The Patient’s Health Record

“You don’t build it for yourself. You know what the people want and you build it for them.”

       Those words were Walt Disney’s discussing customer service.  No one questions Walt’s ability to create and build exactly what people want; movies, theater productions and theme park rides.  In contrast, Healthcare in America was never created to give the patient what they want.  It has been built for payers, physicians and in general, patients are last.

       While there are many aspects to healthcare that are not patient-centric, one specific item that deserves a reevaluation/(or reinterpretation) is the medical record.  For years there was never a “medical record” of care, just the trust in your physician’s clinical acumen and memory.  Then there was a hand written note about patient encounters, then dictated notes until today when the majority of physicians use some type of electronic medical records.ehr-1476525_1280

       Electronic medical records are difficult to use.  For patients it can be impossible to obtain or transfer one’s own medical record.  Physicians loathe EMR’s for taking their gaze and attention away from the patient to document in the EMR, all the while feeling like creating a note in an EMR is geared solely towards obtaining reimbursement from an insurance company.

       With respect to Mr Disney, why didn’t we create a medical record for patients?  With the technology we have today why shouldn’t the patient be in charge of their own record, releasing physicians and their offices from maintaining thousands of patient records. 

       Let’s call it a Patient Health Record, or Patient’s Own Record.  The patient would have access to update their personal and family history anytime they want.  If they have a family member diagnosed with colon cancer, they can add it immediately.  They aren’t waiting until their next office visit, when they are more than likely ill and focused on more immediate concerns. 

       Every physician, nurse, hospital that a patient visited would have access to every patient’s entire medical record because the patient would bring it with them.  This could be on a device or web-based portal.  A physician or member of the healthcare team attending to a patient could record the necessary medical issues, findings and results and most importantly instructions for the patient.  All this would be then given right back to the patient.  The medical record would be a living history of the patient and for the patient. 

       Of course there are downsides to a plan like this.  Medical liability issues would be first and foremost.  How could you defend your medical care when you don’t have a copy of the patient’s chart and do not know the fallibility of those notes?  Without a record keeping system of some sort, how would physicians submit claims and be reimbursed?  A change like this is really almost inconceivable.  But anything that creates a conversation and stimulates ideas that would limit the burdens on physicians and empower patients to be more proactive in their health, is something worth pursuing.

August 2016 MySugr Diabetes Logbook

What it is: A mobile app that provides users the ability to track blood sugar, medications including insulin doses and meals. 

Front Page MySugr

The Monster that greets you in the MySugr Diabetes Logbook

What devices: iPhones, Android devices

Cost: Free (with Premium options you can buy)

Who should use it: People with Diabetes who want to use a mobile app to help track and manage their blood sugars

Why use it: My Sugr Diabetes logbook is serious diabetes app that doesn’t take itself too seriously.  Patients can use the app to track their blood sugars, medications, insulin use, activity, episodes of hypoglycemia or hyperglycemia, carbohydrates consumed and you can even take pictures of your meals.  All of the these tools come with the theme of “monsters” like the one that will “eat” your blood sugar levels that you log.  Graph mysugr

     The experience of using the MySugr App is intuitive and easy to track all the important facets of diabetic care.  At the top of the app is a graph of blood sugars that you scroll though to easily see a visual trend of blood sugars.  Once you have logged enough values, it can even estimate your A1c, and as all diabetics know, this is one the most important values your doctor looks at.  With just a swipe across the phone you can easily review the last 7, 14, 30 and 90 day averages.

     Other great features of MySugr Diabetes Logbook include the ability to create individual reports of all the metrics you track.  In CSV format you can print, email or text the values.  With a an upgrade subscription to MySugr Pro, at $27.99 per year, you can create PDF or Excel files for your data. There are several Challenges built in to the app to keep you engaged and feeling a sense of accomplishment.  The app can also sync with several blood glucose machines, like the Accu-Chek Aviva Connect.  With this device, when checking your blood sugar the meter can immediately and wirelessly sync up with MySugr app.  

     Overall, MySugr Diabetes Logbook is an excellent and easy to use tool to monitor as aspects of diabetic care.

Input MySugr

The input screen for tracking all the important diabetes metrics.

Profiles in Digital Health: Dr Matthew Haden

       Matthew Haden has practiced medicine in very diverse types of healthcare systems.  He has worked in the county hospitals heavily dependent on state Medicaid, at Mayo Clinic in Scottsdale, Arizona with a much more affluent patient population with private health insurance and even a system of universal healthcare while working in Costa Rica.  Now he is working in a new model of care and sees digital health as an important tool.

       Dr Haden has created a new Direct Primary Care practice in Washington DC called doctor-matthew-r-haden-family-gpModern Mobile MDs.  Direct Primary Care is a new model of care the eliminates the fee-for-service insurance payment in lieu of direct monthly payment to your doctor.  That lack of interference from insurance companies can free physicians to be more engaged and creative with their patients. 

       “When you cut the reins that insurance imposes, it unleashes innovation and flexibility.  Suddenly all that matters,” says Dr. Haden,  “is providing good care in whatever way is most appropriate, weighing the medical issue at hand, appropriateness of in-person versus virtual care, on-demand versus asynchronous care.”

       The combination of Direct Primary Care and digital health technology can create better team based medical care as well.  By using nursing staff, nutritionists and health coaches virtually, Dr Haden says “you can more rationally divide the work amongst the team.”  Even the patient becomes an active part of the Direct Primary Care Digital Health Team.  For his patients with young children, Dr Haden recommends parents purchase the Cellscope Oto product and he can review eardrums where he or his patient happen to be.  By being able to provide these digital health options, Dr Haden can put his patients needs first, saving time, money and parents from a few sleepless nights.

       In his current practice, Dr Haden does not perform virtual video visits.  He sees that changing. “As my practice grows, I see it as essential to provide good and convenient care.”

       Dr Haden leverages digital health technology with the flexibility he has outside of traditional insurance model to provide top quality patient-centered care.  He can not imagine a time when he is in anything other than a Direct Primary Care practice and knows that digital health technology is an exciting component of the future.  “Technology will continue to empower and evolve the way direct primary care is provided.”

Profiles In Digital Health

Today I am posting the first of a new series about Digital Health in real life.  How are physicians and patients using Digital Health and where do they think the future is?  Our first profile is of Dr Matthew Haden.  As always, any feedback on the post or my website in general is greatly appreciated.