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The Digital Divide Within

The Digital Divide Within

Lack of interoperability, HIPAA misunderstandings, and COVID-19 No Visitor Policies have created an overwhelming digital divide within the traditional four walls of medicine across the nation.

I’m looking at you: “innovative, award-winning, world-class, transformative, patient-centered” health care delivery organizations.

Patients who are in the hospital in critical care situations are unable to access their medical information and records in real-time. Their primary carepartners, families, and advocates have been prohibited from the bedside due to COVID-19 No Visitor Policies, leading to lack of communication, breakdowns in trust, and uninformed decision making.

When patients are in critical condition, i.e., sedated on a ventilator, on life support, in a medically induced coma, or recovering from surgery, their primary carepartners desperately ask the following questions:

  • Why can’t I see the records that the doctors, nurses, and care coordinators see?
  • Why are strangers (doctors, nurses, residents, physician assistants, discharge planners) making decisions about my loved one’s care without letting me see the same information and including me?
  • I’m the point person or designated personal representative for the patient. Why can’t I see the records that have been generated thus far? I know they have electronically available results.
  • No one is giving me updates. Is my loved one getting worse? Are they dying? I need to see the records..

Most hospitals don’t give access to medical records until well after discharge.Patients often lay in their hospital beds, watching as doctors and nurses carefully review information about them and their current health situation on computer monitors, laptops, and smart devices. Carepartners helplessly wait at the bedside or are home waiting for the phone to ring with an update, with no electronic access to real-time information.

We frequently acknowledge that there is a digital divide in many rural and marginalized communities. Yet, we never recognize the digital divide we have created in every hospital, cancer center, and health care delivery organization, where patients and their families do not have access to real-time health information that is the driving force of potentially life and death care decision making. Patients and carepartners are literally on the outside looking in hopes someone will share even a crumb of information.

This is a significant barrier in critical care and emergencies, in patients who are deteriorating and require emergency care, such as in COVID-19, and in making end-of-life care decisions, where patients do not have months or weeks, but rather hours and moments to make a decision.

These patients, carepartners, and family members may not have any access to the latest information and have been told they have to fill out a formal records request (and wait up to 30 days, if they are lucky).

These carepartners don’t want a copy of the patient’s records. They want to see the most recent and relevant results and findings guiding clinical decision-making to answer questions and make informed, educated decisions about their loved ones’ care. In some cases, they want to see records to see if life-support should be terminated, ventilators removed, or a risky surgery pursued.

In these critical care situations, it is unacceptable that health care delivery organizations withhold access to information, suggest people seek a formal medical records request, and wait up to 30 days as per HIPAA (right now), when the information is readily available electronically often footsteps away on their care teams computer or smart device screen.

The current status quo leads to significant trauma, breakdowns in trust, and hostage bargaining syndrome (HBS). HBS due to lack of access to pertinent information results in patients and carepartners not being equipped to ask questions, unable to discuss potential concerns, errors, or omissions in care, as well as exacerbating feelings of anxiety and fear of being labeled as a burden or difficult for fear that it could negatively impact the level of care the patient receives.

We know that HIPAA permits, though does not require covered entities and hospitals to share information in records during a care encounter that pertains to a patient’s care with carepartners and family members. This includes any person advocating for the patient’s care and safety, so long as the patient has not openly objected or specified otherwise.

While this is permitted as per HIPAA, it is far from routine in everyday clinical practice. This needs to change to do right by the patient.

Yours in Unblocking Health,

Grace Cordovano

The Right to Inspect

The Right to Inspect

HIPAA grants individuals the right of access and the right to inspect one’s medical and health information within designated record sets maintained by HIPAA covered entities.

The right to inspect one’s medical records is not frequently discussed.

Why would someone ask to inspect their or their loved one’s medical record? What if you don’t want an actual copy of the records, but you just need to see them?

In the real world, the story is always the same.

A patient is hospitalized. The patient and their carepartner may have many questions that are unanswered about the current medical situation. The patient may be unconscious. Whether it is hospitalization due to a motor vehicle accident, a stroke, heart attack, a surgical complication, cancer treatment, COVID19, pregnancy, or a mental health condition, patients and their carepartners need access to information to make informed decisions about care.

Patients and their carepartners often wait for updates on test results, consultations, and diagnoses watching helplessly from the bedside. Doctors, nurses, clinicians, and members of the care team all refer to computer screens and smart devices for information about the patient’s medical condition. If the patient is not conscious or is unable to speak or advocate for themselves, the carepartner is often alone in their quest for the latest information.

Why isn’t it standard operating procedure to welcome patients and carepartners to pull up a seat, to view their caregiver’s screen, and welcome patients and carepartners desperate for information to follow along in real-time?

In critical care situations, there often isn’t time to formally request access and copies of all medical records. Some decisions can’t wait for days and weeks. Some decisions need to be made on the scale of hours, minutes, moments. We need to meet patients and carepartners where they are and support their right to inspect their medical records.

Sometimes patients and their carepartners need to see what the doctors and care team see to:

  • be on the same page.
  • participate in shared decision-making.
  • process the gravity of their current situation.
  • help make an unimaginable and unfathomable health situation somewhat tangible.
  • fill in missing gaps in information.
  • ensure nothing has been missed.
  • be confident that all information thus far is correct.
  • have all the information required to make a life or death decision.

The right to inspect medical records can be fundamental, especially in critical care circumstances. The rapid deterioration associated with many COVID19 cases has shown us how quickly and unexpectedly, people can become incapacitated and unable to speak and advocate for themselves. Primary carepartners play a significant role in needing to stay abreast of all of the latest information to make an informed decision about their loved one’s care. No Visitor Policies have further isolated patients and broken lines of communication between families and care teams.

We are failing patients and their carepartners in supporting their right of access to inspect their medical records. Frustrated and overwhelmed patients and primary carepartners are often heard saying the following:

“Why does everyone here know everything about my spouse/partner/parent/child/loved one, but I can’t see the same records also to be a part of the decision-making process?”

“Why isn’t anyone telling us anything?”

“I want to see what’s in my/my loved one’s chart.”

“Show me what you see on your screen.”

“Who made this discharge plan without my/our input?”

Patients and carepartners: don’t be afraid to ask to inspect and review the medical records used to guide clinical decision-making. While covered entities technically have 30 calendar days as a timeframe for providing access, many covered entities will be able to grant immediate access to electronic information thanks to health information technology. Be firm, especially when your loved one’s life depends on it.

In cases where the patient cannot advocate for themselves, carepartners should know that a covered entity may share the individual’s information with the family member or other person if the covered entity determines, based on professional judgment, that the disclosure is in the best interest of the individual.

Hospitals, healthcare delivery organizations, doctors, and practices should prioritize expediting access and the ability to inspect records, especially in critical care situations.

Sick Enough to Die & the Last to Know

Sick Enough to Die & the Last to Know

In a culture, society, and democracy that protects freedom of speech, we do a terrible job of talking about the one inevitable thing that unifies us all: death. Openly speaking about death is a rarity and often taboo. One word of advice goes out to doctors:

One word of advice

There are thousands and thousands of patients across the nation who are sick enough to die and don’t know. Diagnoses are delivered without an explanation of the severity and gravity of the situation. Treatments are recommended without explanations that they are not curative. Urgent procedures and surgeries are recommended without explaining the risks or impacts on quality of life. Palliative care is too rarely called in as an extension of the care team. Hospice is often called too late in the end of life trajectory. Families are entirely unprepared for the inevitable, sometimes lost in a sea of medicalese and incomprehensible vernacular.

Suppose doctors and care teams aren’t talking about the end of life and the possibility of death. How can patients and their families make informed, educated decisions about their care, especially in times of medical emergencies and life-altering diagnoses?

As a patient and as a person who will one day die, ask yourself the following:

  • Would you want to know if you were sick enough to die?
  • Would you want to prevent unnecessary treatments, prolonged hospitalizations, and possibly significant out of pocket expenses and financial toxicity if you were sick enough to die?
  • How would you feel if your care team knew that you were sick enough to die, but no one told you?
  • If you were sick enough to die, would you approach your care and life decisions differently?

If you answered yes to any of these, here are words of advice for you.

If your doctor and care team aren’t telling you all of the information you need to make an informed decision about your care, you or your carepartner must request to see your medical records.

  • Request to review your latest imaging report. Scroll down to the section called Impressions. This section is a summary of any findings made by the radiologist. Abnormal findings and recommendations for the next steps will be found here. If your care team isn’t discussing this section, ask the doctor what the impressions mean for your care and life.

  • Request to review your biopsy or surgical pathology report. The College of American Pathologists has resources to help patients and their carepartners better understand their pathology reports. Scan down to the diagnosis section. Review the diagnosis identified. Note any details on stage, grade, or tumor markers. These details will help guide treatment and care decisions. If your doctor and care team are not discussing the diagnosis details, ask what these details mean for your care and life.

  • Request to review your latest bloodwork. The American Association for Clinical Chemistry AACC) has resources to help guide patients and their carepartners understand their bloodwork. Scan the results for anything flagged as High (H), Low (L), or out of the reference ranges. Some reports may have an actionable interpretation of the results. If your doctor or care team does not address any items that have been flagged as out of the normal limits, ask them what that means for your care and life.

  • If you are being prepared for discharge from a hospital stay, ask your discharge planner and care coordinator what your diagnosis is, what your expected outcomes are, what the treatment plan will be, when your follow-ups are, and where you are being discharged to. If you have any concerns or questions, ask to see your medical records and request that your care team carefully review these details and what they mean for your care and life.

If you have received a life-altering diagnosis or find yourself in an emergency medical situation, don’t be afraid to ask if you are sick enough to die. Every patient has a right to fully understanding the answer to that question, whether it is no, yes, or somewhere in between. Doctors and care teams do not have to get death right. There is often no magic predictive algorithm. But they can get the conversations about end of life right. Patients and families can also help by getting the questions and discussions ready.

Medication Reconciliation: Scarier Than All of Halloween's Horrors

Medication Reconciliation: Scarier Than All of Halloween's Horrors

Adverse drug events (ADE) are a leading cause of patient harm and death worldwide. Almost 70% of patients’ medication histories noted upon patient admission to hospital have at least one error, with 30 – 80% of patients having a discrepancy between the medicines ordered in hospital and those they take at home. Here is one patient example of the dangers and frustrations of poor medication reconciliation.

In preparation for an upcoming surgery, a patient & their carepartner followed up with all the patient’s care team and the patient’s primary care physician (PCP) to discuss the patient’s upcoming surgery & medications. The patient has multiple comorbidities with an extensive prescription history list that includes 30+ medications over their lifetime, with 20+ medications currently being actively taken on a routine basis. The carepartner accompanies the patient to help coordinate care and reduce friction due to language and health literacy barriers, hearing loss, and the complexity of navigating multiple comorbidities managed by numerous physicians across various health systems.

To prepare for these appointments and discussions, the patient and their carepartner printed out a copy of all the patient’s medications from their PCP’s patient portal. The patient and carepartner carefully reviewed the list of drugs and noted any discrepancies, such as over-the-counter (OTC) medications that were missing or prescriptions that were discontinued. Medications were discussed with each respective prescribing physician, including confirming their names, dosages, frequencies, their impact on surgical outcomes, and if any needed to be stopped in preparation for surgery. Upon completing all the follow-ups with the entire care team, this patient now had a comprehensive, up-to-date list of medications they deemed their Master Medication List.

The patient provided a copy of the Master Medication List with their new patient intake forms for their new patient surgery consultation appointment. The surgeon’s office was a private practice which currently does not have an EHR.

The following week, the patient & their carepartner went to a pre-admission testing appointment at the hospital for surgical clearance. An internist, who was not the patient’s regular PCP, reviewed all of the patient’s medications using pharmacy prescription records, not the copy of the Master Medication List that was provided by the patient that was also just given to the surgeon. This created a tense and frustrating situation as the patient felt ignored and not heard.

The internist also said she could not “see” the list of medications that was confirmed with the surgeon at the surgical consultation because they don’t send that information to the hospital even though the doctor is affiliated with the hospital and would be performing the surgery there. The patient and carepartner were bewildered and now even more concerned.

This is a significant workflow, interoperability, & patient safety concern.

In the days before surgery, the patient received numerous calls from the hospital and surgical team. Many of the calls reviewed prescriptions using the outdated prescription history files, not the patient’s curated master list. No one was willing to start with the patient’s Master Medication List or hear the patient’s concerns. At this juncture, the patient & carepartner were gravely concerned about safety & communication.

Upon being admitted into the pre-surgical unit on the day of surgery, the medication reconciliation chaos resumed.

A pre-operative nurse pulled up the medications, referring to the historical, outdated prescription history list.

The carepartner needed to frantically pull out notes while the patient was being prepared for surgery. Thankfully the carepartner had a copy of the patient’s Master Medication List on hand to help facilitate the process.

The nurse, patient, & carepartner were interrupted during the medication reconciliation process multiple times by PAs, surgical consent forms, a visit from anesthesiology, the surgeon, & security picking up the patient’s belongings for storage. The interruptions made it more difficult for the nurse, patient, & carepartner to correct all the information. An additional challenge was that the nurse referred to many drugs by a different name than the patient and carepartner understood. The nurse may have been referring to medications by their generic drug name while the patient and carepartner, in some cases, were accustomed to the brand or trade name. Now the carepartner was also trying to furiously Google drug names to be sure that they were correct.

In addition to working through the list, the nurse asked:

  • what medications the patient did and didn’t take the morning of surgery?
  • what time the patient took the drugs that they did take?
  • what medications were temporarily discontinued in preparation for surgery & when?
  • what medications was the patient no longer taking in general?

At this point, everyone at the pre-op bedside was incredibly frustrated.

The patient was overwhelmed & panicked that there would be a medication error, the anxiety was exacerbated by the fact that the carepartner could not be at the bedside post-operatively due to strict COVID19 protocols. All of this took place moments before the patient needed to be wheeled in for a complicated surgery with many potential risks and anticipated difficult recovery.

This level of chaos and disorganization can be substantially improved and harm reduced if patients and carepartners are:

  • coached about the importance of medication reconciliation
  • guided as to how to create their Master Medication List
  • recognized as essential contributors to their safe, well-coordinated care.

With the cultural shift from paternalistic to participatory medicine, patients and their carepartners want to brief their medical team and be active contributors to patient safety & outcomes, to reducing costs and improving communication.

Patients should not be given paperwork and information unidirectionally. Care teams need information from the patient & carepartner to be successful in delivering safe care.

Patients & carepartners need to be better prepared with updated, safer ways of confirming & reconciling medications, especially pre-operatively and during any care transitions. Identifying medication discrepancies between what may be listed in the hospital or care team’s EHR and the realities of what a patient IS taking is a serious matter of patient safety to ensure proper, safe care.

Patients can and should prepare their Master Medication List, whether in preparation for an upcoming surgery or for continuity of care. This list should detail what medications, prescription or OTC, a patient is or is no longer taking. Patients should request their medical records from each member of their care team and confirm their current treatment plans to make their master list. There are several resources that patients and carepartners can use to help guide the creation of their medication master list, including from the Agency for Healthcare Research and Quality (AHRQ), the American Society of Health System Pharmacists (ASHP), and the World Health Organization (WHO). Programs such as Vials of Life may also help patients and their carepartners with medication reconciliation efforts.

Let’s reduce the number of medication errors, adverse drug events, poor transitions of care, and emergency room visits due to medication discrepancies by empowering patients and their carepartners with their medical records and guiding them on advocating for their health and safety. Horror stories should be associated with Halloween, not healthcare.

Over My Dead Body

Over My Dead Body

If you died today, who would you want to have access, or not, to your medical records? The Health Insurance Portability and Accountability Act (HIPAA) ensures that personal health information (PHI) is not wrongfully used, improperly accessed, or shared. Did you know that HIPAA also protects an individual’s right to privacy for up to 50 years after their death?

There are many reasons why loved ones may need access to a deceased individual’s medical records. Sadly, families frequently face difficult challenges in trying to access their deceased loved one’s medical records at a time when they may desperately need them the most. It’s both disappointing and concerning to see that discussions and prospective planning about access to one’s medical records after death are often not emphasized throughout life, especially during conversations about end of life care or end of life care planning.

In the United States alone, over 200,000 people have died from COVID19, with no end to the pandemic in near sight. Many of these individuals received care at the hospital, with some patients hospitalized for weeks in intensive care units, receiving specialized care while on ventilators. Families are now receiving astronomical bills for outstanding balances while grieving the death of their loved ones. Some families have tragically had more than one family member die from COVID19. In order to carefully review medical bills as well as potentially appeal insurance denials, families need access to all medical records detailing their deceased loved one’s care. Families may face push back and information blocking as they seek to request access to their deceased loved one’s PHI due to healthcare delivery organizations’ (HDOs) staff uncertainties about HIPAA and lack of individual proper documentation.

The reality is many individuals do not have estate plans, wills, a designated personal representative, an executor of an estate, or power of attorney. A vast majority of the general population, especially vulnerable populations, traditionally marginalized communities, and immigrant populations with limited English proficiency, do not even know about the existence of or have equitable access to proper estate planning, preparing a will, noting a power of attorney, or designating a personal representative.

Many frequently say:

  • These processes are strictly for the wealthy, not people like me.
  • I don’t have an estate or possessions of value to need estate planning.
  • I could never afford an attorney to prepare the paperwork to designate a personal representative.

The words we use matter and the words that are currently used to detail the processes, policies, and workflows dictating how to access a deceased individual’s medical records create a significant barrier for the majority of lay individuals and health citizens in our country.

Here are some other examples of why families may need access to their deceased loved one’s medical records:

  • They may want to better understand their loved one’s medical history, especially in the context of cancer, hereditary conditions, cardiac conditions, and other comorbidities.
  • They may be interested in passing down medical records as part of their family legacy.
  • They may need access to medical records in cases of medical errors or malpractice.
  • They may need access to help with the grieving process and to provide understanding and closure about their loved one’s last weeks, days, and moments of their life.
  • They may want to contribute records to ongoing clinical or scientific research, whether it is for COVID19 or other diseases, like cancer or rare disease.
  • They may need to handle administrative issues with respect to workman’s compensation claims, social security disability claims, or life insurance policies.

Whatever the reason may be, everyone should discuss what to do with their medical records when they die.

There are a number of ways that medical records of the deceased may be accessed. If a will is in place, a personal representative or an executor of the estate may be specified who will be authorized with right of access. In situations where there is no will or appointed personal representative, state laws may recognize a surviving family member through a hierarchy process as the personal representative.

The HIPAA Privacy Rule 164.502(g)(4) permits covered entities to “disclose a deceased individual’s medical records to family members and others who were actively involved in the care or payment for care of the deceased prior to death, unless doing so is inconsistent with any prior expressed preference of the individual that is known to the covered entity.”

Therefore, family members and others such as patient advocates, who had access to a patient’s medical records during their living years, designated by a HIPAA authorization form, are recognized to continue with those access rights after the patient’s death.

This is critically important! While there are clearly rules and policies that provide a framework for accessing the PHI of the deceased, this does not mean that things work smoothly and seamlessly. Expect to encounter problems and proactively prepare accordingly.

At minimum, everyone should specify in HIPAA authorization forms who should be granted access to your medical records, emphasizing in life and after one’s death. Including a copy of this designated individual’s legal photo ID, specifying their relationship to you, as well as providing their contact information can make all the difference in helping a hospital or HDO confirm with reasonable assurance your loved one’s role in your care and consequent right to access after death.

We all must plan accordingly so as to not risk having our loved one’s getting locked out from accessing our medical records after our death or to prevent our record’s from being accessed by family that normally would not have access. For example, many marriages and life partnerships end up in separation or divorce. A new spouse or life partner may be granted access but may not share that access with biological children. Loved one’s may be estranged. Many relationships in life are complicated. Death is often a strong catalyst for many tensions to rise to the surface that may unnecessarily complicate accessing medical records upon a loved one’s death.

With a thorough understanding of the many complexities that families routinely encounter in accessing their deceased loved one’s medical records, Unblock Health has thoughtfully and strategically incorporated simple, digitized solutions to best support all patients and their families to proactively prevent barriers and discrepancies in rightfully and legally accessing the deceased’s PHI. These solutions simultaneously support HIM professionals to ensure HIPAA compliance.

Reach out for a demo today to see how Unblock Health is the patient access digital front door healthcare needs now, in sickness and in health, even after death do us part.

Yours in Unblocking Health,

Shahid Shah and Grace Cordovano

Do You Want To Know A Secret?

Do You Want To Know A Secret?

As consumers, we are encouraged to review a copy of our credit report each year. What’s the big deal about reviewing one’s credit report regularly? Your credit report may directly impact your ability to secure a loan, obtain a credit card, lease an apartment, qualify to buy a home and the respective mortgage rates, purchasing or leasing a car, and even a job application. Checking your credit report can help with financial planning, committing to responsible financial and purchasing behaviors, as well as helping spot identity theft.An error in your credit report may impact your credit score, causing significant headaches. Federal law typically allows individuals to get 1 free copy of their credit report from each of the major credit reporting agencies, including Equifax, Experian, and TransUnion. Due to COVID19, individuals will be able to get free weekly copies of their reports online through April 2021. Upon receiving and reviewing a copy of one’s report, any incorrect information must be reported directly to the business that issued the account or the company that issued the report.

Want to know a secret?

Individuals also have the right to request their free annual medical report from the Medical Information Bureau, Inc, OPTUMInsight, Inc, and Milliman, Inc specialty consumer reporting agencies. While there’s an emphasis for consumers to request their credit report, there is very little in advertisement and emphasis about one’s right to also request an annual medical report.

A medical report is similar to a credit report for your health and health records. Your medical report may contain a combination of details, comprised of both medical and non-medical information, which describe you. Your medical report may list the details of health conditions, adverse driving records, criminal activity or arrests, participation in hazardous sports or hobbies, genetic history, sexual orientation, substance abuse, and details from your credit report. Companies in the business of health and life insurance use the information in medical reports to assess people applying for individual insurance.

In the same way that you should review a copy of your annual credit report, you should ABSOLUTELY request and review a copy of your annual medical report for accuracy, especially if you are applying for any insurance policies, such as life, health, or long-term care insurance.

Mistakes in medical report files may lead to higher premiums and out-of-pocket costs as well as give reason for insurers to reject potential coverage and policies. For example, a coding error made by a physician may lead to an incorrect diagnosis being reflected in your medical report, such as diabetes or metastatic cancer, leading to potential insurance policy denials. Fixing mistakes found in one’s medical report could lead to significant savings in health insurance policy premiums. Disputing errors in medical reports is of critical importance.

Have you requested a copy of your annual medical report? Request yours today from Medical Information Bureau, OPTUMInsight, and Milliman. Tell us about your experiences or tweet about them and tag us @UnblockHealth or use the official hashtag #UnblockHealth.

Yours in Unblocking Health,

Shahid Shah & Grace Cordovano

OneDrive Monthly Subscriptions

Now Where Do I Put Them?

It’s great to raise awareness about medical records and one’s right of access by HIPAA. People naturally begin asking more involved questions, which is a good thing! One question we at Unblock Health get quite frequently is:

Once you get a copy of your medical records, where can I as a patient or carepartner store them electronically? Do you have an app for that?

Unblock Health is not a personal health record (PHR). We do not offer an app to help you store your records once you have collected them. While we are not formally vetting and recommending apps to patients, carepartners, and consumers just yet, there are options currently available for individuals to consider.

Microsoft OneDrive allows users to save their files and images and access them anywhere. A OneDrive Basic account with 5GB of storage is free while 100 GB storage is $1.99/month. Files can be accessed across all devices and even offline. OneDrive can help patients, their carepartners, and families collaborate, sharing records, files, images, and folders of health information via an email or text link. OneDrive options for monthly subscriptions are available here

The CARIN Alliance, a multi-stakeholder collaborative committed to ensuring individuals get access to their digital health information so as to fulfill their health care goals, recently launched the My Health Application website. The website provides consumers with a listing of apps that have committed to the CARIN Alliance Trust Framework and Code of Conduct who have the functionality to aggregate health information. While any apps listed on this site should be carefully reviewed, especially their use cases and privacy policies, these are a great starting point.

What other apps or services have you come across or actually use to maintain your health records? We look forward to watching this space grow with the advent of the health care digital app economy.

Yours in Unblocking Health,

Shahid Shah and Grace Cordovano

20 Ways Patients Request Medical Records & Their Health Information

20 Ways Patients Request Medical Records & Their Health Information

The concept of patient access is often spoken about very matter-of-factly, “just request a copy of your records” or “patients have a right to access their medical records”, as if it was a straight-forward, standardized process.

There is a significant difference between technical interoperability from a vendor and systems standpoint and the real-world interoperability that supports the workflows of a patient navigating their care and their life with a diagnosis or diagnoses.

Medical records and health information need to flow continuously, seamlessly, and actionably in order for patient care to be coordinated, safe, and guided by informed decision making.

Because of a fragmented health care ecosystem, patients must carry a substantial burden of coordinating the intricate details of their respective care. Much of the success and sustainability of the work patients and their carepartners do is deeply dependent on access to all patient health information.

All patient records requests are not the same, nor are they all equal in priority. Medical records requests may encompass a broad spectrum of points of contact as there is rarely a single contact that handles the broad-spectrum of patient records requests.

Here are 20 ways that patients may request medical records:

Patient access is an ever-evolving and complex continuum of endless possibilities. Too many patient access workflows are poorly organized, primarily manual, and paper-based, with zero empathy while simultaneously lacking real-time communication. HIPAA is too often misunderstood by individuals at HDO or physician practices and erroneously cited as the reason why patient and carepartner records requests cannot be fulfilled. It’s no surprise that patients and their carepartners face severe information blocking.

This is essentially a cruel version of the game of hide & seek: finding how to get to my HIPAA-promised medical records and health information.

The American Medical Association (AMA) recently published their Patient Records Electronic Access Playbook to help dispel myths about HIPAA as well as to provide support to physicians and practices on how to properly drive patient access to their health information. The Office of the National Coordinator (ONC) has a guide for patient access, with resources on how individuals may obtain a copy of their medical records. Both resources primarily focus on traditional access to records, not the broad-spectrum listed above.

Unblock Health recognizes that patients and their carepartners have critical work to do in navigating their diagnoses, coordinating their care, as well as in advancing clinical research and innovation. Information blocking denies patients access to the very information they need to make empowered, informed decisions about their care. Every minute lost to a poorly designed patient access workflow is time lost to a diagnosis.

While essentially every aspect of the patient experience has been digitized with innovation, the health care industry has repeatedly turned a blind eye to modernizing the medical records request process.

This ends now with Unblock Health.

Unblock Health is a FHIR native, EHR integration-friendly solution that replaces current inefficient medical records request and patient access workflows with standardized, fully digitized processes, designed to bring empathy and real-time communication to best support patient access. Our technology is the bridge builder between HDO and physician practices and patients and carepartners.

Unblock Health:

  • simplifies and standardizes the continuum of patient access workflows,

  • triages the broad spectrum of incoming access requests,

  • supports real-time lines of communication between brick and mortar health care and modern-day patients, carepartners, and consumers,

  • supports health information management (HIM) professionals prepare their organizations for compliance with Cures Rules

  • helps HDO and physician practices become Cures Rules compliant through personalized education and modernized technology as a corrective action,

  • remedies outdated information blocking workflows and reduces, if not prevents, potential future penalties as per the Cures Rules.

Reach out to continue the conversation with an Unblock Health demo today.

Yours in Unblocking Health,

Shahid Shah and Grace Cordovano

Telemedicine & Patient Data Access: Pandemically Perfect Together

Telemedicine & Patient Data Access: Pandemically Perfect Together

For the last 5 years, telemedicine has been predicted to be the key to transforming health care. COVID19 gave the understudy a coveted, centerstage role, removing more red tape in a matter of weeks than in the last 5 years.

With many states practicing social distancing and sheltering at home, caregivers, patients, and carepartners needed to rapidly pivot and adjust to ensure continuity of care.

In hotspot areas, such as in NJ and NY, health care providers escalated telemedicine implementation efforts to deploy virtual care on the scale of weeks. Many doctors, nurses, and caregivers received some version of training to prepare them to deliver high-quality care virtually. Training may have included aspects of using various technology platforms and equipment, communication skills, documentation, time management, scheduling, and new payment workflows. The American Medical Association (AMA) released their AMA Telehealth Implementation Playbook to help support caregivers and practices in expediting the scaling of telemedicine. Cleveland Clinic shared a COVID19 Response Digital Playbook with resources on implementing a rapid implementation plan for virtual care.

One can’t help but wonder, where is the training and support for successful patient and carepartner rapid implementation and use of telemedicine?

John Sharp, MSSA, PMP, FHIMSS, Director, Thought Advisor of Personal Connected Health Alliance and HIMSS published A Patient’s Guide to Telemedicine as a strong start.

Aside from the basic technological learning and adoption curve, patients need to be coached through how to best prepare for their virtual encounters. The strongest way to start is by reviewing one’s medical records. In general, people should proactively request a copy of their medical records from their doctor or hospital, especially if the case of chronic illness, multiple comorbidities, or a life-altering diagnosis, such as cancer. During this pandemic, accessing one’s medical records to understand your health, to prepare for emergencies, and to make informed, educated decisions about your care during times of uncertainty has never been more important.

Patients need access to their medical records to be proactively prepared for their virtual encounter. Carepartners can help play a significant role in coordinating care by helping with accessing and reviewing medical records.

Medical records hold important details to your health journey. Use them to your personal advantage! They’re yours! Carefully create a basic timeline of your medical history and key health information. Use your records to prepare for appointments and healthcare encounters as if they were a business meeting. Proactive preparation, as a means of emergency preparedness, can be a matter of life or death. The Office of the National Coordinator (ONC) for Health Information Technology (HealthIT) has resources on how to access and use medical records.

Use your medical records to answer these questions & discussion points in preparation for your telemedicine appointment: 

  • What are your diagnoses & when did they roughly start?
  • Do you have a family history of any health conditions?
  • Do you have any concerning symptoms you would like to discuss?
  • What are the names and contact information of the main doctors that you see regularly, for example, your primary care doctor, your oncologist, your cardiologist?
  • Are you currently being treated with any medication? If so, what medications do you regularly take, what dose, and how often, for both prescription & over-the-counter (OTC) medications?
  • Do you have any allergies? How serious is your allergic reaction? Do you carry an Epipen?
  • What is the name of your pharmacy? Where is it located? Phone number?
  • Have you had any surgeries? If so, when?
  • What are you most worried about at this moment?
  • Do you have an advance directive? If so, do you have it on file at your local hospital and with your doctor(s)?
  • Does your family know your end-of-life wishes in the event of an emergency, such as hospitalization for COVID19?
  • Who is your emergency contact? Name, relationship, and contact info?

If you do not speak English or there’s limited English proficiency (LEP), note you’ll need a translator or have a plan as to who will be a make-shift translator in the event of an emergency.

If you are handicapped, have a disability, or need accessible services, this must be noted &conveyed. There are many tools that can help.

In order for telemedicine to be successful for the health system/caregiver side AND for patients/carepartners, patients will need to have their medical records ready as a reference. Don’t assume your patient portal has everything you need. Login and check it out before your telemedicine appointment! Every telemedicine guidance and training should prioritize emphasizing patient data access to their health record and information.

Health systems and care providers would benefit from streamlining their internal records request and patient data access workflows to best support telemedicine adoption, scalability, and sustainability, as well as patient engagement, patient safety, and continuity of care.

Contact us to learn more about how to use Unblock Health as your digital solution for medical records and patient data access workflow transformation to best support your telemedicine efforts.

Yours in Unblocking Health,

Shahid Shah and Grace Cordovano