Pro Tips for Using Online Medical Records

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Why you should read your medical record

Have you ever left your doctor’s visit and still had unanswered questions, or didn’t remember exactly what they told you?  Research shows that patients remember less than half of what they are told in a doctor visit. There are many reasons for this. You are anxious, the information may be presented too fast or using language you are not familiar with.  Often you will find the answers you need in the office visit notes of your medical records.

By law, most of the notes and test results in your electronic medical record (EHR) must be immediately available for you to view through a secure online portal.  This is mandated by The Open Note’s Rule of the federal 21st Century Cures Act, which went into effect April 21, 2021.  It is against the law for health care organizations to block this information.

There are many reasons you should review your medical records

• Help you remember important information from your conversation with your provider.
• Make sure that your provider correctly recorded the information you provided them.
• Ensure that your medication list and allergy list are correct and up to date.
• So you can gain insight into the provider’s thought process and reasoning about important health care decisions they will help you make.
• To help you prepare questions for your future health care visits.
• You can view test results as soon as they are available and prior to your next scheduled visit.
• So you can share important information with family members or health care providers who don’t have access to your EHR.

Remember, if you have complex medical problems and see more than one health care provider, each of them is looking at each other’s notes and using that information to make decisions.  It’s critical it is recorded correctly.

 

MR Madness

Imagine if an IOS (Apple) phone couldn’t call an Android (Google) phone or a Windows OS (Microsoft) based phone!  That is analogous to the state of affairs for EHR’s a few years ago.  Things are slowly improving, not fast enough.  Now some EHR’s can pull records from some institutions using the same EHR, and a few using a different EHR.  It can be very difficult to get all of your medical records and make them easily available to all of your health care providers.

 

How to access your medical records

Your records can be viewed through a patient portal.  To create an account for a patient portal you must obtain an access code or invitation.  When you register at a health care facility (hospital, Dr’s office) they will often send you an email invitation to the portal. So first check your email.  If you have not received this ask the office staff or navigate to the facility’s web page and patient portal information.   This should tell you who to call or email to obtain an access code.  When you have this you can create a patient portal account on your computer or tablet and see your records.

In order to see your medical record on a smartphone first install the correct app.  If you don’t see a link to do this on their web page, or after you open the patient portal on your computer, you can go to the appropriate app download site and search for the facilities app.  For example, to install the app for Elsewhere General Hospital on your Android phone you would go to the google play app store (or Apple app store for IOS) and search “Elsewhere General”  

If you don’t find an institution-specific branded app you can find the “generic” app used for your provider’s EHR. When you log in with this you will get the institution’s branding and configuration.  Fortunately, about 75% of health care institutions and providers use one of the following EHR systems.

EHR Company	Patient portal/APP	Download	Download
EPIC	MyChart
CERNER	HealthLife
Meditech	Meditech Health Portal
Allscripts	FollowMyHealth

 

You will need to set up a separate portal access account for each institution/practice from which you receive healthcare. This is true even if they use the same EHR system (Epic,Cerner etc.).  If you have multiple accounts using the same EHR they can usually be linked so you can easily switch between sites. But each still requires a separate sign-in.  Unfortunately, linking also does not actually integrate the information as a single coherent, chronological, organized record. 

A tip for EPIC users:

1. If you have multiple EPIC accounts go to MyChartCentral and create an account. This is the closest thing to an integrated-across-institution electronic medical record you can find and permits single sign-in to see all your information.  Many, but not all Epic/MyChart sites allow access to this.  
2. Once you have a MyChartCentral account you can create a LUCY document. This is a summary of your health care across participating EPIC institutions.  These are a great way to share summary information. For more information about MyChartCentral and Lucy see MyChartCentral/Lucy FAQ’s

 

 

Health Care Proxy: Accessing records of a minor or adult for whom you are the caregiver.

Proxy access gives you the capacity to fully view and control another individual’s online portal medical record.  You can make appointments for them, request medication refills, and communicate with their health care team. It is not the same as being the legal health care proxy. The latter gives you full decision-making capacity. 

PROXY ACCESS FOR A CHILD:

Below a state-specified age, you should not need anything more than a signature to access their medical record.  Past that specified age, the minor must give consent for a parent to access portions of their chart.  You may need to establish separate portal accounts for the child and for yourself.  These are then linked so you can control the child’s account. 

Depending on your health care provider’s policy and/or EHR you may be required to download, print, and then email or fax a  Minor Proxy Authorization form.    When the child is beyond the cutoff age you will require approval from the child to see portions of the record.  At age 18 you will lose access. 

HEALTH CARE PROXY FOR AN ADULT PATIENT

You will need to look at your portal to find the mechanism for your case. Give this plenty of time, it may take days or weeks to be approved.  The time to think about these issues is before you or your loved one becomes incapacitated and unable to provide consent for a proxy.  This is best accomplished by creating an advanced directive with proxy and power of attorney authorization. 

EPIC/MyChart makes the process simple, assuming the patient is capable of granting permission via computer.    Here is a VIDEO that takes you through the process.  

With most other EHR platforms you will need to have a paper health care proxy form signed and sent to the patient’s health care facilities information technology/EHR department. Instructions for this should be found on your patient portal web page.  You will need to send or upload the signed documents to the correct location as indicated on your portal. 

A legal health care proxy document permits someone to gain full legal control of another person’s medical affairs in the event they become incapacitated.   Here are LINKS to official proxy forms by state. 

 

Obtaining “outside” medical records. 

Many people have important medical records with multiple providers, in multiple different offices or hospitals, and each may be using a different EHR. You may relocate, change insurance networks or your doctor’s practice may be bought out by a large heath care system. Each time this occurs your records become more fragmented.  

Rapid access to all of your previous records can avoid a lot of duplicate testing, save time, limit radiation exposure from repeat x-rays, and save you a lot of money.  But it is not so simple. The old cliche’ is apropos:  “It is hard to believe that we can send men to the moon” but we still can’t get all of our electronic medical records to work together. Do not assume that your providers can easily obtain records from “outside” health facilities. Things are improving but the task is far from complete. This results in great inefficiency in our health care system. 

You can help your providers obtain timely access to all of your important information in several ways.

• Have a list of the names, addresses, and telephone numbers for of all the places you have previously received health care.
• If your provider is using EPIC Systems EHR (which has the largest market share in the U.S.), make sure they check Care Everywhere, a built-in feature in EPIC. Records from all other EPIC user sites, and many non-epic organizations, are available. But they need to know where to look may have to specifically query the system.  Sometimes providers don’t think to check this and miss valuable information.  CERNER-based EHR’s may also be linked to some other health systems/providers but these vary by institution. 
• There are many Health Information Exchange (HIE) programs whereby institutions and providers in a geographic area, or with a common interest, agree to make their records available to one another. Some states have statewide systems. Unfortunately,  participation may not be mandatory.  If you have a list of your previous sites of care your providers will then have an idea of which HIE’s may hold your information.  HIE’s are underutilized by providers.   Many may not even know what an HIE is. 
• If they are unable to immediately access your records through their computer/EHR you will need to sign a consent for the release of information.  This will be faxed to the outside facility’s medical records department. They will fax your records to the interested provider. But this often takes hours or days and may result in a delay in diagnosis, care, and the expense of a return visit. 
• Request an electronic or paper copy of your records well in advance of your upcoming appointment with a new provider. By law, you are entitled to receive timely copies of your records at a reasonable cost. But not immediately. 

 

Organizing and Sharing your EMR

• Perhaps the best, and the least utilized, option is to take full control of your health record by creating a Personal Health Record (PHR).  This is 3rd party software that allows you to electronically pull in records from different providers/institutions/labs. It takes a little work sometimes but this is your best bet if you have multiple unaffiliated health care providers.  It is much easier to share all of your records with your health care team when they are all stored on one site and properly organized.  Par for the course, none of the available products are perfect at electronically accessing your outside records. Each does not necessarily communicate with all the available medical information storage organizations.  But you can usually download your records from one institution to your home computer and then upload them manually to your PHR. Then it is easy to share everything with your providers and family in an organized fashion. See the section on PHR software below. 

Second best alternatives: 

• Keep a list of all of the hospitals, health systems, labs, and pharmacies where you have a health record or information. If all else fails your providers can request faxed or emailed records. This can take hours to days. 
• Keep paper copies of your records from each health care encounter.  Bring them with you whenever you plan to see a different provider.  You can also download or scan them to a computer and create a secured electronic copy to access or share at the point of care. Put it on a thumb drive, make sure it is password-protected, and keep it with you at all times. 

Computer/Electronic Sharing of Medical Records

In EPIC there are multiple ways to do this. 

Go to the Mychart main menu

 

 

Then scroll down to the “sharing section”

SHARE MY RECORD: This is where you go to assign health record proxy access, download or send parts of your record. 

SHARE EVERYWHERE:  This generates a share code. You send this to the person you want to share with. They go to www.shareeverywhere.com and enter this code. 

 

Sharing your records with Cerner/Myhealth

From the main menu select “Health Record” then “Visit and Hospital Summary.”

You will then see a list of your visit care summaries.  Choose those you want and hit send:

You will have two options:  “direct” and “unsecured.”  Unsecured is standard email and lacking high-level security features.  

Direct utilizes a special technology standard developed by the DirectTrust organization.  DirectTrust is a secure information exchange for sending health information electronically.  You need to know the “direct address” of the person or organization you are sending information to.  This is not a standard email address (although it looks like one) and will not work with g-mail or any other email application.   

If you have a MyChartCentral account through EPIC you have your own Direct address which is shown below your name on the top right side of any LUCY PAGE.  This can be used to send records from a CERNER-based system to EPIC/LUCY. 

 

Personal Health Record: “3rd party” apps

After you download and sign up for access to these products you need to import information from each health care provider/system you have visited.  Information is stored on their side, so you can access your records from anywhere, anytime.  Then it is easy to share all your vital information.  Here a few of the best products: 

• Records are obtained from each institution by e-mail request and then added to your account.
• You can also manually upload documents

 

 

 

 Via the internet this will pull in your information from outside EHR’s and institutions where you have portal access.  You can also upload your own documents

 

This is another great option.  Pulls your records from other portals into the PHR. You can easily assign proxy access or share for 24 hours. Easily download a PDF of your information or securely e-mail it.  Upload your own files to the app. 

 

Apple Health

The Apple Health APP is compatible with both Cerner/HealthlLife EpIC/MyChart.  Unfortunately not all health systems using EPIC offer this option.  Here is a LIST of health care systems and providers which are supported by Apple Health.  If all of yours are on the list it is a great option.