> Medical records- hmmm.
> I've lost medical records to office closure/illegal disposal, a bankrupcy
> (records went where?) and a doctor simply disappearing.
Well, in part, this is the concern with EMR/EHR. What protocols are in place
to ensure these records impacted by office closures, changes of medical
groups, sales of hospitals, and all of the other business issues that impact
the medical profession don't impact the access to YOUR records?
We've spoken before about what happens when an employee departs an
organization and if nothing has been done proactively to ensure the records
they were responsible for were properly turned over. One of the LAST things
on someones mind is "Oops.. gotta turn over those files and make sure the
data on my computer is in order for the next guy!" Well, this might be
inconvenient, but if it's your MEDICAL RECORDS, it could be devastating.
There have been numerous cases in the past where this has happened and the
physical records GENERALLY still existed, and you may have had to pay a fee
to gain control of them, but you had that option. If they're stored on a
server, or a PC, or CDs or an optical disk, that stuff usually leaves with a
departing party because it has value and can be re-purposed... and for the
most part, it can be reformatted and reused. Paper/physical records are
typically abandoned in place.
I kind of wish I had gotten and kept personal copies.
> However:
> Here in SoCal, personal copies of records should survive earthquakes, but
> maybe not fires or floods/mudslides.
> What about the folks in Laguna and other parts of SoCal who had homes
> literally slide off of a hill/cliff? Many of them were not permitted back
> into the homes to retrieve personal effects.
> Personal copies would be gone. Unless the records are then copied back
> into whatever medical organization a person currently uses, they are of
> little use.
> Lots of people move frequently, and/or live in less than ideal
> circumstances. Personal copies of medical records might easily become an
> early casualty of a rushed move.
> What about expense?
> A lot of folks are living on the wrong side of the edge, and really don't
> need another expense!
Well, we've also been reading a lot about things we as individuals can do
regarding our personal "vital records" and some of us have been following
these practices for years now. I don't live in SoCal, but I do live in the
beautiful part of the state, NorCal =) and we have to live with the threat
of earthquakes all of the time. And yes, I DO have my records copied and
backed up and the backup CDs are routinely sent out of the area for records
that I CONSIDER vital to my family. We use a system of planned dispersal
within a ring of friends and send CDs or DVDs to each other routinely.
And in the case of maintaining personal copies of health records, you're
right, it can be an expense. And not having them could be an inconvenience.
But never having them again could be life threatening.
Paper lasts well if properly handled, stored, etc. It doesn't always copy
> well after a few generations, it tends to be bulky, etc. Then there's
> film...
=) If you use QA as part of what you do at work, there's no reason you
wouldn't apply the same practices to the copying of your personal records.
And from what I've seen each generation of copier is making HIGHER quality
copies of the source documents than the "originals". As for the bulk,
well... it's relative.
Maybe I'm a raving optimist, but methinks a TIFF or PDF is likely to be
> readable for a long, long time.
Providing the images and/or the media they're stored on doesn't degrade over
time. And it does. And while the image formats may be readable, if the media
it's on isn't... you're hosed.
CDs are going to be readable for a long, long time.
Wake up and smell the coffee on this front. There are CDs that were
generated on early writers/readers at 4x and 8x that can't be read in
current hardware. There are tons of inexpensive CDs and DVDs that are
delaminating and can't be read any longer. And we're on the edge of either
HD DVD or BluRay coming out, that is supposed to potentially eliminate the
use of CDs in the future. This is similar to the issue with QA on paper
copies, but in addition, you need to be vigilant and periodically migrate
your content to avoid obsolescence and degradation of media and formats and
stay compatible with current hardware and software.
And yes, I DO know where to find a 5 1/4" floppy drive!
And I can but 8 track players still, but the quality is no better than it
used to be =) You might be able to find the drive, but is the operating
system that you used to format the disk still mounted on the machine you
intend to install the 5 1/4" floppy in? If it isn't you may have a hard time
reading the data... and is it a SD, DD or HD floppy? The mind reels...
Don't get me wrong, it's not that I think there isn't a time and place for
the move to EMR/EHR, bu the groundwork needs to be done to ensure it works
properly. There are many protocols that need to be put in place about WHO
establishes the STANDARDS, and I mean REAL standards, not industry best
practices, but ANSI level Standards that are based on a consensus process
for development. It needs to be determined what formats will be captured,
what thresholds for capture will be used, what media will be used for
storage, how it's backed up, who controls the repository of the images, who
controls who has access to the repository, who ensures it's kept current and
accessible, who pays for the periodic conversion and migration, who verifies
it when it happens (it's not a 'lossless' process), and what happens to it
when the individual it's related to dies.
And there's other process and protocol 'stuff' as well, but the physical
management of it is where everyone is focusing right now. Before this
happens, there should be a solid, standardized process in place, and we RIMs
should be part of how this is designed.
Larry
--
Larry Medina
Danville, CA
RIM Professional since 1972
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