What do you do with those little tidbits of information that you want to remember about a patient, but that you may not want to write in a chart for the whole world to see?
Case in point – A patient tells me her BRCA gene test results on the condition that I not put it in her chart. She paid for the test out of pocket, and is under no obligation to tell those results to anyone. I understand this, but if I don’t write it down somewhere, I won’t remember it the next time I see her.
In the past, this has not been a problem. I just put that information on a little stickie note in the chart. That way, it was right in front of my nose, but not shared if ever a copy of the record was requested.
The nature of my job means that I get told a lot of intimate stuff that relates to my patient’s gynecologic health. Perhaps there is a history of sexual abuse that impacts her ability to be examined. Or her husband is impotent, or has certain sexual needs that are affecting her. These details are important to our interaction both that day and on future occasions, but my patient’s insurer does not need to know then in such detail to confirm their medical necessity.
Simple. Just use a post-it! That way, if a colleague is seeing my patient for a related reason, I can pick up the phone and transmit the more sensitive information confidentially, sending over just the paperwork needed to care for the patient without blaring her personal life over the fax machine.
But now we have an electronic medical record, and my little post-it system is no more.
In the EMR, the only option I have is to make an entire encounter confidential, so that no other provider in our system can read it. I do use that option for the occasional celebrity patient or for the employees who wants their records uber-protected. But that does not work as well, in my opinion, for handling those little bits of personal information that count.
I wish so much that I were one of those doctors who remember every single detail about their patients, and rarely need to write anything down. Sadly, I am not. I can barely remember my wedding anniversary, let alone personal details about a patient I have not seen for months. I really do need these little notes to myself.
So, for now, it’s all going into the chart. (Or not, depending on just how sensitive the information is.) I’m trying to develop a little code system that will remind me, but that’s remains a work in progress.
If any of you out there using an EMR have tackled a similar problem, do tell me your solution.
Because if I don’t write it down, I will forget it. And that’s a promise.
I think that is extremely considerate of you. I recently had to tell a doctor something very personal and then later I realized he probably had to dictate it and now it is in print. Not the end of the world – but embarrassing. Makes me want to hold back info.
OK, here is what I would do if I were you. I would make up criptic shorthand that you understand but isn’t obvious. Then, write the notes on a paper that you give to the patient to hold and tell them to bring it back each time.
While this seems a big obligation on the part of the patient, if they want to keep the notes to themselves then they have to participate. The criptic notes will maintain the secrecy.
I don’t think that you have much of an option except maybe to log in the comments in a spreadsheet that is just for you, but that is twice the recordkeeping…not such a good use of time.
Schtruggling-
I like it. Then when they bring it back, neither they nor I will have no idea what it means – Double-blinded privacy!
Hey, I can’t come up with everything for ya!
I would be happy to help you create a “rosetta stone” of ever-so-personal notes…
Could you not ask your IT folks to create a separate page in the EMR for these “stickies?” That way, all users with access to the EMR could still see everything in the record EXCEPT the “personal notes” page written and read by only one unique user.
Talk to your IT folks — there ARE commercial products for the Windoze-based systems that function in the same way as physical Post-Its(tm). Perhaps one such program may be interfaced with your proprietary EMR, or at least be accessible from the same computer — then a keyword that you know means “see the post-it outside of the EMR” could be used — say “Odysseus” which the insurance companies and government regulators wouldn’t have a clue to…
Too bad that the private document doesn’t have a patient-chosen password associated with it. That way, any physician could see that there is a private document, and could ask the patient for permission to unlock the information. The patient would be able to choose to provide the password or not. The password would have to be something standard that they would remember, though.. like mother’s maiden name, for example.
Derrick, Wil and Lisa:
Great ideas, every one of them. I will bring them up to our IT guys.
I think that there are two views points to be considered when strongly advocating the use of EMR in practices. For a Doctor it needs to easy to use and save time so that more time can be spend on the patient. Currently we have many vendors with different types of EMR that are so hard to use that it simply puts them off. I think healthcare technology companies need to develop product after regular interaction with doctors to ensure that they provide just what is required. At binaryspectrum we have developed our healthcare solutions after spending countless number of hours with doctors to ensure that its work flow is kept simple and intuitive. This is then followed up with a period of Beta testing in real time environment before it is offered as a product in the market.
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