How reliable is your patient history?

You've probably noticed that discussions and announcements of patient portals and Personal Health Records (PHRs) are starting to dominate the health care media. Despite the buzz around Stage 2 Certification, EHRs are becoming yesterday's news and we're moving on to communications, both provider-to-provider and provider-to-patient. Which type is more important to establish for your business? Both are important, of course, and perhaps the two need not be juxtaposed. Nevertheless, herein lies an interesting discussion.


Your patient encounter has long begun with a patient history of some sort, right? For years, your patient has arrived early, sat in the waiting room filling out paper forms, then a staff member has entered data into your practice-management and/or EMR software. Next, your pretest technician sits with the patient and reviews the paperwork, asks a few more questions and records as a complete a personal, family and social history as possible. As the doctor, you probably attempt to improve on whatever you've been given, knowing the patient will tell you more because you're the doctor.


The essential question is, "How reliable is that patient history?" 100%? 80%? How about 20%? Last week, I was in an office supervising the Go-Live process for a new client. I sat with the technician through the pretest, observing documentation of the patient history. 


"Any medications you're on right now?" the technician asked. The patient gave the names of two medications.


Given the benefits of integrated e-prescribing, I had been able to take an advance peek and knew that the patient was actually taking nine (yes, 9) different medications and that all nine had been refilled in the past month! Before the doctor saw the patient in the exam lane, I mentioned, "I'm not going to tell you how many meds this patient is on but I can tell you it's a lot more than she told your technician. You might want to see if you can get a better history."


Try as he might, the doctor was not able to get the patient to move off the original report of two medications. Now, we could find all manner of reasoning to say that this is the exception rather than the rule. However, it's not the exception; it's the rule! Whether it's about medications or family history, a lapse of memory, genuine ignorance or downright deceit, we are consistently finding that patient histories, on average, are about 20-25% reliable.

That poses an interesting problem for the patient portal, does it not? How does patient information, entered into an online form, change the reliability factor? Can you expect it to be any more reliable at all? Let's suppose, though, that this approach yields an unlikely 100% improvement. Is that enough? Is it sufficient that you record a patient history you believe to be 50% accurate on average and pass that along to the next provider? Remember, if you are doing Meaningful Use, when you finish your exam, you are giving the patient a copy of their Continuity of Care Document (CCD).  Think how it reflects on your office reputation when that patient gives your CCD to the primary care physician and it's inaccurate. Supposing the information is only 25-50% accurate, does it reflect well on you as one of the patient's health care providers?

You have an alternative that's better than any patient-dependent history, whether given verbally or via web portal.  Just as you must be able to create and give the patient an electronic copy of the CCD after your exam, as a requirement of Meaningful Use, so must the patient's other physicians.  Ask the patient to request that the physician send you the CCD electronically and it is now technically possible for the CCD to automatically populate your exam forms with highly accurate information. Although portals are popular today, consuming the CCD from the primary care physician into your exam is the very best way not only to decrease the amount of effort to document an exam, but to get the improvement in quality of data needed for success in the new arena of health care delivery.

Patient portal or a CCD containing the problem list, meds list, allergies list and lab results from the PCP, which would you rather have? Yes, both of course. That's where we're going. Before we get there, certain conflict issues need to be resolved. For our part, we're betting first on the CCD.


Jim Grue, O.D.
Alistair Jackson, M.Ed.