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NousDefionsDoc
12-08-2009, 20:12
I've been thinking about keeping medical records for me and my family on a USB drive or something. Any of you guys doing this?

Upsides/Downsides?

Any tips?

Formats?

lksteve
12-08-2009, 20:17
Makes sense...PDF for format?

NousDefionsDoc
12-08-2009, 20:18
That's what I was thinking. I've seen a couple with pre-designed forms. MyPHR looks ok and the forms are free.

NousDefionsDoc
12-08-2009, 20:19
I wonder how hard it would be to get the Doc's office to fill them in as stuff is done?

lksteve
12-08-2009, 20:29
I wonder how hard it would be to get the Doc's office to fill them in as stuff is done?I thought something like that was going to be the wave of the future 15 years ago...

Saturation
12-08-2009, 20:38
Just some thoughts-

Not sure how the docs are doing where you are, in my area the doctors are charging most everyone for medical records, have substantial lag times for requests (referrals, refills, statement of medical necessity,etc), and have had to cut office staff beyond the minimums. That would lead me to believe that it would be difficult to have the physician update your records. Perhaps if you are using one of those VIP doctor programs you would have no problem or can reach a fee agreement.

Depending on the complication of your health issues it may be worth your while to simply accumulate/input the information yourself. The med list, allergies, and major issues/hospitalizations would be a great foundation. Better would be adding your baseline lab values.

Pretty soon we'll all have chips implanted anyway ;)

JJ_BPK
12-09-2009, 03:28
My GP/ Surgeon is still pencil to paper,,

But my Cardiologist has all the rooms wired with laptops. If I want a copy of today's whatever, I just ask at the desk on the way out, normally while setting up the next appointment..

The fact that the Doc's, the PA's, or the nurse all record, "Interactively", makes for a longer visit, but I think the data is much more accurate. Most times, we will review the recorded statement before the end of the session.

The VA clinic in KW and VA hospital in Miami also use laptops in each room..

You may be able to take your thumb drive and plug it into the doc's pc while you wait??

PedOncoDoc
12-09-2009, 05:54
You should be able to fill in most of the crucial information: Name, date of birth. Medical conditions, year (approximately) thos conditions were diagnosed, and surgery with date of surgery (and indication if you have it.) Hospitalizations - date (Approximate), length of stay and reason for stay. Any major complications from surgery or during hospitalization are a plus. Medications and current doses - good to keep in a spreadsheet anyway, IMHO. Allergies - medication and otherwise. Vaccination history and date of last booster for Tetanus/diptheria/pertussis. It should be easy enough to grab a set of vitals, weight and height on yourself.

For the kids you might want to include any particular complications with pregnancy or in the newborn period as well as the above - this becomes less important in aftert puberty. The vitals are less crucial, but growth and weight percentiles are always helpful, as well as the most recent weight (for dosing meds).

A one-time record request may be needed to fill in some of the above baseline information if you've not taken a very active role in your health care. Alternatively, some health systems have a public access version of their electronic charting where you can access your labs and medical history. Afterwards you should be able to keep everything up to date. The vitals are still typically pen to paper and then put in the computer system - you can copy those down at any and all visits. Most doctors offices I've worked in are happy to mail you a copy of their visit notes if you request it. This is different than a record request and typically is provided free of charge.

The baseline lab values are only useful if you have some chronic conditions which lead to abnormal values.

That's my $0.02 on the matter. The only other thing to consider is where you will keep the USB drive to ensure it is secure but is accessible when you need it. What was your intended use for these records?

Slantwire
12-09-2009, 07:49
You may be able to take your thumb drive and plug it into the doc's pc while you wait??

I hope not. DoD has banned thumb drives for a reason. It's far too easy to turn those things into an "auto-hack" tool.

olhamada
12-09-2009, 08:32
NDD, GREAT idea. Many are actually advocating this and some have developed cards the size of CC cards for this purpose. Still in its infancy though.

Problem is, it will have to be initiated by your MD as most are not going to let you plug a USB thumb drive into their computer.

Some will give you a CD-ROM with your records if you ask them.

Google has also developed a "secure" online patient based medical record system. But, of course, there are many concerns with this as who knows who has access to the "cloud".

https://www.google.com/accounts/ServiceLogin?service=health&nui=1&continue=https%3A%2F%2Fhealth.google.com%2Fhealth% 2Fp%2F&followup=https%3A%2F%2Fhealth.google.com%2Fhealth% 2Fp%2F&rm=hide

HowardCohodas
12-10-2009, 02:53
I wrote this for a newsgroup back in April:

Whether you are a xxxx sufferer or not, the
problem of communicating emergency information to
emergency care givers and family can be problematic.
Medical ID bracelets are certainly one answer, but as
a certified nerd, here is a tree-part solution that I
have developed. Some of this was refined during a
Certified Medical Responder course I was taking.

First, is the information in my wallet, including
xxxxx condition, medications being taken and other
medical care information.

In some emergencies, you may become separated from
your wallet. One of our class, an LEO, recalled an
incident where someone was separated from his wallet
by gunpoint and then rendered unconscious, the
condition in which he was discovered.

Thus, second, my cell phone has an entry <space>In
Case of Emergency. The leading space puts it as the
first item in the directory. Should any responder in
an emergency have the presence to look at your cell
phone, this strong clue should be sufficient. The
phone numbers in this item, for me, are my home, my
wife's cell phone number and her work number.

And third, I carry a "thumb drive" as part of my EDC
(Every Day Carry). This is sometimes called a flash
drive. It contains a directory (folder) labeled "_In
Case of Emergency". Here I store images of all of the
emergency ID information I carry in my wallet plus a
text file containing contact information, and medical
care information. In this directory (folder) I have at
a minimum, images of my drivers license, insurance
cards (auto and medical), drivers license, passport,
eye-classes prescription, pilots license and concealed
carry licenses (I'm usually armed).

Tangentially, I have another directory (folder) that
contains photocopies of everything else I carry,
especially my credit cards. This directory is encoded
to prevent unauthorized access, but would come in
handy if my wallet were lost or stolen. You can add
other stuff hard to replace in case of a fire at home,
like certificates, policies, inventories written or
photographed.


I began writing the specs for a software application when I discovered the following two products already in the marketplace.

911 Medical ID (https://www.911medicalidaccess.com/)
MED Flash (http://www.med-flash.com/)

(Full disclosure: I am considering becoming a distributor for the 911 Medical ID. I'm in the middle of my "due dilligence" process).

NousDefionsDoc
12-10-2009, 19:42
I hope not. DoD has banned thumb drives for a reason. It's far too easy to turn those things into an "auto-hack" tool.

DOD banned them for the reason that they are your user name. I don't however see many allowing my thumb drive in their network. That's a lot to ask.

Can they charge for medical records? I would have thought that would be illegal.

NousDefionsDoc
12-10-2009, 19:55
I wrote this for a newsgroup back in April:



I began writing the specs for a software application when I discovered the following two products already in the marketplace.

911 Medical ID (https://www.911medicalidaccess.com/)
MED Flash (http://www.med-flash.com/)

(Full disclosure: I am considering becoming a distributor for the 911 Medical ID. I'm in the middle of my "due dilligence" process).

The 911 Medical ID "Buy Now" button doesn't work. What's the price?

PedOncoDoc
12-11-2009, 06:41
Can they charge for medical records? I would have thought that would be illegal.

They can't charge you for providing you your personal information - they CAN charge you for processing the request, making copies, administrative fees, etc.

swatsurgeon
12-11-2009, 06:45
IMHO, the issue/problem with electronic medical records (jump drive, smart card, etc) is they are only useful when you arrive at a facility that can read it on a computer. Statistics would show that the major intervention in the field for severe trauma is what sets the stage for ultimate success or failure (yeah, I know, a lot of variables go into that statement....time, distance, level of care, etc) but having a readily accessible medical info "card" that can be read in the field could be the difference between life and death.
An example, read this..... http://www.tacticalmedicine.com/files/TWMay09.pdf

Now the field issue for the above article I wrote was less important because of proximity to the trauma center, but put yourself in the sandbox, in the rural areas or wilderness where travel /transport times are extended and I would rather have the medical information available to the field medics/docs AS WELL AS the hospital personnel. I think having both would be the best of all worlds: complete medical history for the facility (jump drive , etc) and a brief history that includes meds, allergies, major medical problems, emergency contact info and primary doc (laminated card). I would be happy to post what I use with local law enforcement...every SWAT member and eventually the entire dept. will have a laminated card on them with this info....we have areas that are extremely remote so the USB idea won't be optimal.

ss

Slantwire
12-11-2009, 08:23
DOD banned them for the reason that they are your user name.

Hard to refute that. I'll rephrase without referencing DoD: Your doc shouldn't let patients connect their own thumb drives to his computer, because it's easy to turn the drive into an attack tool.

Odd Job
12-12-2009, 18:24
Best option at present is a hybrid solution where your full health record is kept at home on your PC, and an abbreviated record with only the essential items are stored online (eg Google Health).

Needs three steps:

1) Preparation of the master records / home PC
2) Preparation of the records that are to be hosted online
3) Arranging access to the archives referenced in (1) and (2) for third parties.

I'll address (1) first, and assume you want resilience and privacy of your records:

If that was me, I would have two 750gb hard disks running through a cheap RAID controller (it may already be on your PC motherboard, then you don't have to buy a separate card) and I would format those as RAID 1 (plain mirror, one drive is an automatic backup of the other which means your total storage is 750gb). You'll have to set that up according to the instructions that came with your RAID controller. From this point on, those two drives show up as a single drive on your PC.

You then make new partitions on that drive according to how many family members you want to store records for. (On Windows XP you use the Disk Management tool in the Computer Management application accessible by the control panel). Lets say it is you, your wife and one kid. That's three partitions, which means you each get a 250gb partition. You then quick format those partitions in the Disk Management tool.

Once that is done, download Truecrypt (which is free and available for Mac and PC) and encrypt those partitions one at a time from within the Truecrypt application. It requires you to pick a password before it 'formats' the partition. I recommend each family member chooses their own password. Formatiing can take a while. I recently timed an external USB drive (400gb) and the Truecrypt conversion of that drive (as a single partition) took 2 hours. Probably on internal SATA drives this will be faster. From that moment on, those three partitions will retain their original drive letters in Windows, but if they aren't mounted with Truecrypt they appear as unformatted partitions. Make sure everybody understands this and does not try to format them in Windows!

Truecrypt has an auto mount button, which means it looks for partitions and entire devices that have been encrypted and prompts you for a password before mounting them. I have mine set up so that all my partitions mount with one password because I am the only user of this PC. When you use yours, you will only know one of the passwords so the right partition will mount automatically and it will show up as a new logical drive in the operating system. When you go to My Computer you'll see the original three 'unformatted' partitions or disks that Windows has detected and one other virtual drive that is your unlocked partition.

From this point on, you can transfer your records onto that partition. I would start with very basic folders on there such as MD notes, operations, diagnostics, immunisations etc. I wouldn't be too fussy about the format of the files at first because the aim is just to get them onto the PC in one place. For example you could end up scanning some MD letters using your own scanner at home, and that could be stored as a compressed LZW TIF image in the MD folder. Or if you don't mind lossy compression you can go for jpeg.

You might have a CD of the last CT scan you had at a clinic. That should be in DICOM format with its own viewer on the CD. Make sure they don't give you jpegs only! For these DICOM files you want to copy contents of the CD exactly as presented, to the root of an individual folder within the Diagnostics folder on your partition. You can't place multiple DICOM studies from different sources in one folder. Also you may want to write that study back to another CD (if you lose the orginal) and you'll need to retain the original file structure or they might not be able to import that onto their PACS system in radiology.

Things like immunisations can be stored in an Excel spreadsheet. That's what I intend to do with mine, because you can set up the cels so that they change colour on a predetermined date and that can be a reminder that a shot is out of date or a booster is needed.

Next section I'll post later...(anyone can PM me if they want help with this first part)

NousDefionsDoc
12-13-2009, 09:07
They can't charge you for providing you your personal information - they CAN charge you for processing the request, making copies, administrative fees, etc.

"They"?;)

PedOncoDoc
12-14-2009, 05:09
They being whoever makes the decisions on billing and finances at your health care providers. If it's a larger institution it definitely isn't going to be the docs.

Edit: I'm assuming you wanted a "We" instead of "They." Sorry - those decisions are made way above my pay scale. :)

Odd Job
01-09-2010, 02:44
I found a great site that discusses the international perspectives on access to medical records:

http://recordaccess.icmcc.org/

rltipton
01-09-2010, 08:49
Just some thoughts-

Not sure how the docs are doing where you are, in my area the doctors are charging most everyone for medical records, ...

You cannot legally be charged for it if it is requested in order to provide evidence for a VA claim.

Edit: Make the request on a VA 21-4142 and it's free.

Knowledge is power.