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Medical Forum / General / General / May 2004Medical Records?
Hi All, When you go to a doctor's office, you sign a release that says he/she can pull up your medical records (I assume this means past medical history). Where does this information come from? Is there a national database that stores this information or do they get the info from the insurance provider? If it comes from the insurance provider, how does the insurance provider have your complete medical history? If you went to the same provider, I could see them having all the information but if you changed providers how would they have previous medical information? Do they get the medical history from the previous insurance company? Thanks > When you go to a doctor's office, you sign a release that says he/she can > pull up your medical records (I assume this means past medical history). > Where does this information come from? Is there a national database that > stores this information or do they get the info from the insurance provider? I wish. No, there isn't. > If it comes from the insurance provider, how does the insurance provider > have your complete medical history? Again, I wish. No, they don't. > If you went to the same provider, I > could see them having all the information but if you changed providers how > would they have previous medical information? They would request records from your previous physician(s). This requires that you (the patient) sign a release form authorizing said release. > Do they get the medical > history from the previous insurance company? Insurance companies do not provide physicians with health information. If they track it, it's for their own use. Some insurance companies (usually HMOs) employ companies like Wellsource to "manage" certain chronic medical conditions, like diabetes, and will occasionally send physicians reports. These are typically of little value. > > When you go to a doctor's office, you sign a release that says he/she can > > pull up your medical records (I assume this means past medical history). > > Where does this information come from? Is there a national database that > > stores this information or do they get the info from the insurance provider? > > I wish. No, there isn't. Perhaps not in the US, but there are national databases in other countries, both administrative and medical, that are used to track resource use. CMS also has an administrative database to track utilization in the Medicare Part A and Part B program. It lacks drug data. > > If it comes from the insurance provider, how does the insurance provider > > have your complete medical history? > > Again, I wish. No, they don't. Why do you wish insurers to have a complete medical record? Personally, I think that my providers and I are entitled to a complete record - but my insurer and employer are not. Moreover - there is NO way that I would ever endorse a governmental agency having my medical record. > > If you went to the same provider, I > > could see them having all the information but if you changed providers how [quoted text clipped - 9 lines] > Insurance companies do not provide physicians with helth information. > If they track it, it's for their own use. That is NOT true. Some insurers routinely feedback information to providers based on standard UR models. The first of such models was implemented in the 70's to manage Medicaid data in Texas and Indiana if I remember correctly. The models were UR outlier based. > Some insurance companies > (usually HMOs) employ companies like Wellsource to "manage" certain > chronic medical conditions, like diabetes, and will occasionally send > physicians reports. These are typically of little value. Except to that physician and his patient. js > Perhaps not in the US, but there are national databases in other > countries, both administrative and medical, that are used to track > resource use. Whatever. This doesn't sound like a clinically useful database, which is what the OP was asking about. > CMS also has an administrative database to track > utilization in the Medicare Part A and Part B program. It lacks drug > data. Also clinically of no value, and (AFAIK) completely inaccessible to providers. > Why do you wish insurers to have a complete medical record? I wish *somebody* did. > Personally, I think that my providers and I are entitled to a complete > record - but my insurer and employer are not. Well, that's a big reason why we don't have centralized medical recordkeeping. > Moreover - there is NO way that I would ever endorse a governmental > agency having my medical > record. And another reason. However, I believe there are many advantages to centralized medical information that override the liberal point of view. I'm not suggesting that complete records necessarily be maintained in a central repository, but some basic continuity-type information (e.g., problem list, medications, allergies, surgical history, etc.) would certainly be useful. >> Some insurance companies (usually HMOs) employ companies like >> Wellsource to "manage" certain chronic medical conditions, like >> diabetes, and will occasionally send physicians reports. These are >> typically of little value. > > Except to that physician and his patient. Nah, they're pretty worthless even then. > > Perhaps not in the US, but there are national databases in other > > countries, both administrative and medical, that are used to track > > resource use. > > Whatever. This doesn't sound like a clinically useful database, which > is what the OP was asking about. GPDRS - may not "sound" clinically useful, but it is extremely useful to the NHS. > > CMS also has an administrative database to track > > utilization in the Medicare Part A and Part B program. It lacks drug > > data. > > Also clinically of no value, and (AFAIK) completely inaccessible to providers. Available to researchers for a fee - has implications for provider organizations and suppliers. Do you ever read the medical literature? > > Why do you wish insurers to have a complete medical record? > > I wish *somebody* did. OK - I think (and the government agrees) that I own the content of my medical record. I should be responsible for maintaining it. There is technology available to allow this. > > Personally, I think that my providers and I are entitled to a complete > > record - but my insurer and employer are not. > > Well, that's a big reason why we don't have centralized medical recordkeeping. No, that is NOT the big reason. The big reason is - NO ONE wants to pay for it. > > Moreover - there is NO way that I would ever endorse a governmental > > agency having my medical [quoted text clipped - 6 lines] > information (e.g., problem list, medications, allergies, surgical > history, etc.) would certainly be useful. Useful to whom? It is MY medical record and no one elses. If there is to be a record maintained I will maintain it. Given the storage capacity of small disks, this is hardly going to be a technology problem. > >> Some insurance companies (usually HMOs) employ companies like > >> Wellsource to "manage" certain chronic medical conditions, like [quoted text clipped - 4 lines] > > Nah, they're pretty worthless even then. You just don't get it - what is it with you and your snippets? http://www.wellpointrx.com/wpw/clinicalservices.screen#thermg read it and then tell me specifically what makes the programs "worthless"? js > GPDRS - may not "sound" clinically useful, but it is extremely useful > to the NHS. But the OP wasn't asking about the NHS. > Available to researchers for a fee - has implications for provider > organizations and suppliers. Do you ever read the medical literature? But the OP wasn't asking about provider organizations and suppliers. And yes, I read the medical literature. What that has to do with the OP's question, I have no idea. > I think (and the government agrees) that I own the content of my > medical record. I should be responsible for maintaining it. There is > technology available to allow this. Any patient is free to maintain a copy of their medical information on their own. What's stopping you? Many of my patients want (and receive) copies of their test results. Some of them keep detailed logs and graphs of their blood pressure and other parameters. A few of them maintain summary sheets containing a list of their medicines, allergies, surgeries, family history, the names of all of their doctors, etc. Very useful. Unfortunately, I could probably count those patients on my fingers (and most of them are engineering/computer types). It seems few people really want to take the time to do this. Even if they do, physicians must still maintain records for their own use, both for the provision of care and for mediolegal reasons. This usually isn't a problem until you need to see a doctor who doesn't know you (say, in an ER, when you're unconscious). >> Well, that's a big reason why we don't have centralized medical recordkeeping. > > No, that is NOT the big reason. The big reason is - NO ONE wants to > pay for it. That's another big reason. >>> Moreover - there is NO way that I would ever endorse a governmental >>> agency having my medical >>> record. You're in ample company. > Useful to whom? Everyone involved in your care. > It is MY medical record and no one elses. If there > is to be a record maintained I will maintain it. Given the storage > capacity of small disks, this is hardly going to be a technology > problem. This has actually been tried several different ways. To date, none have really taken off, for a variety of reasons both practical and economic. >>>> Some insurance companies (usually HMOs) employ companies like >>>> Wellsource to "manage" certain chronic medical conditions, like [quoted text clipped - 6 lines] > > You just don't get it - what is it with you and your snippets? You mean my opinions? They're no less valid than your own. > http://www.wellpointrx.com/wpw/clinicalservices.screen#thermg > > read it and then tell me specifically what makes the programs > "worthless"? I've yet to receive a report from Wellsource or any similar entity that added anything to what I was already doing. All it did was generate extra work in the office to pull the chart and file the report. Maybe I just take really good care of my patients. > > GPDRS - may not "sound" clinically useful, but it is extremely useful > > to the NHS. > > But the OP wasn't asking about the NHS. No? The question was - are there national databases - and the answer is yes there are. > > Available to researchers for a fee - has implications for provider > > organizations and suppliers. Do you ever read the medical literature? > > But the OP wasn't asking about provider organizations and suppliers. > And yes, I read the medical literature. What that has to do with the > OP's question, I have no idea. Physicians are suppliers. > > I think (and the government agrees) that I own the content of my > > medical record. I should be responsible for maintaining it. There is > > technology available to allow this. > > Any patient is free to maintain a copy of their medical information on > their own. What's stopping you? Nothing at all other than inconvenience. A bit contrarian today? >Many of my patients want (and receive) > copies of their test results. Some of them keep detailed logs and > graphs of their blood pressure and other parameters. A few of them > maintain summary sheets containing a list of their medicines, > allergies, surgeries, family history, the names of all of their > doctors, etc. Goody - so? > Very useful. Unfortunately, I could probably count those > patients on my fingers (and most of them are engineering/computer [quoted text clipped - 3 lines] > usually isn't a problem until you need to see a doctor who doesn't know > you (say, in an ER, when you're unconscious). OK - so the solution is to have a complete and accurate medical record available that can be accessed and updated. Fine - why does it need to reside in a national database? > >> Well, that's a big reason why we don't have centralized medical recordkeeping. > > > > No, that is NOT the big reason. The big reason is - NO ONE wants to > > pay for it. > > That's another big reason. The big reason. > >>> Moreover - there is NO way that I would ever endorse a governmental > >>> agency having my medical > >>> record. > > You're in ample company. And for good reason. > > Useful to whom? > > Everyone involved in your care. The only person that matters is me. It needs to be valuable to me without compromising my confidentiality and my relationship with my physicians. The issue of patient confientiality has been addressed by HIPPA for very good reason. It is important to people to have control over the access to there private information. > > It is MY medical record and no one elses. If there > > is to be a record maintained I will maintain it. Given the storage [quoted text clipped - 3 lines] > This has actually been tried several different ways. To date, none have > really taken off, for a variety of reasons both practical and economic. OK - so there's your solution. > >>>> Some insurance companies (usually HMOs) employ companies like > >>>> Wellsource to "manage" certain chronic medical conditions, like [quoted text clipped - 8 lines] > > You mean my opinions? They're no less valid than your own. The lack of depth of thought. Opinions are fine - but without any rationale or substance they are just snippets of baseless conjecture. Hardly makes for discourse. > > http://www.wellpointrx.com/wpw/clinicalservices.screen#thermg > > [quoted text clipped - 5 lines] > extra work in the office to pull the chart and file the report. Maybe I > just take really good care of my patients. And maybe you are just above being informed of ways to improve your practice? js > The lack of depth of thought. Opinions are fine - but without any > rationale or substance they are just snippets of baseless conjecture. > Hardly makes for discourse. Which is precisely why I'm going to conclude this discussion. To date, I have yet to have a conversation with you that I enjoyed. Frankly, my friend, you seem a bit of an a.shole. Feel free to killfile me; I welcome it. > > The lack of depth of thought. Opinions are fine - but without any > > rationale or substance they are just snippets of baseless conjecture. [quoted text clipped - 4 lines] > friend, you seem a bit of an a.shole. Feel free to killfile me; I > welcome it. You just can't stand it when someone actually stands up top your pompous a.s and does so with data. Frankly - if I am a bit, you are the whole, as far as a.sholes are concerned. No - I won't killfile you - I'll keep track of your opinions and show them for what they are. js > I'll keep track of your opinions and show them for what they are. If it makes you feel better, go right ahead. Anything I can do to help. >When you go to a doctor's office, you sign a release that says he/she can >pull up your medical records (I assume this means past medical history). [quoted text clipped - 5 lines] >would they have previous medical information? Do they get the medical >history from the previous insurance company? Insurance companies do not maintain medical records. Doctors do. If you signed a release of information at your doctor's office, perhaps it was to have your prior doctor send your new one the records he has about you. PF > Hi All, > > When you go to a doctor's office, you sign a release that says he/she can > pull up your medical records (I assume this means past medical history). > Where does this information come from? From your previous doctors. The medical privacy laws allow docs to share medical records for patient care. Jeff When you apply for life insurance or medical insurance, the respective company does medical research before they underwrite you. Where does the insurance company get their information or do they go based on the questionaire you fill out? PS: I'm in the US >Hi All, > [quoted text clipped - 9 lines] > >Thanks > When you apply for life insurance or medical insurance, the respective > company does medical research before they underwrite you. Where does > the insurance company get their information or do they go based on the > questionaire you fill out? As an F.P., I routinely receive requests from life insurance companies, long-term care insurance companies, etc. requesting copies of records. In all cases, the patient has to have signed a release form. There is a clearing house of health insurance medical claims. I doubt it is specific to the actualy diagnosis but I do know it is regularly used to underwright health insurance policies. They pull and "MIB" report, which stands for Medical Information Bureau. I wonder how what one of these really says. Having been an insurance agent in the past I never saw one since it was for underwriters only, but it would be interesting to see how this fits in with HIPPA and ADA. -- Patrick H. Mason M.S. OHST, EMT-CT Certified Safety Engineer Emergency Medical Technician-ALS > > When you apply for life insurance or medical insurance, the respective > > company does medical research before they underwrite you. Where does [quoted text clipped - 4 lines] > long-term care insurance companies, etc. requesting copies of records. > In all cases, the patient has to have signed a release form. > The only person that matters is me. It needs to be valuable to me > without compromising my confidentiality and my relationship with my > physicians. The issue of patient confientiality has been addressed by > HIPPA for very good reason. It is important to people to have control > over the access to there private information. Epidemiology would benefit GREATLY from such a huge collection of information. Indeed, epidemiologists do a great job of ensuring confidentiality while maintiaining huge databases. With a centralized database of medical records, there would be the potential for patients to benefit from automated screening for diseases such as cancer. The challenge of maintaining confidentiality seems to be the primary obstacle. Whether a database is implemented by a government agency or a private company, legislation will be the way for the public to ensure that information is kept in the right hands. |
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