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Medical Records Database

 A nationwide bank of every patient's medical history, available to health professionals, insurance companies, and patients
 
(+1, -1) 		  [vote for,
against]

In this day and age, patients shouldn't be the only ones keeping track of all their medical histories. The reliance in the USA by doctors to have patients report their histories to them, or to have patients acquire information from past doctors, can leave the current medical professional with incomplete and sometimes inaccurate information. "Oops, I forgot to mention I'm taking a new prescription drug" can result in dreadful consequences when going into surgery or whatever.

As one person is likely to be treated by more than a handful of doctors & nurses during a lifetime, not to mention at least a couple of differing health insurance companies, who are constantly inquiring about specific information to determine proper coverage, it seems necessary that *somebody* keep track of it all, systematically and with ease of retrieval when relevant (like in E.R.).

In an effort to reduce errors, paperwork, phone calls, and overall inefficiency, especially during emergencies, I suggest that an independent databasing corporation (or perhaps several corporations) take charge and start keeping track of every patient in the US nation, noting dates and details regarding:

• doctor visits (doctor names and contact information, any diagnoses given)
• dates of visits, summary of visits)
• medicines and therapies they've been prescribed (name of doctor prescribing, drugs prescribed [along with dosage details], therapies prescribed [details included],
• medical procedures they've had done (surgeries [both in- and out-patient], tests,)
• charges for all items listed
• food and drug allergies
• current insurance coverage details
• any other pertinent information

I envision this system to be similar to the current system used in USA for keeping track of credit history, only with a better system of error-checking and correcting. Liabilities for any errors would be held with the databanking corporation, and therefore held to the highest standards.

Information should be accessible to the patient him-/herself (and parents, if patient is a minor, or/and other loved ones, especially if the patient is not literate, not English-speaking, or otherwise incapable him-/herself), doctors medical staff, and health insurance professionals. Information should be easily checked and corrected by patients reviewing their own records.

Data should be collected directly from medical personnel *as things are prescribed or done to each patient*. Therefore, doctors and hospitals, etc. would need to be trained and equipped to transmit relevant patient data instantly via Internet or other efficient means to the databank. But this would mean that the information would be as fresh and accurate as possible, typed, and spelled properly.

Each patient's records should be kept uniquely identifiable with the patient's social security number, or other unique proprietary information. A father/mother check may also allow users of the info to make certain the records are for the right person (as in the case of similar SS#s or similar names, etc.). Other means of record keeping or security with regard to the information could be used as well, but it would have to be kept private enough to keep your acquaintances from snooping and yet public enough for you to get proper treatment at any hospital or doctor's office.

Catching up on old data may be possible by having patients or their doctors' offices fill in where they can, but as the date of such a system's release would be well-known by the medical community, they would treat any information older than that date as possibly questionable, compared with the more current information. Also, any information submitted by the patient may be marked for verification by medical staff.

Professionals who know about the world of medicine should originate all records regarding medical records, and those who know best how to store data efficiently should be handling the technical aspects of the database. Patients' medical knowledge and technical skills vary widely, and therefore are not a reliable source for tracking even their own medical records, yet we all rely on expert medical attention when the need arises. An efficient system such as this one would allow medical staff to treat patients with better judgment and far fewer mistakes.

—XSarenkaX, Jan 21 2003

(??) NHS medical records http://www.nhsia.nh...002/med_records.asp
baked [squeak, Oct 21 2004]

(??) Barcodes on Hospital Patients http://www.cnn.com/...codes.ap/index.html
A related advancement regarding the tracking of patient's health information [XSarenkaX, Oct 21 2004]

(??) Medem's iHealthRecord http://yourmd.com/pat/pat_ihr.cfm
THIS is what I'm talking about. [XSarenkaX, Jun 03 2005]

(??) eMR http://www.maxsyste...hy-eMR-anywhere.php
[XSarenkaX, Jul 11 2013]

[link]






       I think this system was implemented on Sienfield once, with dire results...
—pluterday, Jan 21 2003
   

       I'm not sure how practicable this is but I'm all in favour of it as my own history is spread over 9 hospitals, 12 consultants, 4 GP's and 2 countries. Encompassing 25+ surgeries, my notes at just one of the hospitals fill 3 files each 4 inches thick and this doesn't include all the imagery!   

       All doctor's notes are meant to be accurate and comtemperaneous so hopefully getting this kind of data into the system should be fairly straight forward, especially with the increasing numbers of healthcare providers who become computer based.   

       The link to an individual patient could be provided by a smart card carried by the patient.   

       This could contain all the data that would be needed in the event of the patient being involved in a medical emergency and the emergency services could carry portable readers.
—oneoffdave, Jan 21 2003
   

       The system we have now is crap - I agree - but I propose new standards for recording the information. The medical records need to be kept a lot more professionally. I also propose that insurance companies rethink their system of rejections. Those who need it most are turned away.   

       Incidentally, [IVnick8or], are you saying that you consistently lie about your medical history? If this is the case with many patients, the system definitely needs to be revamped in greater ways that I propose here because it is not working.   

       If you fishbone this, what's a better solution? Certainly not what we have going on now!
—XSarenkaX, Jan 21 2003
   

       IV, I thought there were pre-existing condition laws that prevented insurance companies from refusing to cover those kinds of cases.   

       XsX, I can't really agree that the current system is crap. It's worked okay for me, having had 4 or 5 doctors over the last 25 years, in two different countries. When I've moved from one to the other, I authorize a transfer of my medical history, so my current GP has everything there is. I'm not sure why anyone else needs that information.
—waugsqueke, Jan 21 2003
   

       I'm glad it works for you, [waugsqueke], but it's not working for others. My parents are immigrants from farm country who don't speak English very well and have no technical skills. They are 65 or so years old and each have a list of medical problems, take many kinds of drugs, and have had numerous visits to doctors and hospitals for diagnoses, tests, surgeries, etc. The bills and paperwork alone are enough to drive us all mad. What with insurance asking for this and that minor detail before paying a cent of an expensive procedure, the bill for which keeps coming with a note saying it's past due, etc. My parents are incapable of keeping track of their own medical histories, but their medical providers do need to know what they've had done, what other conditions they might have, what drugs they're on, etc.   

       Perhaps patients can opt-in or opt-out of this system as they see fit. It would definitely be a godsend for my parents, though, as even I, with my technical abilities, cannot make sense of all the information that is relevant to their healthcare. I have tried for decades now.
—XSarenkaX, Jan 21 2003
   

       I'm sorry to hear about your parents' situation. Why can't their doctor(s) look after all of this stuff for them? My doctor acts in that regard - he's not just GP but also a medical 'agent' of sorts.   

       Unless it's the insurance issues that are causing the problems...? Would this database solve those issues?   

       I don't have to keep track of my medical history. I have never actually seen my medical records - the doctors have handled it all.
—waugsqueke, Jan 21 2003
   

       Assuming this databank and personnel do a proper job of handling the information, it would solve the problem of requiring my parents to try to keep track of anything relating to their medical histories. I think this sort of thing should be left to the experts. If they travel and need medical attention, even if they are unconscious, they should be able to punch in a code and get all the information they need to assess their medical needs proceed properly.   

       Another reason I would like to see this implemented is because I never know what kinds of things doctors are looking for when they ask about relevant medical history. Should I mention asthma to my heart specialist? Does my dentist care if I'm on birth control? I mention everything, but find a lot of times I get a silly look or even a chuckle because the info I give is irrelevant. If the doctor went over my history profile online and scanned for what s/he needs to know, we could skip that whole guessing game.
—XSarenkaX, Jan 21 2003
   

       What if insurance companies were not allowed access to this health information? Would that make this idea any more appealing?
—XSarenkaX, Jan 22 2003
   

       This is straying a bit, but IVnick8or's situation is very interesting. Keeping genetic testing information from insurance companies seems obvious and necessary (and it's much better than leaving people uninsured), but that sort of information asymmetry creates problems. Insurance works because insurers can work out the odds in aggregate but neither party has any inside information on the likelihood of specific events. If this situation changes, the system becomes much less efficient.   

       If an American learns they're in line for an expensive illness, they can -- and will sometimes need to -- take out insurance they wouldn't otherwise have wanted at a tiny fraction of the eventual (or net present) cost of care. Insurance companies can then survive only by raising rates all around. Effectively, you end up with a system in which people with certain types of predictable health problems get the best of care fully paid for and people with other illnesses don't. (I'm not accusing you of unfairly using your unfortunate DNA test results or anything like that, IVnick8or.)   

       This is, in fact, a lopsided version of public insurance or provision. Going the rest of the way towards the sort of more-or-less free care provided by most rich countries would -- though it comes with many troubles of its own -- probably solve the problem. At the same time, it would remove the need to keep information from insurers and others that's one of the difficulties of systems like the one proposed.
—Monkfish, Jan 22 2003
   

       This is inside information which aids evildoer Insurance companies. Fishbone.
—thumbwax, Jan 23 2003
   

       If the insurance companies are allowed access to this information, consider them the little dude who has your health in its best interests. After all, if you're sick, they have to shell out the bucks.
—XSarenkaX, Jan 23 2003
   

       So far, the discussion keeps mentioning health insurance companies, and the evils they would commit if supplied with too much detail of a person's medical history. But what about other potential abusers?   

       Picture the job interview where the hiring manager is holding a copy of your medical file. Now picture the immigration officer who denies entry solely on the grounds that your future healthcare would be too expensive, making you just a welfare case waiting to happen. Never mind that the rest of your family are already permanent residents or citizens, and will be taking care of you.   

       Make no mistake about it. If a wealth of information exists in a central location, then that location quickly becomes a target to black market traders who sell to those wishing to abuse the information. No matter how careful the security policies and procedures, somebody some day will find a way around them. A one-time leak is all it takes to permanently screw someone over. Once the information can be bought on the black market, it will always be available there. Plugging the original leak will be like closing the barn door after the animals are all outside.
—BigBrother, Jan 24 2003
   

       No way! What if I were to have a banned procedure done? Would that also go onto my medical record? There is enough descrimination against gays and lesbians as it is. I don't want any of my records floating around anywhere. My doctor's office is fine by me.
—linguist, Jan 25 2003
   

       What's in it for the non-profit organization?
—thumbwax, Jan 25 2003
   

       I'm with [BinaryCookies]. Great attention to detail in planning this all out!   

       See, everyone, this could work out.
—XSarenkaX, Feb 05 2003
   

       Great Discussion! I have been thinking about this for a while. I heard that a few years ago, some hospitals in the state of Colarado used this system but the reason for failure was mentioned as confidentiality of the Patient information. However, in America and other countries where Personal Medical information is very private, the best way to start the use of this system would be as follows   

       1. First document the medical condition and medical history for individuals in one standard format. This needs to be done by someone who is an expert in this area.   

       2. Convert these documents and images into electronic records and secure them in a smart card that is always with the individual, like the medical insurance card. A Copy of this smart card is to be secured by the individual either at home, bank locker or physician, like the social security card or the passport.   

       3. Once the technology is ripe enough to gain confidence of the people, then a common database can be created.   

       4. The information on the smart card can be accessed only by the patient and a certified physician (authorized by the patient). If the patient is unconcious, then the attending doctor needs to get the information from patient's authorized physician or use a Veto Code (for emergency). This Veto Code will need approval from the nearest family members of the patient.   

       The whole idea is to avoid storing the medical information in a common database. The data is standardized and is just not at a place. This removes all the confidentiality converns. The further advancement of this will be to embed a magnetic or optical data strip into the skin on the forearm (Like in Beautiful mind).
—concept, Feb 26 2004
   

       In case the card (or whatever medium is used and carried by the patient) is lost, forgotten, stolen, or destroyed? The common database would serve as a fail-safe. One cannot always wait for data to be recovered before receiving medical treatment.
—XSarenkaX, Feb 27 2004
   

       ~ B A K E D ~ See the Medem link - they've made my dream come true!
—XSarenkaX, Jun 03 2005
   

       There was recently an attempt to modernize, centralize and accessibleize patient records here in the UK - I think it failed (as most of our government IT projects do).   

       However, as [squeak] pointed out, the NHS keeps a comprehensive file on each person. I don't know how perfect the system is, but any doctor I've ever seen has always known my medical history.
—MaxwellBuchanan, Jul 11 2013
   
      
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