I, as you may be aware, am not a fan of the behemoth that is the Health Care Industry in the US.  From any angle, it’s massive.  So massive, in fact, that it took up 17.1% of our nation’s GDP in 2014 (according to World Bank Data).  That’s a lot.

My latest beef with the Health Care Industry is the fact that the process of obtaining your past medical history and records — the precise documentation that relays your personal health history — is over-the-top complicated and burdensome.  If you, the patient, want me, your physician, to see what has happened to you before, you need to sign a Release of Information (ROI) for each prior doctor, which I then fax to each of these prior doctors.  I wait (for up to a month) for these to come in, and when they do, they’re bare bones and usually don’t include the most important items like labs, EKGs, imaging (Xrays, CT Scans, etc.). These tests cost money; repeating them is generally avoidable and wasteful.

I have 3 separate patients who have recently transferred care to KCDPC from the same clinic in southern Johnson County, which we’ll call JoCo Primary Care.  JoCo Primary Care has contracted with a local company whose sole mission is to serve as the middleman sending records from one medical office to another.  We’ll call them Copies JoCo for the purposes of our story.

Each of these 3 patients have chronic health conditions, and knowing what has happened before in their care enables me to better care for them, plain and simple.

Patient #1 received a bill for $35 from Copies JoCo for 4 pages of information, one of which was the letter from my office asking for the information.  She missed the bill in her mail pile and ended up with an additional $30 tacked on as a late fee.  That’s $65 for 3 pages of records.  From those 3 pages conveying only a clinic visit, I found about a paragraph useful and relevant to this person’s future care.  If the average paragraph has about 150 words, that’s 43 cents/word.  To take this example a little further, The New York Times has 100,000+ words in each day’s publication, which would be at least $43,000 for your newspaper.  Every day.

Patient #2 received the same $35 bill from Copies JoCo, this time accompanying 5 pages of information (2 of which were my request and a fax cover sheet).  These 3 remaining pages reference multiple labs that were done at that visit.  They referenced a mammogram that was ordered.  They referenced that the patient needed a pap smear.  All of these things are terribly important to this person’s health, particularly if any issues arose in the results.  The results of these tests were not sent along with the records.  Looking at my initial request of information, I had specifically asked for these results.  We called JoCo Primary Care today to protest and let this small, independent practice know how expensive and low-quality Copies JoCo is.  They were unsympathetic.  We asked for the results for the labs mentioned and were rebuffed.  If we want these results, we have to submit another request, which will be summarily sent to Copies JoCo.  (And I’m not sure how this is going to go here, as the initial request we did already send in did specifically ask for these results and I’m not keen on creating a 2nd bill for this patient.)

Patient #3 hasn’t paid that $35 bill.  So we haven’t seen any of his past records, even though the request was sent to JoCo Primary Care 3 months ago.  Mind you, this man has chronic illnesses that would benefit from a thorough review of what care he’s received before, what his prior labs show, medications that have worked, those that have failed, etc..  I shouldn’t show too much remorse, though.  JoCo Primary Care uses an electronic health record (EHR) that, like all EHRs, produces printouts of clinic notes that are filled with inaccuracies and fluff.  I have received reams of printouts over the course of my career from electronic health systems.  Most are tedious to sort through and have little needles of gems buried in pages of computer-generated haystacks.

(Since I’m on a roll, I’ll share another gripe here: we providers cannot transfer your history from one brand of EHR to another.  The notes (which were never designed to be easily printed and read) generally must be printed, faxed or mailed, then uploaded as PDFs into your next provider’s EHR, making them unsearchable an unduly burdensome to review.  This is 21st-century healthcare.)

This is a completely legal way to provide health information.  Both JoCo Primary Care and Copies JoCo are operating within the law and current expectations of the healthcare industry.  And I can even understand why they charge for transferring records: it takes time, resources, and (too much) energy to complete this task.  Our system has evolved so as to prevent seamless record-sharing between clinics, hospitals, and physicians.  The website for Copies JoCo even tips their cap to how burdensome this whole process is, commenting that the founder, “recognized how labor-intensive the release of information (ROI) service had become. True to her entrepreneurial spirit, [CEO] began to research the release of information services industry.”  Copies JoCo even sends a nice note with their bill noting that Kansas allows for $21.00 plus $0.85 per page plus postage and handling for the first 250 pages of records; Missouri allows $24.57 plus $0.56 per page plus postage and packaging.

At this point, I don’t know what to do.  I need prior records to best care for people.  You wouldn’t ask a lawyer to represent you after looking at only half the evidence.  You wouldn’t ask your accountant to file your taxes by surmising your spending patterns based solely on your verbal explanation of what you’ve been doing for the last year.  It’d be silly.  But it’s also silly to ask people to pay $35 for 3 pages of hogwash (or any number of pages hogwash, for that matter).  It just bugs me that the patient (or the patient’s insurance company) already paid to have the office visit completed and now has to pay again to gain access to the information created at that visit. Any suggestions are appreciated.

And now I’ll get off my soapbox.

Allison Edwards, MD