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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

Buckle In

Buckle In

When we rung in the New Year, many called the decade upon us the New Roaring 20’s. March 2020 required a seatbelt buckled in tight.

  • Coronavirus became a regular part of our daily vocabulary.
  • Positive cases began to rise on the West and East coast.
  • For the 1st time in 58 years, HIMSS was cancelled due to the coronavirus.
  • The heavily anticipated rules were released.
  • Handshakes & hugs were replaced with elbow bumps and head nods.
  • A surreal global pandemic grew.
  • The world was reminded of proper hand-washing, cough hygiene, and social responsibility.
  • Social isolation started.
  • Stock markets tumbled.
  • Schools closed, home-schooling began.
  • Businesses closed.
  • Working remotely became expected.
  • Countless have lost their jobs.
  • Life transferred to Zoom, GoToMeetings, FaceTime, or the hospital ICU.
  • Front-line caregivers began running out of supplies.
  • Our visits with the elderly happened through a window pane.
  • Delays in testing and shortages of ventilators became grim.
  • We watched Italy collapsing in front of our eyes, death tolls rising.
  • Weddings, funerals, and graduations were cancelled.
  • The scramble for COVID-19 testing grew into desperation.
  • HIPAA requirements were loosened.
  • The tolls on mental and physical health for those on the front lines: catastrophic.
  • Grocery stores were ransacked, with no toilet paper, hand-sanitizer, cleaning supplies, or essentials in sight.
  • Patients considered high-risk, due to multiple comorbidities, disabilities, being immunocompromised, or in active treatment for cancer were filled with the depths of fear and anxiety.
  • Procedures, surgeries, and treatments were cancelled or postponed.
  • More and more doctors and nurses became sick caring for the most vulnerable of patients.
  • Telemedicine became a necessary lifeline.

The disparities of our healthcare system and the barriers patients face in getting the care they need have never been more self-evident.

The need for patient access to all health information is undeniable. The need for educating patients about the importance of their medical and health information is indisputable. The need to support hospitals to provide tools to best support patients and their carepartners is of essence.

We at Unblock Health have been busy supporting patients, carepartners, and health systems around the clock during what will forever be noted in history as the pandemic of COVID-19.

We look forward to sharing our takeaways and experiential learnings throughout April. In the meantime, we wish you all to stay safe, as healthy as possible while practicing social distancing.

If you haven’t done so already, check out our Patient Impact Stories collection, , also excitedly launched this month, which highlights all the reasons why having access to your health information can be literally a matter of life and death. While you are practicing social distancing, consider submitting your own stories to be added to this dynamic collection!

Yours in Unblocking Health,

Shahid Shah & Grace Cordovano

Patient Advocate Services

Why is an Amazon delivery tracked better than a newly diagnosed cancer patient’s medical records request?

Current patient medical records requests workflows at health systems, hospitals, cancer centers, and physician practices pose significant barriers to patient continuity of care, patient safety, patient outcomes, and, most importantly, trust.

Our health care ecosystem loves to boast about “innovation”, “placing the patient at the center of their care”, “empowering patients”, and “enabling consumerism”. The problem is that many healthcare delivery organizations (HDOs) do a remarkably poor job with the most visible of patient services: initiating, tracking, and resolving medical records requests.

Today it’s easier to track the purchase of a $3 box of cereal in a complicated supply chain than it is for a cancer patient to figure out where a request of their own medical records is at a typical cancer institution. It’s easy for us to find out where we bought our cereal, which truck or plane it’s on, and when it will arrive on our doorsteps.

Every day, patients across the United States make a seemingly straightforward request of their care providers: “may I have my medical records so that I can get a second opinion for my terminal cancer diagnosis?” This deceptively simple patient request kicks off lots of behind the scenes activity at HDOs because it’s more complicated than it seems.

But before we talk about the necessary (or sometimes unnecessary) complications at HDOs, let’s look at another request we make regularly – of our financial institutions. Every day, patients across the country make a similar straightforward request of their banks: “may I have the money you’re holding for me so I can use it buy something another institution?” Think about these two requests – medical records might be a little more complicated, but the reason for the request and the outcomes should be the same, namely that each institution is holding something on behalf of a patient and the patient needs access to it. But, why is it easier to ask our banks for money they’re holding for us versus HDOs that are holding our medical records?

The answer is simple: processes, procedures, workflows, and staff training. The bank knows that they can use our money while they’re holding on to it (e.g. lending it to others) but also know that we can ask for it whenever we want so their entire business is built around that fact.

At many healthcare delivery organizations (HDOs), the medical records request process is stuck in the phone and fax age because HDOs frequently treat patient medical records as internal business documents and not assets they’re holding on behalf of patients. HDOs often believe they’re doing a patient a favor by handling their medical records requests – in reality, and with the newest patient data access regulations clearly stating it, HDOs are supposed to hold records for patients like banks hold money.

Because the requests for medical records is treated like a favor, after making a request, most patients never receive a single confirmation of receipt from their care provider or health system or hear a single update in the form of a call, email, or text. Patients often will fax requests multiple times out of concern that the request may have never been received causing duplicate requests to be potentially put into workflow queues. Patients may fax the same request to different departments and different fax numbers in hopes of expediting the request. Patients may repeatedly call and leave messages regarding their records requests as well as physically stop by the office for updates. This is a waste of everyone’s time and resources – but even more importantly impacts patient outcomes by delaying care or increasing the likelihood of medical errors.

Imagine having to fax a request to your bank to get access to your cash instead of just stopping by an ATM. Now imagine that you needed to pay for an emergency bill for your child and the bank not only doesn’t give you the money it is holding for you, but makes you send multiple faxes and make phone calls to ask why you cannot access your own money. Banks that treated their customers this way would close quickly but HDOs treat their patients this way regularly with no consequences.

Until now. Not having a streamlined process for patients to access their medical records may become a finable offense under the proposed information blocking rules.

Case in point: HHS recently charged Bayfront Health St. Petersburg hospital with information blocking, fining them $85,000 for failing to give a mother HIPAA compliant access to prenatal records about her child. When the proposed information blocking rules are finalized and implemented, entities that are charged with information blocking could face fines as high as $1 million per instance of information blocking.

A second case of information blocking was charged against Korunda Medical, a comprehensive primary care and interventional pain management company in Florida. The company was found to have failed to send a patient’s medical records in electronic format to a 3rd party in a timely manner as well as charging more than reasonably permitted under HIPAA.

Hospitals and care providers should respond as soon as possible to confirm receiving a medical records request. Here’s how:

  • Requests should be submitted through an online system – sort of like a “help desk” for medical records. There are many free, open source, and commercial customer support ticketing systems that can easily handle requests directly from patients – even through patient portals.
  • Requests should be triaged for urgency. All ticketing systems allow sorting and filtering and can highlight the most important cases.
  • Patient questions or concerns should be addresses digitally in the ticketing system. Care partners and patients should have their issues addressed immediately, ideally the same business day for urgent requests that could impact a patient’s health outcomes.
  • Notifications should go out when the state of a request changes. All modern ticketing systems can easily notify, by email or SMS, when information is lacking.

By having no lines of communication with patients or the care partners that may be helping with coordination of a patient’s care, hospitals and care providers risk being flooded with redundant faxed and mailed requests as well as endless phones call inquiries and messages regarding records requests. The redundancy and poor workflows unnecessarily tie up what may already be overextended or limited staff, further jeopardizing fulfilling records requests in a timely, HIPAA compliant manner.

What can you learn from the Bayfront Health St. Petersburg Hospital and Korunda Medical cases? That’s a digital request tracking is no longer a luxury, it’s a necessity.

While you can build your own, a turnkey solution to your patient requests tracking problems is now available. In less than an hour you can have a new system up and running within your institution.

Our company, Unblock Health, has studied common healthcare delivery organization patient request handling workflows and understands the difficulty that patients routinely encounter in attempting to gather their medical records. Unblock Health has designed a standardized, digitized workflow to seamlessly communicate with patients and their loved ones, providing a way to send confirmation of receipt of medical records requests, providing a tracked way of asking questions, status updates, or notifying patients of anticipate delays or request denials.

The turnkey platform strategically collects and composes all necessary information and details pertaining to a medical records request, including flagging for urgency of request. Unblock Health is designed to alert health systems and physicians of unfulfilled medical records requests, drawing attention to poor workflows and inefficiencies, to help prevent requests from falling between the cracks, leading to potential information blocking charges. Not only is Unblock Health meeting patients and carepartners where they are and truly fostering autonomy and empowerment, Unblock Health can strategically assist health systems and care providers in significantly stream-lining and improving their workflows so as to be HIPAA complaint and reduce or even eliminate the risk of being fined for information blocking.

Unblock Health is FHIR native, fully integratable, and ready to partner with hospitals, health systems, and care providers. While fines may be paid and corrective action plans may be put in place, having your reputation publicly marred as being an information blocker as well as endangering patient continuity of care are your most expensive and damaging losses. Reach out to Unblock Health today to discuss how to proactively best prepare yourself for the implementation of the proposed information blocking rules. We’ve solved the Rubik’s cube for you.

Yours in Unblocking Health,

Shahid Shah & Grace Cordovano

medical records errors and omissions

The Dangers of Errors & Omissions in Your Medical Records

So you get a copy of your medical records & dive in, reading line by line, trying to make sense of your new lung cancer diagnosis.

“Wait a second, this doesn’t sound right. This is a mistake. I don’t have a history of a heart condition & I don’t smoke cigarettes”, you mutter to yourself.

You call your oncologist’s office to report the mistake you found & ask to have it updated. You’re told to write down the correction & fax it to the office. You do exactly as you are told.

A month later at your next follow up appointment, you ask your doctor if your record was updated & the correction was made. He looks up at you with a deer-in-headlights-look that clearly signifies a NO.

On your way out, you stop at the front desk, write the correction down again, & the staff assures you they’ll take care of it.

Lather, rinse, repeat. Months later, it’s still not corrected. You also find out your cancer is progressing. The nurse asks if you are still smoking cigarettes. Your treatment options are discussed but there are concerns of trying new medications because of your heart condition. Cardiotoxicity is a common side effect of many cancer treatments. It may exclude you from a clinical trial.

There are endless stories of errors & omissions that patients have found upon reviewing their medical records.

Some common mistakes that are noted include:

  • Incorrect diagnoses & conditions

  • Incomplete family histories, such as an extensive family history of cancer

  • Medications that you’ve never taken or have discontinued

  • Reports of pregnancies in those who have never been pregnant

  • Surgeries in people who have never been operated on

  • Symptoms that have never been experienced

  • Documentation of mental health illnesses, from depression, bipolar disorder, to suicidal ideation where no history exists

  • Errors in tobacco, alcohol, substance use

Imagine getting a copy of your records and finding someone else’s records in your file, such as a sexually transmitted disease (STD) screening or an imaging or surgical report.

Imagine having an anaphylactic allergy to morphine and no matter how many times you make a note of it in your paperwork, it never makes it into your file. Some omissions can be deadly.

Patients need to be able to correct these errors & omissions.

In 2020, this is the epitome of poor workflow, information blocking, patient harm, and downright dangerous.

Unblock Health can ease the burden patients and their families face in correcting errors and omissions in their medical records. Instead of wasting precious time and effort generating handwritten requests for record amendment requests, the patient or their advocate could have logged into Unblock Health to initiate an addendum request and performed the following, entering:

  • basic patient information, name, date of birth, address, and a medical record number if available

  • the nature of the addendum request: for example, incorrect diagnosis or missing anaphylactic allergy

  • the facility contact information that needs to receive the request

  • the fax number, email address of the medical records office.

  • where the addendum request, if approved & even if denied, needs to be linked and sent: facility name, doctor name, their fax number, or mailing address.

  • contact information in case any questions arise,

  • a phone number and email for tracking and communication updates from the hospital.

The Unblock Health addendum request is received by the healthcare provider’s office and a communication confirming receipt is sent to the patient. The healthcare provider may electronically inquire about the addendum request if there are any questions or concerns, all of which are documented and tracked within the Unblock Health platform. Unblock Health requests are triaged by urgency specified by requester. Urgent requests are flagged for expediting. Patients receive real-time tracking updates to monitor requests. Unblock Health requests are carefully tracked. If no response is received acknowledging receipt of the Unblock Health addendum request within a business day for an urgent request, a reminder will be initiated. Patients will receive notifications of approval or denial via Unblock Health. Unblock Health provides patients with a standardized solution to also address addendums that are denied, tracking the entirety of information exchange and communication. Patients may desire to have their denied addendum requests added to their medical record and may request to do so via the Unblock Health platform.

Requests that are ignored will be publicly addressed on a wall of shame and by tagging the facility on Twitter, tagging ONC, OCR, & HHS for awareness. Formal complaints will be filed as necessary. Similarly, requests that are addressed and completed will be acknowledged in the public domain on the wall of data access champions, tagging ONC, OCR, & HHS for awareness.

Have you ever found an error or an omission in your patient record? If you have, were you able to successfully get it corrected?

Yours in Unblocking Health,

Shahid Shah & Grace Cordovano

Information blocking

When a Failing Heart Faces Information Blocking

A 65 year old patient with multiple comorbidities has been in & out of the hospital with what has recently been diagnosed as advanced congestive heart failure. The patient & family are advised to seek a 2nd opinion immediately to both confirm the diagnosis as well as to see if the patient is a potential candidate for a specific, last resort procedure. If the patient is deemed not a candidate for the surgery, at home hospice is advised to be urgently pursued.

The second opinion appointment can’t be scheduled until ALL pertinent records & images on CD are received AND reviewed by the 2nd opinion physician’s office (at another hospital, in another state). This pre-screening process is common at many disease-specific specialists’ practices, ensuring that only appropriate candidate patients are added to schedules that are already significantly overwhelmed with patient emergencies.

The patient & family asked the hospitalist and charge nurse to expedite forwarding records & images on CD to the cardiothoracic surgeon that would be doing the 2nd opinion. The family was told to go to the medical records office. Being that it was 6 pm, office was closed for the day.

The family returned to the hospital the next day, a Saturday morning, to pick up the patient being discharged & stopped by the medical records office which was, to their surprise and despair, closed for the weekend.

The patient’s portal hadn’t been updated with all the critical test results, radiology reports, or anything useful from this or the previous recent hospitalization. The were no MRIs, X-rays, or angiograms available, no lab work or any clinical notes. There was no way to report this back to the hospital to say: Why isn’t my patient portal updated?

Before they left the hospital, a nurse printed out a medical & radiology records request that the family filled out. The family was advised to go to the medical records office and SLIDE THE SIGNED REQUESTS UNDER THE CLOSED DOOR so when the office reopened on Monday morning someone would step on it receive it.

The family called first thing Monday morning to confirm the request was received and left a voicemail. They called 8 more times until finally someone called back that afternoon confirming the request was received. No further information was given as to when it may be ready except that the office was “busy”. The family begged in tears to expedite faxing the records and to have the images on CD be overnighted to the cardiothoracic surgeon’s office as this was the patient’s last hope. The medical records office representative said they would get the records faxed by end of week but that a separate request had to be sent to the radiology department to get copies of images on CDs. Also, CD’s could not be sent overnight as there was no mechanism to accept electronic payment or shipping for that request. Images on CDs would need to be picked up in person or mail standard US mail. The family needed to resend the radiology records request directly to the radiology department as the medical records department stated they did not handle those requests and they could not forward the request themselves as it was “not their responsibility”.

A member of the family needed to leave work early to go to the radiology department to demand a copy of images on CD now so they could be overnighted out of state at the family’s expense.

A patient’s heart is slowly failing and their last chance at hope is in a holding pattern due to a poor records request work flow. Imagine it was your parent’s heart, your spouse’s, or your own. What if this was your child’s heart?

A patient advocate had to step in to escalate and resolve the bottleneck, repeating many of the phone calls, faxes, and also going to the hospital in person, speaking to multiple managers and supervisors.

In 2020, this is the epitome of poor workflow, information blocking, patient harm, and insanity.

Unblock Health can ease the burden patients and their families face in acquiring records in a HIPAA compliant manner in the format they specify by automating the process. Instead of wasting precious time and effort pursuing multiple avenues hunting for medical records and images on CD, the patient’s advocate could have logged into Unblock Health to initiate a request and performed the following, entering:

  • basic patient information, name, date of birth, address, and a medical record number if available

  • the nature of the request and information blocking being experienced: for example, empty patient portal or emergency request to expedite records to an out-of-state specialist

  • the facility contact information that needs to receive the request

  • a signed medical records request, authorizing the hospital listed to release the patient’s medical records for emergency continuity of care purposes

  • the fax number, email address of the medical records office.

  • where the medical records needed to be sent: facility name, doctor name, their fax number, or mailing address.

  • contact information in case any questions arise,

  • a phone number and email for tracking and communication updates from the hospital.

The Unblock Health request is received by the healthcare providers office and a communication confirming receipt is sent to the patient. The healthcare provider may electronically inquire about the request if there are any questions or concerns, all documented and tracked within the Unblock Health platform. Unblock Health requests are triaged by urgency specified by requester. Urgent requests are flagged for expediting. Patients receive real-time tracking updates to monitor requests. Healthcare providers may send requested records to the specified healthcare provider as well as to the patient. Unblock Health requests are carefully tracked. If no response is received acknowledging receipt of the Unblock Health request within a business day for an urgent request, a reminder will be initiated. Requests that are ignored will be publicly addressed on a wall of shame and by tagging the facility on Twitter, tagging ONC, OCR, & HHS for awareness. Similarly, requests that are addressed and completed will be acknowledged in the public domain on the wall of data access champions, tagging ONC, OCR, & HHS for awareness.

It’s time to end information blocking by streamlining the way patients, their carepartners, and healthcare providers work together to handle medical records requests. In many cases, it’s a matter of life or death.

Do you have a personal experience with being unable to get a copy of your or your loved one’s medical records in the context of an emergency or earth-shattering diagnosis? How many phone calls and faxes did it take? Share your stories below. Share Unblock Health with patients struggling to get their health information today.

Yours in Unblocking Health,

Shahid Shah & Grace Cordovano