In my last post, I outlined the need for Health Record Portability as well as the obstacles to its widespread implementation.  However, there are a few inroads being made.  Here are some of those initiatives.

From the healthcare provider viewpoint, some communities have launched their own Health Information Network (HIN) that enables community physicians, hospitals, labs & other healthcare providers to share their information. You can think of it as a healthcare information utility that supports health information exchange.  This sharing is always dependent upon the consent of the individual patient.  One example with which I am familiar is the East Tennessee Health Information Network (etHIN) in Knoxville, Tennessee.  The hospital systems & physician practices pay a fee to etHIN to be able to share their patients’ health information.  One feature that would have helped me to keep track of my pneumonia vaccine is a Vaccination Gateway that etHIN provides.

But what can you do as a patient, especially if you live in a community without a health information network?  From a non-technological perspective, you can keep paper copies of your medical record.  Usually you’ll want to organize them by practice or medical issue, but if you have some condition that gets monitored by some lab test, you’ll want to group them together.

There is a more modern approach that you may want to consider if your physician’s EMR system supports it.  Microsoft has a free cloud storage application called HealthVault that can help you manage all your electronic medical information in one place.  Once you set up your account, you can ask your physicians (past and present) who use an electronic medical record to send your files to your HealthVault account.  Not all EMRs can provide your records in a format compatible with HealthVault.  It is far from perfect, but it is a beginning.  Hopefully we will see more EMRs that are compatible with HealthVault in the years to come.  You can also upload any records that you have scanned into your computer. A great feature is the ability to create an Emergency Medical Information card that includes your allergies, medications you take, health conditions you have and emergency contact information.  It also has access information so an Emergency Room physician can view your HealthVault record.  It can be folded to fit in your wallet or purse.

Next time I’ll share some examples of situations I’ve encountered where health information sharing just hasn’t worked and, in a later post, some possible ways to prevent these problems.  As always, please share your thoughts and comments.

For Your Health – Dr. Bob

Shortly after publishing my last post, The $29,000 Appendectomy! (Brought to You by Cost-Shifting), my daughter e-mailed me a link to a video on the CNN website in which Dr. Sanjay Gupta gives some further insight about hospital charges and cost-shifting. As always, he did a terrific job, and I urge you to Click Here to check it out.

I’ve always admired Dr. Gupta’s interviewing skills and ability to clearly explain some complicated medical issues to his audience.

As always, I welcome your comments!

For Your Health – Dr. Bob

When you need elective surgery, make sure you evaluate your treatment options.

This includes not only how you will be treated, but also where you will receive the treatment and by whom.  Here’s how I viewed my situation – In my case with my multinodular thyroid with an especially large nodule on the right, I was given the option of just having the right side of the thyroid removed.  In that case there was a good possibility I would not have to take daily thyroid hormone replacement, but there was also a small possibility that there might be a cancer in the remaining thyroid.  However, most thyroid cancers are very slow growing.  If I kept the left half of my thyroid, I’d need periodic thyroid ultrasounds and follow-up.  At some point in the future I might need the left side to be removed as well.  Realistically with my cardiac history and advancing age I figured that my risk for surgery will only get worse as time goes by, so I chose to have the whole gland removed.  This way, I will know definitively if this is any cancer in any of the thyroid.  The only downside is that I now have to take thyroid medicine every day, but, since I already take daily medications for my blood pressure, that didn’t seem like such a negative.  Your potential treating physician should be able to help you understand the pros and cons of your treatment options.

Just as important, especially if you are having surgery is how much experience has your surgeon had with the procedure as well as the outcomes of the hospital for that kind of procedure.  I was initially evaluated by specialists at a local community hospital about 20 minutes away from my home.  I considered having my surgery there until I learned that the surgeon does only about 25 of these procedures a year and the hospital had a higher mortality with this kind of surgery than average.  Fortunately I live only 30 minutes away from a national center which also participates in my health insurance network.  Their mortality is better than average, and I had surgery by the chair of the department who does 300 of these a year.  Often your health plan will have some quality information about the hospitals and physicians in their network.  I used the information compiled on www.health.usnews.com to help me make my decision.

I hope these last four posts will prove useful if you are faced with new symptoms that might require surgery.  Please share your experiences with us!

For Your Health – Dr. Bob

As you seek treatment for your problem, you will need to advocate on behalf of yourself on several levels:

1. Make sure you know and comply with your health insurance rules and procedures – Do you need to get tests, referrals or procedures (even if they are outpatient procedures) preauthorized or precertified?
2. Make sure you see physicians and use facilities that are in your health insurance provider’s Preferred Network.  Otherwise, your share of payments may be larger than if you “stayed in network.”
3. Try to move things along as quickly as possible.  The people scheduling the tests & appointments are going to try to fit you in to the schedule where space allows.  If the test can be done at more than one location, you may want to ask whether it can be done sooner at a different location.  Similarly, some doctors practice at more than one office.
4. If the appointment gets scheduled further out than you’d like, ask to be put on a waiting list.  That’s how I was able to get my thyroid removed 3 months earlier than it was originally scheduled.  Someone canceled a week before their operation & the surgeon’s office called me to see if I would like to take their place.  I had to scramble to get a few tests done, but I was able to do it and forego three months of anxiety while waiting for the original date.  I can relax.

Another non-medical reason to try to move things along could have to do with where in your insurance policy year you are and where you stand in regard to your deductible.  If you have already met your deductible for the year, your insurer will usually be paying a greater share of your health care expenses for the balance of the year.  Therefore, it may be financially to your benefit to get your surgery within this year rather than waiting until the following year. A full explanation is beyond the scope of this blog and really depends upon individual circumstances and health insurance coverage.  Next time we’ll talk about planning ahead!

Happy New Year!!

For Your Health – Dr. Bob

About two weeks ago on December 9, I had my thyroid removed because it had enlarged and was pressing on my windpipe.  Though I am still waiting for the final pathology report, the results of the outpatient biopsy and the surgeon’s impressions were that this is not a cancer.  I first noted symptoms at the end of September 2011 and the workup took a little over 2 months.  Over that period of time I had 12 appointments for either testing or physician consultations. I think some aspects of my experience may be useful to help people in similar circumstances understand how best to use the healthcare system.

1. Pay attention to your body.

My symptoms were quite mild actually.  I started feeling a pressure against my throat as if someone was lightly pushing against my windpipe.  It wasn’t painful.  It was just different. My voice was also a little bit hoarse.

2. Understand the potential urgency of certain symptoms

As a doctor I naturally thought of all the things it could be, going from bad to worse.  Because it could start to affect my breathing, I set up an appointment with my PCP early the next week.

As a medical student, I was taught that about 80% of the reasons a person visits a primary care physician get better on their own.  But when you are having symptoms that can affect your breathing, heart beat, consciousness, or are causing an excessive amount of pain or a loss in how your body functions, you need to see a physician sooner rather than later.  For more on this topic check out this previous post, When To Get Care.

3. Get beyond the fear of the worst

The sooner a potentially lethal condition such as a cancer is diagnosed, the better are your chances for remission and potentially cure.  Ignoring symptoms does not treat the condition.  If it is a cancer, the delay gives it a chance to grow locally and spread throughout the body.  I know that this seems to be a very cold, scientific response to a situation that can be filled with emotions.  Everyone needs to work through these issues on their own.  But at this point, where a diagnosis has yet to be made, let your good sense take the lead and get a diagnosis.

In the next post I’ll share more about my recent experience and give you some things to consider if you ever are faced with a similar situation.  Meanwhile, please add your comments and experiences!

For Your Health – Dr. Bob