Medical Records

my GP doctor said they didn't have ready access to my old records because t hey had installed a new computer system for the Obamacare requirements. I asked why the vendor didn't convert the old data base to the new and he sai d the vendors all claimed it was not "possible"!!!

them out!

Laziness and a lack of motivation.

"I _just_ got this text."

"I drank a lot but it was the spicy foods that made throw up"

"I smoked, but I didn't inhale."

"My dog ate my homework."

/eyeroll

Welcome to the Computer Age.

Likely your doctor had the records kept on some private system that may be obsolete or no longer supported by the manufacturer, assuming the programmer wasn't just some kid the doctor hired to make him a system.

With 10s of thousands of doctors all with their own system of billing and record keeping it isn't surprising that he was told it wasn't possible.

This sort of thing happens all the time where systems are not standardized. What I suspect was happening was the Affordable Health Act was trying to introduce a standard record system and considering the benefits that could do for cross feeding records (hospital to doctor to specialist to pharmacy to?) so that other than criminals downloading or accessing inf (why would they bother?) it seems to make a lot of sense.

Someone could make a living by developing interfaces for doctors/hospitals older records to the new system, and serve a public good.

John :-#)#

I know some "kids" who work on projects like that, it pays enough to buy beer and some Xbox games which doesn't seem like a bad living at all for many 22 year olds

n my GP doctor said they didn't have ready access to my old records because they had installed a new computer system for the Obamacare requirements. I asked why the vendor didn't convert the old data base to the new and he s aid the vendors all claimed it was not "possible"!!!

nt them out!

e.

d.

probably lots of red tape before you can work on medical records, and tryin g to reverse engineer some ancient database and figure out a sensible mappi ng between old fields and new fields would be a nightmare

n my GP doctor said they didn't have ready access to my old records because they had installed a new computer system for the Obamacare requirements. I asked why the vendor didn't convert the old data base to the new and he s aid the vendors all claimed it was not "possible"!!!

nt them out!

I think you entirely overestimate the extent of the problem. Doctors rarel y have the time, knowledge or will to try to roll their own systems.

e.

They didn't all have their *own* systems. They had one of some relatively small number of medical software systems available before the ACA mandated change. The number of customers might be large, but the field is dominated by not so many companies. A friend used to work in that field.

d.

Not once the companies told the doctors it couldn't be done. Those records are sitting in storage somewhere and will only be retrieved if absolutely essential.

Rick C.

Rule of Thumb #14B - when someone says "impossible", it usually means "would cost more than we want to pay".

I think your point about standardization is a good one.

In recent months I've seen different hospitals and organizations using different record-keeping systems. My impression is that a lot of the information schema isn't fully standardized - every system seems to have its own way of categorizing the information and records.

What this would mean (I suspect) is that "converting the old data base" might be something that could not be done, accurately, using a fully automated system. Some of the information might come across meaningfully, but it's possible that the old records had information and notes that would have to be re-categorized or reorganized for import into the new system... and to do this accurately might require someone with medical expertise, and thus be slow and expensive to do en masse.

There might also be liability issues. Importing older records _badly_ (and thus having potentially-inaccurate information in a patient's record) might expose the organization to more liability than not having those records for current access at all. If the records are absent, a doctor would ask for the information if s/he felt it relevant... if the records are present but wrong or misleading, somebody might act on them without verifying.

My wife's been through a couple of surgeries in the last year, and in each case we had to go over all of her medication and allergy lists and medical history with the surgical facility because they didn't have access to the records from her primary physician and specialist doctors. When we asked about this, we got basically the same answer - the hospital could _ask_ other organizations for her records, but might not get them, and might not be able to use them meaningfully due to the format difference.

That is completely on the mark.

This kind of problem looks trivial to outsiders, until you have to start considering the 20% rather than the 80%. The UK has spent billions on similar schemes/problems.

Consider a well-known classic thing you find in traditional record from some parts of the UK (specifically, from East Anglia). There some records are annotated "NFN". Everybody from E Anglia (but nowhere else) understands NFN means "Normal For Norfolk". Norfolk has a large aggie industry, so NFN implies the mental acuity associated with the somewhat inbred.

Other areas have similar annotations.

How the hell do you "translate" NFN (and all the other variants) into a common lingo?

Curiously, this I've been dealing with this exact issue today. I've been helping move my daughter 150 miles. Two days before the move, she broke her elbow. They couldn't access the x-rays/records at the new location, so had to re-do the x-rays. That was mildly irritating, but beneficially provided a sanity-check of the initial diagnosis/treatment.

"If you like your doctor, you can keep your doctor."

"If you like your policy you can keep your policy."

Indeed.

Been there, several times. During the early 1990's, I was doing computahs for several medical groups operating around the local hospital. I was also maintaining the computers that produced the release forms in the ER (emergency room). Lots of good stories, but I'll resist temptation and stay on topic.

At the time many of the medical office practices were going through a series of buyouts and consolidations. The resulting company was expected to use a single medical records system. Converting the old data to the new data format was a big part of the exercise.

The problem was that the vendor of the old software didn't want to cooperate (unless we threw money at them) as they were obviously about to lose a customer. The vendor of the new software realized that we were desperate and priced his assistance accordingly. Neither vendor had any interest in talking to the other. In effect, we were paying double for next to nothing.

Since I was the only person that knew anything about both systems, I was somehow elected (in absentia) to make it happen. The old system ran on SCO Unix ODT 3.0 using a weird database that used a sparse filesystem and which used the hard disk block numbers for indexing. The new system was based on Windoze NT 4.0 server running MS SQL. They couldn't have been more difficult. The old data could not be copied to the new server. All I could do was print reports. So, I did exactly that, producing mountains of green bar paper in the process, twice. I then took the printouts and sent them to two data entry companies in Mexico, along with two NT workstations with MS SQL. Each group tediously did their best to enter the patient records. (Yes, this was in gross violation of HIPAA which had not yet been signed by the president).

About 3 weeks later, the printouts and transcribbled CD's arrived. I had someone scribble some simple scripts to compare the two databases. The chances that both sets of typists would make the same exact mistake was allegedly negligible, but happened anyway. Three of us took turns checking the data and in 3 days had a perfect match. I merged it with the current data off the new machine, made a huge mess, and had to bribe one of the people from hospital IT to fix the mess as all of us were dead tired. We were up and running in 33 days at a total cost of about $15,000 (cheap).

Four years later, the big medical office did it again, this time with new software that was allegedly HIPAA compliant. Since I was not HIPAA certified, I was not allowed to do the work. So, I watched the fiasco at a distance and tried not to cry. It took about 9 months, was full of mistakes, cost who knows how much money, but eventually was done.

Just as the finishing touches on the HIPAA conversion were being applied, the big medical office merged with an even bigger medical office conglomeration. Once again, there was a huge mountain of patient records to merge. I was asked to help, but since I was involved in the merging of the computer networks (IP renumbering, SNMP monitoring, transferring authentication servers, internal naming, relocating printers, etc), I turned down the offer, which would probably have been quite lucrative, but would also have probably killed me.

In the middle of all this, the ER department hired a new IT person, who immediately decided that Unix and data terminals were dinosaurs and convinced management to replace everything with Windoze XP workstations and Windoze Server 2000 servers. Of course, all new software, which now need to be converted from Unix to whatever was running on the servers. I diplomatically told the new IT person to go to hell, which effectively ended my relationship with the ER department. The data was eventually converted somehow, but I don't recall how or by whom.

So, why does your GP or his vendor claim it can't be done? Easy. No sane person wants to do it at any price. It's a huge amount of work, with disaster waiting at every turn, and with a real chance of making a fatal mistake that can't be fixed without starting over. With HIPAA rules in place, it's almost impossible to outsource the data conversion at a reasonable price.

Well, ask for a printed copy of your old records. They probably have the old system still running.

Also, I tried scanning some of the computer printouts. Too many errors to be worthwhile. Worse, if I scanned it twice, the reader software would make the same mistakes both times, which can't be detected.

Yes. You're missing your old medical records, or you might be missing them shortly if the old computah system dies.

Been there, several times. During the early 1990's, I was doing computahs for several medical groups operating around the local hospital. I was also maintaining the computers that produced the release forms in the ER (emergency room). Lots of good stories, but I'll resist temptation and stay on topic.

At the time many of the medical office practices were going through a series of buyouts and consolidations. The resulting company was expected to use a single medical records system. Converting the old data to the new data format was a big part of the exercise.

The problem was that the vendor of the old software didn't want to cooperate (unless we threw money at them) as they were obviously about to lose a customer. The vendor of the new software realized that we were desperate and priced his assistance accordingly. Neither vendor had any interest in talking to the other. In effect, we were paying double for next to nothing.

Since I was the only person that knew anything about both systems, I was somehow elected (in absentia) to make it happen. The old system ran on SCO Unix ODT 3.0 using a weird database that used a sparse filesystem and which used the hard disk block numbers for indexing. The new system was based on Windoze NT 4.0 server running MS SQL. They couldn't have been more difficult. The old data could not be copied to the new server. All I could do was print reports. So, I did exactly that, producing mountains of green bar paper in the process, twice. I then took the printouts and sent them to two data entry companies in Mexico, along with two NT workstations with MS SQL. Each group tediously did their best to enter the patient records. (Yes, this was in gross violation of HIPAA which had not yet been signed by the president).

About 3 weeks later, the printouts and transcribbled CD's arrived. I had someone scribble some simple scripts to compare the two databases. The chances that both sets of typists would make the same exact mistake was allegedly negligible, but happened anyway. Three of us took turns checking the data and in 3 days had a perfect match. I merged it with the current data off the new machine, made a huge mess, and had to bribe one of the people from hospital IT to fix the mess as all of us were dead tired. We were up and running in 33 days at a total cost of about $15,000 (cheap).

Four years later, the big medical office did it again, this time with new software that was allegedly HIPAA compliant. Since I was not HIPAA certified, I was not allowed to do the work. So, I watched the fiasco at a distance and tried not to cry. It took about 9 months, was full of mistakes, cost who knows how much money, but eventually was done.

Just as the finishing touches on the HIPAA conversion were being applied, the big medical office merged with an even bigger medical office conglomeration. Once again, there was a huge mountain of patient records to merge. I was asked to help, but since I was involved in the merging of the computer networks (IP renumbering, SNMP monitoring, transferring authentication servers, internal naming, relocating printers, etc), I turned down the offer, which would probably have been quite lucrative, but would also have probably killed me.

In the middle of all this, the ER department hired a new IT person, who immediately decided that Unix and data terminals were dinosaurs and convinced management to replace everything with Windoze XP workstations and Windoze Server 2000 servers. Of course, all new software, which now need to be converted from Unix to whatever was running on the servers. I diplomatically told the new IT person to go to hell, which effectively ended my relationship with the ER department. The data was eventually converted somehow, but I don't recall how or by whom.

So, why does your GP or his vendor claim it can't be done? Easy. No sane person wants to do it at any price. It's a huge amount of work, with disaster waiting at every turn, and with a real chance of making a fatal mistake that can't be fixed without starting over. With HIPAA rules in place, it's almost impossible to outsource the data conversion at a reasonable price.

Well, ask for a printed copy of your old records. They probably have the old system still running.

Also, I tried scanning some of the computer printouts. Too many errors to be worthwhile. Worse, if I scanned it twice, the reader software would make the same mistakes both times, which can't be detected.

Yes. You're missing your old medical records, or you might be missing them shortly if the old computah system dies.

I once began a database conversion by replacing the printer with software that wrote the text to disk.

hen my GP doctor said they didn't have ready access to my old records becau se they had installed a

endor didn't convert the old data base to the new and he said the vendors a ll claimed it was not

rint them out!

ible.

ct

What common lingo??? Converting doctor's records from one computer data ba se to another isn't a problem of international communication. That is an e ntirely separate problem that exists independently of the conversion. If s omeone reading "NFN" doesn't know what it means, it won't matter if they ar e reading in on paper or on a computer screen.

And exposing her to more x-rays. I've had a few x-rays over the last few m onths and so far not one person involved has been able to tell me how many sieverts I will receive. Yes, each x-ray from any one time is low, but x-r ay dosage is cumulative over your lifetime. Some are higher doses than oth ers and back in the day they all were much higher. So I'm starting out wit h a larger base load.

At least the last doctor indicated he might look it up for the next patient who asks.

Rick C.