“It’s all in my chart.”

“I’m sure you’ve read all about my history from my chart.”

“You can just look in my records from my other doctors.”

“I don’t know/remember, just look that up in my records.”

I hear statements like these frequently, and I cringe every time. It’s not your fault, but I have found that there is a general assumption among patients that medical practices have access to your complete medical record/chart. Unfortunately, this isn’t true. Let’s clear up a big misconception.

The Misconception

Many people believe that there is some sort of database or central access point to your Electronic Medical Record (EMR) that all medical practices/hospitals have access to. If you are under the care of multiple doctors, they all have access to the same medical record.

This isn’t true. But, it would be nice if it were.

EMRs were sold to all of us as a way to ensure continuity among all of your healthcare providers.

But that never happened.

It’s not uncommon for me to see a patient in clinic and have no access to any of their previous medical records. The patient may have access to it, but I do not. Patients often will pull out their phones, log into MyChart (or another company’s equivalent), and show me test results that are relevant to their treatment. It’s not that I didn’t care to look before, but I actually don’t have access to those test results. In fact, I may not even be aware they had those tests done! There are even times I can’t access results of tests I ordered for the patient myself!

SO HOW DID THIS HAPPEN?

Let’s go back to old school medical records. There used to be a physical file/folder with actual pieces of paper that composed your medical record/chart. Each separate doctor’s office had a completely separate physical folder for you. This system meant there was no quick and easy way for a doctor to access information from your other medical records at other offices. Obviously, it’s ideal for all your providers to be on the same page and aware of what the others are doing/recommending. The workaround was mailing or faxing copies of medical records back and forth among the providers so they could continuously update your physical folder at each doctor’s office.

Imagine your primary care provider (PCP) is treating you for five different things. However, one of those things requires referring you to a cardiologist (heart doctor). After seeing the heart doctor, getting some tests run, and making a plan for treatment with that heart doctor, you go back to your PCP to continue working on the other four issues.

At this point you have two completely separate physical records at two different locations that each contain different information. The only way for both offices to be on the same page is for someone at the heart doctor to send a physical copy of your record to the PCP AND that physical copy is received and appropriately filed in your chart at the PCP office. Now, that must happen every time you see either of those doctors. The administrative burden gets even more complex and confusing if your PCP later tells you you also need to see a specialist for your lungs, or if you’re later diagnosed with cancer and need to see another specialist.

“Oh, can you please send those test results to my PCP, lung doctor, and cancer doctor too?”

Now multiply that situation by the thousands of patients a single doctor sees. You can imagine with the rooms lined with filing cabinets full of physical records, sometimes things slipped through the cracks, and there’s a decent likelihood that medical records across multiple doctor’s offices were not in sync.

ENTER THE ELECTRONIC MEDICAL RECORD!

What if your medical record was digital instead of physical and was accessible from anywhere? If you can check your email from anywhere in the world, why can’t we do that with your medical record? So any doctor you see can simply log in and see your medical history, test results, and all of your other doctors’ notes! This system would be continually updated in real time and immediately available to you and all your providers. Problem solved!

Except not.

In theory, this works great! However, in practice this never happened. When medical records were “going electronic” many companies created their own version of EMR software. Think of Google vs. Bing, Facebook vs. Twitter, Apple Music vs. Spotify, iOS vs. Android, etc. Pretty soon the medical record market had many competing EMR programs, all with their own pros and cons. Here’s the big catch though: Different EMR programs do not communicate with one another! In fact, the same EMR program doesn’t necessarily even communicate with itself across different health systems!

A health system is a collection of hospitals and medical practices under the same umbrella company. For example: Mayo Clinic, John Hopkins.

An independent practice is not affiliated with any healthcare system. It’s sort of like opening your own local burger place instead of a franchise or chain.

As with everything, there are politics involved. But setting politics aside, here’s how this all shakes out. This could get complicated, so I made some visual aids.

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Essentially, if all the right things line up, EMRs work beautifully! However, they frequently don’t. If all of your medical providers are in the same healthcare system and also use the same EMR program, then sweet! But if not, they are essentially forced to revert to the old way of faxing or mailing records to each other. This is wasteful and inefficient. I mention the ridiculousness of what I call the “print-scan-fax-print-scan” system in THIS POST.

For a field that prides itself on being on the cutting edge of technology, healthcare (at least in the U.S.) is HEAVILY reliant on fax machines. Think about that…

Disclaimer: Yes, some EMR systems have some limited communication ability among them; however, it feels like an afterthought. Navigating that functionality is clunky, often unorganized, and unreliable.

The EMR Mirage

More disclaimers:

1: This discussion isn’t meant to simply bash EMRs. They are not inherently bad. I actually really like certain EMR systems (and dislike others). There are many pros and many cons to EMRs. This post is simply meant to dispel a common misconception I hear often by explaining one specific aspect of EMRs.

2: I am not necessarily calling for all of healthcare to be on the same EMR system. That gets real political real fast. I do have opinions about that, but this post is long enough already. 🙂

Learn more, stay humble

TL;DR: One supposed benefit of moving from old school physical medical charts to Electronic Medical Records was that all of your medical providers would have easy access to your medical history/record. But that never happened. Yes, your chart is all digital now, but that doesn’t mean your doctor can access it. And there’s still a good chance it all gets printed out and faxed anyway. 🤷‍♂️