Before starting third year, we had a week-long course that taught basic skills not learned in our first two years of medical school: suturing, knot tying, injections, note writing, etc.. One critical skill they left out was how to use a fax machine and how to deal with medical record offices.
To outsiders, it probably seems pointless to learn how to operate an archaic communication tool like a fax machine in the age of email and electronic medical records (EMRs), but therein lies the problem. There is no standard EMR, there are over 100 companies creating them, with 20 platforms taking up the majority of EMRs used. Systems don’t talk to each other which means you cannot share information between them. EMRs are supposed to reduce overhead, streamline communication, decrease errors, and increase access to patient information, and in some of those areas they have succeeded, but far too often they haven’t lived up to their potential. What we’ve done is created a fragmented EMR system to go with a fragmented health care system and we haven’t implemented EMRs in a way that can not only help bend the cost curve, but to also allow physicians to be more productive.
Often, patients get their care at different hospitals, so when creating a health care system that tries to reduce cost, it would behoove of the designers to create software platforms that are able to communicate with each other regardless of where care was received. Unfortunately, they didn’t. It was left it up to the market to provide products that hospitals can pick and choose from, and as these are competing companies, making it so one firm’s EMR communicates with another is not maximizing the revenue creating potential of using their EMR platform.
Here is where medical students come in. It is the definition of scut work, but we are tasked with hunting down medical records from the various locations patients have gotten their care from.
It might seem like a simple task, but it’s a huge pain and takes hours. Sometimes the faxes aren’t received, so care is delayed a little and patients stay longer, increasing risk of hospital acquired illness. Sometimes it’s a Friday at 2 p.m. and the records offices close at 4 p.m., and they don’t send you what you need in time, so now it’s the weekend and as I’ve learned, very little gets done in hospitals over the weekend. So you ultimately order a few simple tests or order more imaging because you don’t have the information that should be readily available, but maddeningly it’s not, and the waste mounts and the radiation exposure increases.
So until we have a single health record for all patients or until private companies create platforms that communicate with one another, my advice for medical students is this:
1. Learn how to use a fax machine.
2. Write “stat” at the top of your medical request form.
3. Call the records office before you send the request and get their fax number. Tell them you will be sending a fax and to please look out for it. Ask the employee their name, thank them several times and tell them how big of a help they are being. They’re about to send over a lot of records and it takes a while to find what you’ve requested and send everything through. The nicer and politer you are, the faster they will send.
4. Call them after you’ve sent the fax to ensure they received said fax, and thank them profusely again.
Mike Logan is a medical student.