Do Full Medical Records Even Exist?

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A recent New York Times blog post makes a great point about the debate over whether and how political candidates should release their “full medical records”: The idea that anybody could share medical records detailing their entire health history is misleading. There’s no such thing.

Despite a massive federal investment of more than $30 billion over the past decade, the digital age vision of an electronic health record that moves seamlessly with a patient from one doctor to another—from a hospital in San Diego, for example, to a clinic in Minnesota and from the allergist’s office to the emergency room—has never been realized. Most medical records remain scattered in the various doctor’s offices and facilities people have visited over the years, either in paper files or in varying electronic systems. Patients still have to lug their records from one office to another, and doctors have to rely on a patient’s memories or their family members’ knowledge to ensure that health histories are correct and medication lists are up-to-date.

Errors and omissions in health records and relying on the sometimes faulty memory of patients can have real-world safety consequences. Medical professionals need to know when a patient has allergies or an implanted medical device. They should know the results of recent lab tests and whether a patient’s medication might react poorly with a new prescription. And having instant access to accurate medical information when an unconscious patient arrives in an emergency room can save lives.

The problem is that even when digital records are kept, different systems are not interoperable—they can’t talk to one another. One of the biggest problems is patient matching—making sure that those with similar names, or who have used different names after marriages or adoptions, don’t get confused. Additionally, electronic health records don’t use standard formats or data fields, which makes information difficult to transfer, leads to errors and confusion, and endangers patient safety.

Pew is examining potential solutions to these problems, researching the types of patient-matching approaches that would be embraced by clinicians and patients and could be scaled to a national system. While improving patient safety is the main reason to adopt a nationwide solution, it may also help reduce health care costs. One Rand Corp. study estimated cost reductions of $77 billion to $154 billion per year if such a solution were adopted by 90 percent of the health care system.

The presidential election has shined a spotlight on the challenges associated with aggregating patients’ records in one place. Now, all stakeholders—including patients, hospitals, doctors, and electronic health record vendors—should examine ways to address the technological and policy barriers standing in the way of making electronic health records complete, so patients and their doctors have all the information they need when they need it.

Josh Rising directs The Pew Charitable Trusts’ health care programs.