Hi there - this is Kevin Grassi, MD with the PB team. You are absolutely correct that many primary care doctors rely on the patient to provide a medical history and rarely need the specific information located in the medical record. However, if you have complex medical issues, your primary care doctor may want to see specific data - especially lab or imaging reports.

Many specialist doctors need to see previous medical records before evaluating and treating the patient. This is especially true in oncology. We work with the Smilow Cancer Hospital, part of the Yale-New Haven Hospital, to help ensure that all oncology patients present for their first visit with a complete medical record.

One final note that is my assessment of how physicians operate in the current system - doctors are accustom to working with incomplete information. PatientBank is striving to make previous medical information more accessible to your next doctor. My hope here is that increased access to information will cause doctors to pay more attention to your data and lead to better care.

Thanks for your question! I hope this clarifies things.

Actually, this brings up a good question. Why not build a system where a patient can keep their record with them and only share as necessary. I'm thinking along the lines of a password manager.

This also removes the need for a giant centralized database which would be a nice ripe target.

Somewhere else in the thread someone mentioned about what happens when there is a network of hospitals speaking to each other. Some places in New York would call it a regional health information organization (RHIO).

If all your providers are in that RHIO, there will most likely be a central hub/repo where everyone posts their information to. There are a few localized initiatives in specific states, and there are larger statewide programs that try to consolidate all your records.

After all of that, some state funded RHIO's will get incentives for working with specific partners and even the Social Security Administration (SSA), which brings up a whole lot of headaches and having to meet their standards while at the same time meet all your local partners' standards as well.

Because the government has a high interest in ultimately getting everyone on one network they actual spend a lot of time and effort to try and better these connections and improve data transfer. One of those is this Blue Button initiative [1]. They even have multiple github repos [2] so you can see the underling logic of what a patient model comprises of. What they use is per the HL7 spec that was established in 2011/2013. (Every vendor references the same PDF spec. but there is still a lot of ambiguity in it. Essentially it is really hard to apply all the conditional logic of a clinical document into an XSD.) The funny thing is that with a stamped-and-sealed specification that people still fight over on calls, the HL7 organization are now pushing over to FHIR [3], a JSON based clinical item model. That will be interesting.

To answer your question/concern, there are definitely initiatives to try and make this better, but it will take time to get legacy systems up-to-speed and to meet new standards that are stagnated. You can reference my previous comment with my concerns about that [4].

Lastly, if anyone is new to the EMR/HIE/Medical field, Motorcycle Guy [5] will be your best friend.

[1] https://www.healthit.gov/patients-families/blue-button/about.... [2] https://github.com/blue-button [3] https://www.hl7.org/fhir/ [4] https://news.ycombinator.com/item?id=12264411 [5] http://motorcycleguy.blogspot.com/

Very interesting! Thanks for sharing.

Because then the patient can alter those records or see data the shouldn't (doctor writes a note about patients hypochondria).

Junkies can go from doctor to doctor getting the same script and then deleting the record.

<insert handwaving here>

I was thinking more along the lines of a credstick or leveraging blockchain like tech where a prescription would be signed. So data is still held local in some sort of secure enclave but something that requires both a doctor and patient to sign...

Medical histories are useful when thinking about diagnosis and management. The problem is that they're rarely accessible in a concise or summarized format. Medical systems produce huge amounts of paperwork, even a simple day trip to an A+E department will produce about 30 sheets of paper, and there's no automated way to extract the pertinent information from that. Its much easier to just ask the patient about important things in their medical history, and if any of the previous diagnoses are particularly significant you can delve into the previous records.

This is a great point. As a MD I don't think the process of asking a patient his/her past medical history will every go away. It clarifies how the patient thinks about their medical problems and develops a good rapport.

But as you allude to, having a summary of pertinent medical information, compiled from patient records located in various hospitals, would be enormously valuable for a doctor seeing a new patient. For example, your emergency room doctor having a one page summary of your medical information to be reviewed quickly in an emergency.

Not an MD, but an EMS provider. I know that delivering patients to a hospital often results in the nurse or provider taking a history, even when the patient has been seen (recently) in the ED.

House's rule number one, patients can't be trusted. You wouldn't believe how often patients give the hospital contradictory information to what they gave me, and on the most "innocuous things", past medical history, allergies, and so forth.

So it can be as simple as 'trust but verify', or 'clean slate'.

It can be hard for patients manage all their health information. That is the problem we are trying to solve! Obviously, this starts with patients having more control over their data. Imagine the next patient you transport pulling up their PatientBank account and it has an up to date medication list, allergies and PMH. Instead of relying on memory they have all their information in one place - when they need it.

Critically important in some circumstances. I spent 3 hours yesterday obtaining conclusive evidence that a patient had a specific type of valve replacement surgery, because their treatment (years after the surgery for a totally unrelated issue) depended on this and various providers had documented conflicting data previously.

It turned my 15 hour workday into an 18 hour workday, but I could not have slept without knowing the answer to this question because of the degree of impact it had on this patient.

Yes exactly. Like the answer to pretty much every question about data, a treatment, a test, etc - the answer is, "Well, it depends on the problem".