pertinent but is required to produce a thorough dictation. A detailed family history in a 93-year-old patient having a heart attack is an example of information that really doesn’t aid me in formulating a treatment strategy.
Some patients are very good at providing details of their personal history whereas others are more of a challenge. I once had a mildly demented, elderly patient brought to me by his family who claimed he had never had any heart problems. I had no reason to doubt this as I looked over his medication list and saw no cardiac drugs. When I examined his chest I was surprised to find a scar running down his breastbone and a lump below the left shoulder that looked suspiciously like a defibrillator. “Oh that,” the family replied, “I guess he’s had a couple surgeries.”
The opposite end of the spectrum is the patient who brought me a hundred-page typed manuscript detailing every medical exam, test, drug, and symptom he’d ever had. The only diagnosis missing from the voluminous dissertation was obsessive compulsive disorder.
I have to believe that patients get a little tired of recounting the same details to every doctor that comes to see them when they enter the hospital. What medical problems have you had? What about surgeries? Medications? Allergies? Over and over.
What we need is some centralized electronic medical record that is available to you and any doctor you’d like to share it with. The first time you compile your medical history you could go through the lengthy litany of questions and then never have to answer them again. Sure, things change all the time, but there are some parts of your health history that are pretty much set in stone. Never again would you have to recount how your Aunt Melba died of gangrenous onychomycosis, or how you came down with beriberi while trekking through the Belgian Congo, or how you once had a hallucinatory reaction to a dose of Anusol. These pearls of your medical past would be available for all to assess and would never again require repeating. Of course security for such information would have to be airtight. No one (especially nosy employers or insurance companies) would be allowed access without your explicit permission.
The advantage of such a system is obvious. It saves you and your doctor time and doesn’t rely on your sometimes-sketchy memory. No longer would you be subjected to unnecessary repeat testing just because a doctor’s office doesn’t have your most recent results. Pertinent points of your history would never be forgotten or overlooked.
The good news is that many such electronic health records already exist. The bad news is that none of them gracefully combine ease of use and meticulous thoroughness. I test drove one just the other day to see how good it is. Google Health (brought to you by the same people who bring practically everything else to you) is a nice, simple system that allows you to enter your medical data and store it on their secure site. Then, from anywhere in the world, you can simply log on and retrieve whatever information you’ve stored. Stuck in Antananarivo with a nasty recurrence of malignant logorrhea? Hop on the net and in seconds your doctor will have every detail he needs to get you on your way.
The site starts by querying you about demographics and quickly moves into prior medical problems, surgeries, medications and the like. If you happen to have had tests or procedures done at a select few hospitals in the U.S. (such as the Cleveland Clinic) you can request and upload those records to your collection (sorry, Alegent has yet to link into this system). Numerous pharmacies allow you to access your prescription history and add it to the mix. For a fee (they quoted me $98), a third party affiliated with Google Health will track down records from other sources for you, digitize them, and add them to your file. The website also helps you search for a doctor in your area and you can arrange to have your profile forwarded to his or her office.
The down side is that you have to be pretty computer savvy to get this up and rolling, and it works best for patients with a fairly uncomplicated medical history. For some of my patients getting all the complex twists and turns distilled down to this antiseptic site is a bit of a daunting task. Of course, precisely those patients are the ones who’d benefit most. The site also has no place for things we doctors need, such as family history, occupational exposures, and unhealthy habits (smoking, drinking, carousing, being a Sooner fan).
Also, what if you want to see a doctor but don’t want all aspects of your past made available? What if you did inhale when you were “experimenting” back in the sixties? That information you may want released to your pulmonologist but not necessarily to the guy doing your Botox. I saw a patient just last week who explicitly asked that I not review his prior dictations and testing so that I could approach his case with a fresh, unbiased perspective. From what I can tell Google Health doesn’t allow you to send out a selectively amended version of your record.
Give it time and I think we’ll see some form of centralized health record rise from the sea of chaotic confusion that we currently rely on. At that point I will finally be able to spend more of my time focusing on your immediate problem and less on the twentieth recounting of your 8th grade appendectomy, all the while having access to all critical details of your past.
Dr. VDG, I enjoy reading your Cardiology blogs. I found this blog to be very interesting to me as I am taking a course in Emerging Trends in Healthcare Technology. I was not aware about Google Health (GH). I immediately went to the site to sign up. I found that my pharmacy is associated with GH and can import my medications. I am also going to sign my mother up who has dementia and would benefit from this. I agree that GH could be more detailed as far as history but I am sure in time improvements will be made to benefit the patients and healthcare professionals.
My concern is that "old" diagnosis' sometimes change. How will medical facilities adequately store pertinent records instead of faulty information that may lead to incorrect treatments?
Dr. Van De Graaff
Tara, I've actually thought about this idea and think it's not as far fetched as you think. As it is now, any time I implant a pacer or defibrillator into a patient the device is programmed with a small library of information that includes the patient's name, my name, our phone number, date of implant, indication, etc. It wouldn't be much of a stretch to envision the addition of another few megabytes of memory that would allow the device to become the patient's own medical record. The data could be managed and updated using the wireless programmers we currently use to adjust the device's functions. Add a few gigabytes more and you could throw in an iPod for good measure (Bluetooth headphones not included). Using a stand-alone microchip with the capacity to be updated should be within the capacity of our current technology--I just don't think it'll go in that direction. The current trend for personal computing is the move to "cloud computing" (http://en.wikipedia.org/wiki/Cloud_computing) where we will all give up our personal computers and our own hard drives and disk-based programs, and will simply own a keyboard, a screen, and a connection to the internet (keyboards optional in the future) where all programs and files will be located. At that point it would make sense to park your medical record in the "cloud" so that you--or anyone you want--could access it and update it from anywhere. I don't think any of this is too distant in the future. Thanks for you comments--now go back to reading your Isaac Asimov. Dr. VDG
Do you think it would be wrong to implant micro-chips containing medical history into people as we do with dogs and cats and their vaccination and owner information? Sounds a little sci-fi but it might be the future of medicine!!