This is a tale of my nearly year-long attempt to integrate my family’s medical records from a small outpatient provider (MIT Medical) into my Kaiser Permanente HealthConnect EMR.
From 2008-2010 my family was living Boston where I was getting my MBA at MIT Sloan. We had been long-time Kaiser members before we moved to Boston and I had all intentions of continuing with Kaiser when we moved back West.
It seemed only natural that Kaiser would be eager to receive and integrate my records from MIT Medical. For example, I had assumed that Kaiser would be interested in the following:
- The asthma symptoms that my kids had developed while in Boston, and the associated medications they had been prescribed.
- The immunizations my kids had received.
- The preventative tests and checkups that we had all received.
Retrieving Medical Records from MIT Medical
MIT Medical is a self-insured outpatient clinic and a long-time user of Allscripts EHR. MIT Medical is no stranger to technology – they are part of MIT, after all.
However, gathering my family’s medical records was not a high-tech experience by any stretch. In May of 2010 I descended into the basement of MIT Medical into their small medical records office, where I signed the necessary HIPAA forms. There was no mention of CCD/CCR, though in all fairness I was hesitant to ask – this looked more like a paper shuffling office than anything else.
I elected to have the medical records sent to me (not Kaiser). I was told that I would be charged a fixed amount for every page of my record, but there was no way of knowing how many pages would eventually be sent. This struck me as odd, but I still agreed to pay the unknown bill when it came.
After moving back to California, I wondered how long it would take for my medical records to arrive. I received them within 2 months, which I assume, is the time it takes for a carrier pigeon to make its way from the east to the west coast. During this time period my daughter began to have problems with asthma symptoms and I had to take her to the Kaiser ER, where her doctors had no past information on her asthma symptoms other than what I could remember.
Nevertheless, with the precious records finally in my hands, I was ready for the next step.
Getting External Medical Records into Kaiser HealthConnect
Still hopeful of achieving interoperable-EHR nirvana, I contacted KP member services and was given the address of their medical records office. I mailed in the MIT medical records, and presto! I assumed I was done. However, in the back of my mind I knew it wasn’t going to be that easy… I never received a confirmation from KP that my medical records had been received, which made me doubt the whole process. However, I had other things in life to attend to besides this medical record integration project, and so I did nothing further and continued to hope for the best (the ‘best’ being that some individual or algorithm was turning the unstructured data from my MIT medical records into structured data and inputting this data into KP HealthConnect).
It turns out that I should have been a bit more pessimistic. It soon became clear that my doctors and KP in general had no idea that I had sent in the records. My pediatrician was asking me for my kids’ immunization records for the 2 years we were in Boston, and I kept getting automated reminders from Kaiser to schedule preventative tests and checkups that had already been done.
I then called the KP medical records office and had a very unsatisfying conversation where I was told that my records had never been received. With a feeling of defeat, I knew I would have to begin the process of secure-emailing KP member services to get to the bottom of this. The following is an account of those interactions:
- After contacting KP member services, I was told to call the medical records office (again).
- I called the medical records office twice but my messages were not returned.
- I secure-emailed member services again and asked how they were going to resolve this issue. They never got back to me.
- After a few weeks I secure-emailed KP member services again. Finally something got put into motion.
- I was called by someone from the medical records office. She told me that my medical records had never been received. She suggested that they had gotten lost in the mail? She advised that it was probably best to physically drive to the medical records office and submit the records in person.
- 10 minutes later I was called by yet another person from the medical records office who sounded a lot more authoritative than the previous person (she had no idea that someone had called me previously and had told me to drive to the office). She then informed me that my MIT medical records had been in HealthConnect since August 2010! I asked her why my doctors, member services, medical records personnel, and seemingly all of KP had no idea that the MIT medical records existed. Her response was along the lines of “They probably didn’t check HealthConnect”. Speaking to her further, I learned that the MIT records were stored as various PDFs within some content management section of HealthConnect (that apparently that clinicians don’t pay much attention to).
I secure-emailed my pediatrician and told him to check HealthConnect for the PDF. Luckily he was able to find the kids’ immunizations, reconcile them with what was in HealthConnect proper, and then prescribe the immunizations they were lacking. Total time it took to get this information to him? 10 months.
At this point I was more than a little disgruntled. Going through this process has shown me just how far away we still are from EHR-interoperability nirvana. I have been trained however. Whenever my doctors/nurses seem to be lacking information, I know now to remind them to please “check out that huge PDF file in your content management section of HealthConnect”. To my surprise, my clinicians are really only interested in the immunization data, ignoring the rest – even if that means that care and tests are duplicated.
The Big Picture
I realize that in this personal story of EMR integration gone wrong, the stakes for my family were relatively low. We do not suffer from complicated co-morbidities, deadly allergic reactions, or the like. There was never really any danger of life-threatening circumstances arising due to lack of EMR integration. For other less fortunate families who change healthcare providers, the stakes are obviously higher.
All in all, this experience has clearly demonstrated the general lack of interest in EHR interoperability among two very tech-savvy providers. There was absolutely no process in place at MIT Medical or Kaiser that made it known to me, the healthcare consumer, that I should take steps to integrate my medical records. Why didn’t MIT Medical suggest to that I might want to take my medical records with me when I left Boston? Why didn’t Kaiser ping me for my medical records as soon as I arrived back in California? Every step of the process was lengthy and painful, and required great initiative on my part.
There are some obvious reasons for this lack of interest in EHR interoperability in that the competitive advantages around not sharing patient data are just too powerful (but this is another post).
Looking forward to Stages 2/3 of Meaningful Use, I am left pondering how various parts of MU will break down if we do not accomplish data sharing. For example, how are we going to engage patients by giving them access to their clinical data if this data isn’t portable in a computable format? I remain reluctantly hopeful, and look forward to the day when the data in that PDF file residing within HealthConnect is finally fully integrated.