#HealthXPH: Will doctors let patients read what they write?

#186481441 / gettyimages.com

 

I was scanning my Twitter feed a few weeks back when a tweet by Joseph Babian (@JoeBabian) caught my eye. It was a link to Dr. Leana Wen’s (@DrLeanaWen) post, “When Patients Read What Their Doctors Write.” In our Twitter conversation, I told Joe that I have one clinic that still had paper charts. I see many patients and I disliked having piles of these paper charts on my desk as I saw them in my office. My secretary would hand the patients’ charts to the patients as they sat in my waiting room. The patients would hand the chart to me as they came in the consultation room. I gave them back the chart to hand back to the secretary at the end of the consult. They can wait a long time in the queue and could read their medical charts at any point while they had it. I can say then that I let patients read what I write, for this one clinic. The other clinic I am in has an EMR – my patients there do not get access to my notes. And so I read with interest about the OpenNotes experiment. As it says on their website –

OpenNotes is a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.

I excitedly asked Joe if #hcldr tweet chat will be discussing this as I wanted to do so on #HealthXPH. As I related to him how patients can read their paper charts in my clinic, he wanted to know if patients had ever told me anything about what was written in their charts. Below are some things patients have shared with me –

  • Wow, I didn’t realize I’ve been seeing you since 2007 Doc! You and I have gone a long way.
  • Doc, in my list of medications from the last visit aspirin was included. However in the prescription you gave me then aspirin was not on it. Should I still be taking aspirin?
  • Here’s my HbA1c result Doc. I noticed on my chart that it’s better than the last time but looking further back on my record, I did better last year.
  • I was looking at my chart Doc if you had noted my ultrasound results from I think two to three years ago. I feel something painful here and maybe we should repeat that ultrasound. Your notes in my chart said it was normal. Should we repeat that ultrasound this year?

I can say then that I have not had any unpleasant experiences from patients being able to read what I write. I also see overseas contract workers who are seeking pre-employment clearances. I summarize my clinic notes and my recommendations – yes on paper still :) – and give it to these patients to give back to their pre-employment clinics. Some years back, one of the referring doctors asked me to seal my clearance notes in an envelope so that patients cannot read them. Apparently, it sometimes happens that despite giving my clearance for employment these patients are not allowed to work abroad for some other reason. These patients have argued with them about my evaluation since they were able to read it. I replied that I will continue giving them their evaluations unsealed. The unemployment rate in the Philippines is so high that many seek better jobs abroad. It is often heartbreaking when their medical conditions prevent them from being employed outside the country – they deserve to know what their medical evaluation says.

Let me quote from Dr. Wen’s post –

But there are new controversies arising. Should patients receiving mental health services obtain full access to therapy records, or should there be limits to open records? What happens if patients want to share their records on social media? Will such “crowdsourcing” harm the doctor-patient relationship? What if patients want to develop their own record and videotape their medical encounter? Are doctors obligated to comply?

Although my patients can read their charts, I’ve turned down requests to have their charts photocopied. Instead I provide them their case summaries. I can only think how easy it will be to share patients notes in digital format online on social media. I’ve not had any requests to videotape their medical encounter. A handful of patients have asked to have their photos taken with me. A few were happy overseas contract workers leaving for two to three years who wanted a souvenir to remember me by. Some few others were patients who wanted to document our encounter for their relatives who were not with them but most often were paying for their care – as proof that they consulted with me! I found that strange but I agreed to have a photo taken.

I’m very excited to have this conversation! Join us on Sept 6 Saturday 9 pm Manila time as we try to answer some of Dr. Wen’s questions at the #HealthXPH tweet chat.

T1 As a healthcare provider, will you let patients read your notes in their medical records?

T2 What do you think about patients sharing their records on social media?

T3 Do you think doctors are obligated to comply if patients want to videotape their medical encounter?

 

Teaching health informatics #HI201 (again)!

#122301775 / gettyimages.com

 

This is only the third semester that I will be teaching HI 201 for the MS Health Informatics program in the UP College of Medicine. I’ve added new topics such as global health, enterprise architecture and gamification. The old topic list is here. I haven’t changed my teaching strategy though – check out my 2012 lesson plan on edublogs.org. I have abandoned edublogs though and asked my students to host their blogs wherever they wanted this year. I had proposed then that the course will use project-based learning, which Wikipedia defines as,

“use of in-depth and rigorous classroom projects to facilitate learning and assess student competence (not to be confused with problem-based learning).”

Each week starts off with a driving question which gets answered by an assignment or “project.” According to leadingpbl.org

A Driving Question is one that focuses all other questions towards a solution or product. This question is complex, requires multiple activities and the synthesis of information from numerous sources. Driving Questions serve to organize and drive activities; and these activities result in a series of artifacts, or products, that culminate in a final product that addresses the original question.

In this class, students blog about their assignments as a form of learning portfolio. A few already had blogs but there were also those who were forced :) to blog for the first time. Blog posts are to be announced at the Philippine Medical Informatics Society Facebook page (tagged #HI201) and on Twitter (#MSHI) so the students can engage in meaningful discussion with others about their work. To gently start my students on blogging, I asked them to post what they wanted to learn from this class. Here’s what some of them said –

I think HI 201 will be the gateway of the direction of information I will learn and can learn. It will give me an overview of exactly where informatics play a role in the health care system and delivery. In the process, I think I will learn to appreciate data more, make sense of data more, program electronic medical records to be useful, create a website, a blog site, and education site, among others. In the end, it will be fun to learn something new again.

www.kidseyes88.wordpress.com

Having little to no understanding of the Healthcare IT industry, I would like to grasp some insights of the current status of Healthcare IT in the Philippines and how far advanced has it become compared to other countries, and I think HI201 (Health Informatics) would be an introductory course that would fill in my queries.

www.burrheber.wordpress.com

Here are my main learning objectives for HI 201, to be able to do the following: 1. discuss health informatics in general and in the Philippine context, 2. analyze the significance as well as barriers and limitations of health informatics in various domains and disciplines, particularly in the Philippines, and 3. practice the application of health informatics concepts and principles.

www.marthaumali.wordpress.com

As an administrator of a small private secondary level hospital, I see HS 201 as my entry point to learn the fundamentals of Health Informatics. Eventually, I would like to learn to set up a hospital information system which fulfills our needs.

www.jdonsoriano.wordpress.com

As a novice in the field of Medical Informatics, I’d like to learn more about how data through context can be turned to information. How information with semantics can become knowledge and perhaps serve as a world model though ontology.

http://grz23.tumblr.com

As a novice of the program, I am deeply interested in learning the needed IT tools that may aid healthcare professionals identify and manage predicaments hindering efficiency of healthcare delivery. As a community oriented worker, I would also like to learn how to further strengthen the foundations of the national healthcare system (primary healthcare workers) by alleviating or at least decreasing their hurdles by means of ICT solutions.In line with this, I would also like to learn how to increase their capacity for technology adoption, one of the main reasons of sustainability failures.

www.theironhive.blogspot.com

 

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Clinic Schedule

Faculty Medical Arts Bldg. (FMAB), Philippine General Hospital
Tues & Fri 10 am-12 nn , Wed 1-4 pm
Tel. No. (632)708-0000
www.upmc.net.ph

Rm 303 Don Santiago Bldg. Taft Avenue, Manila
Mon & Thurs 1-6 pm, Wed 9 am-12 nn, Fri 1-4 pm
Tel. No. (632)543-7445

MSHI HI 201 Student Blogs

Mon, Aug 18, 2014
Dr. Peter San Diego
Fri, Aug 22, 2014
Dr. Lyndon Bathan
Sat, Sep 06, 2014
Burr Heber
Sun, Sep 07, 2014
Wendi Joyce Subido
Wed, Sep 10, 2014
Grace Villareal
Thu, Sep 11, 2014
Arjhei Balandra
Sat, Sep 13, 2014
Paolo Sicat
Sun, Sep 14, 2014
Dr. Dodjie Soriano