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Curbside Consult with Dr. Jayne 3/25/19

March 25, 2019 Dr. Jayne 15 Comments

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Back in November 2017, the Epic-using world was abuzz about Share Everywhere, which was supposed to let the rest of us who are using other systems have one-time access to key patient information such as medication lists, problem lists, test results, allergies, and possibly physician notes. I remember from the announcements that the feature was version-dependent and figured it would take some time for the most current general release version to roll out to the various health systems that surround our independent urgent care.

Share Everywhere allows patients to generate an access code that allows the patient to give access to a provider, home health worker, therapist, or other member of the care team who doesn’t already have access to the patient’s Epic chart. It’s supposed to be accessible through MyChart. Since anyone in my city who has been hospitalized in the last year has been cared for on an Epic system, I figured a year would be enough for the hospitals to roll out the latest and greatest so that patients could let our urgent care providers peek behind the curtain at their records.

Now that flu season is starting to abate and I have a little more time to breathe while I’m talking with patients, I decided to make a concerted effort to ask patients about their use of MyChart in general and Share Everywhere in particular.

Patients frequently pull up information on medications, whether it’s from MyChart, the Walgreens app, or their CVS profiles. Some even access their pharmacy benefit manager, such as LDI or Express Scripts. Many patients still carry a paper copy of their medication list in their wallet, often with strike-outs and additions.

Today, I had four patients offer to pull up their account in MyChart. None of them had any knowledge about Share Everywhere or how to access it. I decided to go digging for it myself once I got home, accessing my account at Big University Hospital. Once I found the link at the bottom of a little-used tools menu, I generated a code for myself.

Despite having an accurate problem list in my patient-side account, the “share” version of my chart was lacking a problem list of any kind. It’s basically blank. The medication list contained a list of items that didn’t show any date of prescription or the name of the prescribing provider, only the person documenting it whose name I didn’t recognize. Only the items documented pre-Epic that came in with a conversion had start dates. Allergies were up to date (fortunately) but immunizations were blank. I found some useless test results that all said “see scanned report.” The family history information was clearly entered by the clinical geneticist I saw a while back, based on its specificity. There wasn’t any kind of a list of providers, which might be useful for patients that see a few more providers than the two I see each year.

Going back to MyChart, I also found a “Wallet Card” feature I had never seen before, which was supposed to have a “convenient, printable summary” of my medical information. The diagnosis list was blank, the medication list was blank, the allergies were blank, and it included a work phone number where I was last seen in 2007. I’m not sure how it’s even in the chart since I make sure to review the updates every time I’m seen at a practice, but it’s in there nevertheless. I found a handy way to print my eyeglasses and contact lens prescriptions, but unfortunately it doesn’t have my name on it or the name of the provider, so it’s not useful to try to get lenses dispensed. Good idea, poorly executed.

I’m a curious person and I was on a mission, but I wonder how many other people know these features are available to them or how to use them? Certainly Big University isn’t sending out an email telling patients that if they wind up at another place’s emergency department or an outside urgent care, here’s the best way for that competitor to access their records.

Now that I know how to tell patients how to find the Share Everywhere code generator, I’m at least able to go back to my desk and peruse their records without having to try to read them on a phone in the exam room. I’m not due to go back to Big University as a patient until at least July, so I’ll have to try to clean up the phone number issue at that point. I’ve learned from battling the billing team through the patient portal that it’s not worth trying to deal with it remotely. It hasn’t been effective in the past and I ultimately have to call a physical office.

We’re still a long was from patients being able to truly hold their records in the palms of their hands, but at least we’re taking baby steps. Maybe I’ll start a grassroots movement to have patients actually review their records and inundate the health systems with correction requests where needed. Depending on the volume, it might spur some changes in documentation habits or help providers understand that there are people outside their own system that are seeing what they are putting into charts. I’ll have to follow up with some of the more senior members of my family that have more extensive records and see what resemblance theirs bear to reality.

I’d be interested to hear from non-Epic providers whether they’ve had much utility with Share Everywhere and whether other hospitals and health systems are doing a better job keeping it accurate than mine is apparently doing. And from patients, are you aware how to generate a token for your providers to access your information? It’s only good for five minutes, so you have to do it right there, but in the right circumstances it would be useful. I’m also curious whether the other major software players have similar access for outside providers. If you can point me in the right direction, I’ll start polling patients. It’s got to be easier than watching people try to populate an intake form from memory.

When’s the last time you shared your record? Leave a comment or email me.

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Currently there are "15 comments" on this Article:

  1. Pointing the finger at Epic Systems is not fair the issue is getting data out of the legacy systems that process is broken. If the legacy EMRs could easily produce a complete patient’s history via HL7, CCD, and interface they would not being moving off those EMRs.

    Epic does not control the extraction from legacy systems they simply make a recommendation for how the data should be moved to their application and for Epic that is into Epic Care Everywhere to try and support not having upstream and downstream data issues.

    Epic has been forced to turn the clinical end user into a data entry person to support data validation through the accepting or rejection process in Care Everywhere for a patient’s history of MEDS, Allergies, Immunizations and Vitals.

    There is no way Epic can own moving the complete history from a customer that is running for example MEDITECH, eCW, Greenway, GE and McKesson they have to rely on the health system to work with their legacy vendors to extract the data and then format it so Epic can ingest it into Care Everywhere.

  2. Epic does this from time to time; puts out apps it doesn’t really care if anyone uses or solves any real problems, so that when criticized for its role in the “unholy mess,” it can say, “but we’re interoperable! We have Share Everywhere! We have Lucy!” Remember Lucy? No? Early 2010s version of “PHR.” Epic kids wearing little thumb drives around their necks at HIMSS, etc.

    • I find it interesting that you pick on Epic for Share Everywhere and Lucy, while completely ignoring the impact of Care Everywhere on industry interoperability capabilities. The problems Jayne mentions are real issues, but I would also very much consider giving the patient their ability to share their record with anyone a “real problem”.

      • Sorry to be dense, but why would it be a real problem for a patient to share their records with whoever they want? The data does belong to the patient. HIPAA requires that the patient be able to get a copy of their records anyways… I would think the patient could do whatever they liked with their records once they had them (including sharing) – that’s the whole point of that legislation, wouldn’t you say?

        Perhaps I have just misinterpreted your comment…

        • It was a poorly written sentence on my part….giving the patient access to their data and the ability to share it with anyone is an important problem we need to solve. Not something that Epic just plucked out of thin air.

          • It is a real problem and is not a problem Epic picked out of thin air, nor, as evidenced by Jayne’s experience, is Share Everywhere a meaningful attempt to address it. Press release + special update that includes it does not = adoption. Epic has done well promoting adoption of its technology that actually has a meaningful impact, like Care Everywhere, as has been pointed out. When it doesn’t think that thing that made a good press release at the time it needed a win really has a sensible use, it doesn’t bother trying to ensure its customers are using it together, consistently, or that it works instead of pulling in junk, etc. You can tell by Epic’s own efforts that it doesn’t really care about this or believe it solves anything. When it does, critical mass would be doing it because essentially their clients work for them.

        • The patient does not own the data. The data are about them and they have a right to see and distribute.

          Can they modify their record? Do they pay a record storage fee to the HC org to hold their data? If not, it’s not owned by the patient.

          • The Crux of the matter is the severe discomfort of the inability to buy the data.
            Even if the consumer was ready to pay top $$, the consumer still can’t get their complete medical records.
            Money minded consumer can’t get around the fact it’s not easy to buy ur medical record. Same way there is no easy way to buy a cancer cure.

            Purpose of medical documentation was never to share the data with consumers. It was meant for consumption by a trained medical eye only at their discretion. Nothing stops a doctor to order those already done lab test again. Past medical record or no record..

  3. Much of health care is driven by a “Show me the Business Case” model, not a “What is the best way to employ information about an individual patient, at every interaction, in a way that benefits the patient” model.
    It is hard to see a profitable business case of providing access to data when a patient wanders out of the captive data pool of a specific organization. On the other had it is easy to see the moral, compassionate, empathetic, social justice, “why I went into medicine in the first place” model. In the old paper world many hospital rules and regulations were specific in noting that the information within the record belongs to the patient, but the vehicle of that information (the Chart) belongs to the hospital. This provided the basis for providing a “vehicle” for the patient: a printed copy at a cost of 2 or 5 or 10 cents per page. Is this any different than EHR vendors charging to move the stored data when a practice changes vendors? The “ownership” of the data has never been equivalent to open and easy access to the data. There has always been a cost associated with transfer of information from vehicle to vehicle and profound disagreement around who should bear the cost.

    • IMO, this question of who should bear the cost goes right to the heart of the most challenging problem in the US healthcare system today – which is this: when people receive more healthcare, more dollars flow into the healthcare system, which is an ecosystem of businesses.

      Transfer of patient information results in decreased use of the healthcare system. Why? Because having those records available results in earlier intervention and in fewer repeated diagnostic tests.

      Decreased utilization of the healthcare system is important to the survival of only two parties I can think of: (1) the patient (obvious benefit), and (2) the payor (cuts costs).

      Therefore we should be looking at the patients to pay, or the payors to pay. No-one else seems to have a dog in this fight. I realize it sounds quite callous to put it this way, but I feel it is realistic. There are indeed providers who act for the greater good and act in support of transfer of patient records. However, hoping that all providers will support timely transfer of patient info – without some inducement to do so – may be misguided.

      Note that I have left vendors out of this discussion. There are vendors who produce goods and services that support transfer of patient records. (I work for a vendor who specializes in this area.) However, it needs to be bought and paid for in order to be used. The decision power rests in the hands of the consumer.

  4. “Today, I had four patients offer to pull up their account in MyChart. None of them had any knowledge about Share Everywhere or how to access it.”
    That’s on their provider’s lap, just like it is on your Big University Hospital’s lap for your specific issues.

    You’d think Epic would get some credit for making this feature available, and turned on by default on their recent versions. Of course, all the organizations can screw it up and not implement it properly, but should you leave that on Epic’s lap? Are they supposed to automatically make all the information available without their customers consent? I’d be curious to see how you’d implement this if you were the vendor. Make all the data available to patients even without the provider’s consent? Including lab results before the providers have reviewed them, including data from other vendors that may have come in through an interface? How long do you think the vendors would be in business for going against their customers wishes in such a big way?

    I don’t think most organizations would want to publicize this feature as it just invites more patient involved customer support. They’d rather not deal with it unless they have to, and for that they should be shamed as it’s their patients (aka customers) that are suffering. At the same time vendors should be applauded whenever they make moves in the right direction as it only encourages them to keep doing more of it. On the other hand, when they catch flak for implementing data sharing features, what good does that do anyone?

  5. Sorry for the spam, found another health system that advertises it on their main page under RESOURCES:
    https://cchealth.org/mycclink/

    This is how to give it visibility when you actually want your patients to use it. I’m guessing their implementation is more up to par.

  6. Sat down with my mother recently and pulled up her MyChart because we were interested in what they had on file and we were pleasantly surprised to find labs, meds (with dates and prescribers), office visits, procedures, vitals, a variety of encounter locations (IP, OP, OPS) – all very accurate and going back a few years. I was also amused to see how tickled pink she was to find this vault of personal info. After spending most of my career in HIT it was nice to see a healthcare consumer happily using our hard work! I would point the finger at the health system doing the implementation and how good a job they do setting it up – as opposed to the vendor – on this one. Cheers Jayne!







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