Medical record mix-up

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azurekep
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Medical record mix-up

Post by azurekep » Wed Dec 28, 2016 8:12 pm

I'm helping someone navigate the process of getting their medical record corrected. The guy is in excellent health with no health issues. His record got mixed up with that of someone who has a serious disease. The mix-up was discovered when my friend got a referral to a disease specialist.

To date, the only thing that's happened is that a retraction of the referral authorization was made. Along with profuse declarations of "We're sorry. We made a mistake." But the office visit where the disease was diagnosed remains on my friend's medical record.

What is the process for getting this rectified? I've heard that it's very difficult to get medical records changed, but this is pretty serious. At some point, does a notarized affidavit need to be prepared to provide proof of identity to the medical records people?

The only commonality between my healthy friend and the guy with the disease is that they have the same PCP. Does a PCP have enough leverage to get the Medical Records people to change a record?

Any help would be appreciated. A step-by-step outline of the correction process would be especially helpful..

Thanks.

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Re: Medical record mix-up

Post by prudent » Wed Dec 28, 2016 8:29 pm

Topic moved to Personal Consumer Issues.

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Re: Medical record mix-up

Post by sport » Wed Dec 28, 2016 8:38 pm

The last time I want to see a doctor, the assistant reviewed my medications. There were some in my record that I no longer take. So, she removed them from the record. It seemed easy for any doctor's office in the network to correct the record.

toofache32
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Re: Medical record mix-up

Post by toofache32 » Wed Dec 28, 2016 9:18 pm

I don't understand why this is such a big deal. The PCP should just make an addendum stating "an error was made and Mr. Smith has NOT been diagnosed with X Disease." Takes 60 seconds. What am I missing here?

PoppyA
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Re: Medical record mix-up

Post by PoppyA » Wed Dec 28, 2016 10:09 pm

Call the insurance company and see what they recommend.

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Re: Medical record mix-up

Post by toofache32 » Wed Dec 28, 2016 10:14 pm

PoppyA wrote:Call the insurance company and see what they recommend.
What does this have to do with insurance? They do not have the medical records. The person who made the error simply makes an addendum to correct the inaccurate diagnosis.

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Pajamas
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Re: Medical record mix-up

Post by Pajamas » Wed Dec 28, 2016 10:22 pm

One of the many benefits of HIPAA is that patients have a right to examine their medical records and request corrections of inaccurate information and providers are required to comply or face fines.

Most providers will cooperate if you ask for an error to be corrected, and if not, then mentioning HIPAA to someone competent should do the trick. If that doesn't work, then you could file a complaint.

In this situation, I would be worried about the extent that the error had been propagated and would ask about who might have gotten the incorrect information to make sure that every instance were corrected. That might include the specialist to whom a referral was made if records were sent, an insurance company or payor, etc.

It's not clear in your post who "Medical Records" is. Did this take place in a hospital? In a doctor's office, the doctor and the office are responsible for the medical records. In most cases (or maybe all, these days), that record is electronic. Regardless, the doctor and the office staff should know.

Something else to consider is that in addition to the record of the office visit, there may be a separate listing of diagnoses, one for medications, another for procedures, etc. that might need to be corrected in addition.

https://www.hhs.gov/hipaa/for-individua ... anguage=es
Last edited by Pajamas on Wed Dec 28, 2016 10:28 pm, edited 2 times in total.

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azurekep
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Re: Medical record mix-up

Post by azurekep » Wed Dec 28, 2016 10:27 pm

toofache32 wrote:I don't understand why this is such a big deal. The PCP should just make an addendum stating "an error was made and Mr. Smith has NOT been diagnosed with X Disease." Takes 60 seconds. What am I missing here?
I may have misspoke earlier.

The PCP referred the sick guy to Specialist A and it was Specialist A who referred the guy to Specialist B. My friend got the second referral authorization. The PCP is still in the loop, but it was Specialist A who made the error.

There were obviously tests done by Specialist A and written observations made and they all should have gone into the sick guy's record. Now all that information needs to be expunged from my friend's record and manually entered into the sick guy's record.

But yes, there should be a way for a physician to make a note explaining the situation. My impression is that there could be pushback from Medical Records for making the actual data entry changes, but I could be wrong on that. But since medicine is a bureaucracy, it would be good to know the procedure for correcting things beforehand so it can be taken care of quickly.
Last edited by azurekep on Wed Dec 28, 2016 10:43 pm, edited 1 time in total.

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azurekep
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Re: Medical record mix-up

Post by azurekep » Wed Dec 28, 2016 10:42 pm

Pajamas wrote:One of the many benefits of HIPAA is that patients have a right to examine their medical records and request corrections of inaccurate information and providers are required to comply or face fines.

Most providers will cooperate if you ask for an error to be corrected, and if not, then mentioning HIPAA to someone competent should do the trick. If that doesn't work, then you could file a complaint.
Thanks. We'll look into that.
In this situation, I would be worried about the extent that the error had been propagated and would ask about who might have gotten the incorrect information to make sure that every instance were corrected. That might include the specialist to whom a referral was made if records were sent, an insurance company or payor, etc.
So far, the propagation seems to have ended at Specialist B's office. Phone calls from that office abruptly ended after the mix-up was brought to the attention of the originating parties.
It's not clear in your post who "Medical Records" is. Did this take place in a hospital? In a doctor's office, the doctor and the office are responsible for the medical records. In most cases (or maybe all, these days), that record is electronic. Regardless, the doctor and the office staff should know.
Activities took place in the PCP's doctor's office, followed by Specialist A's office, and it was the staff at the PCP's office that was alerted to the error. They were the ones who brought up the mysterious "Medical Records people". They were also the ones who contacted Specialist A and informed them of their error.
Something else to consider is that in addition to the record of the office visit, there may be a separate listing of diagnoses, one for medications, another for procedures, etc. that might need to be corrected in addition.
Exactly. There could be a whole paper trail, with that trail attached to the wrong record. I can see how there could be a lot of typing and re-typing done to correct everything.

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Re: Medical record mix-up

Post by celia » Wed Dec 28, 2016 10:47 pm

azurekep wrote:The PCP referred the sick guy to Specialist A and it was Specialist A who referred the guy to Specialist B. My friend got the second referral. The PCP is still in the loop, but it was Specialist A who made the error.

There were obviously tests done by Specialist A and written observations made and they all should have gone into the sick guy's record. Now all that information needs to be expunged from my friend's record and manually entered into the sick guy's record.
In this case,
toofache32 wrote:The PCP Specialist A should just make an addendum stating "an error was made and Mr. Smith has NOT been diagnosed with X Disease." Takes 60 seconds. What am I missing here?
Apologies to toofache32 for changing your text.

Your friend should call Specialist A and request his record to verify it has been cleared up. I assume the PCP and Specialist A are in the same medical group as A seems to have access to your friend's records and address. In that case, the PCP can probably verify it has been corrected too.

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Re: Medical record mix-up

Post by toofache32 » Wed Dec 28, 2016 11:19 pm

celia wrote:
azurekep wrote:The PCP referred the sick guy to Specialist A and it was Specialist A who referred the guy to Specialist B. My friend got the second referral. The PCP is still in the loop, but it was Specialist A who made the error.

There were obviously tests done by Specialist A and written observations made and they all should have gone into the sick guy's record. Now all that information needs to be expunged from my friend's record and manually entered into the sick guy's record.
In this case,
toofache32 wrote:The PCP Specialist A should just make an addendum stating "an error was made and Mr. Smith has NOT been diagnosed with X Disease." Takes 60 seconds. What am I missing here?
Apologies to toofache32 for changing your text.

Your friend should call Specialist A and request his record to verify it has been cleared up. I assume the PCP and Specialist A are in the same medical group as A seems to have access to your friend's records and address. In that case, the PCP can probably verify it has been corrected too.
I agree with this. I deal with this a few times a year in my practice now that we have electronic medical records. I never saw it happen even once in the prior 10 years with paper records.

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Re: Medical record mix-up

Post by kiddoc » Wed Dec 28, 2016 11:53 pm

This should be an easy thing to fix at Specialist A's office. I use 5 EHR systems and they all have the capability to mark a note "in error" or "deactivate" it from the patient's chart. All they need to do is copy the note's text, paste to the right patient's chart, and mark the incorrect note appropriately. Should take less than 5 minutes.

Making it qualify for meaningful use and making it disappear from the EHR's problem list... will take them a lifetime!! :mrgreen:
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Re: Medical record mix-up

Post by azurekep » Thu Dec 29, 2016 12:37 pm

kiddoc wrote:This should be an easy thing to fix at Specialist A's office. I use 5 EHR systems and they all have the capability to mark a note "in error" or "deactivate" it from the patient's chart. All they need to do is copy the note's text, paste to the right patient's chart, and mark the incorrect note appropriately. Should take less than 5 minutes.
Does "deactivation" actually remove it from the patient's record? Human nature being what it is, it's easy for me to envision emergency or other health professionals looking at someone's medical record and reading information that's still present, even though having been marked as in error.

So far, though, it sounds like this is no big deal. I do wonder, though, about the other affected party. In my friend's case, it's a matter of deleting/deactivating information already entered. In the sick person's case, it's a matter of having all that information re-entered into their own medical record. Is that a big deal?

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Re: Medical record mix-up

Post by kiddoc » Fri Dec 30, 2016 2:07 pm

azurekep wrote: Does "deactivation" actually remove it from the patient's record? Human nature being what it is, it's easy for me to envision emergency or other health professionals looking at someone's medical record and reading information that's still present, even though having been marked as in error.

So far, though, it sounds like this is no big deal. I do wonder, though, about the other affected party. In my friend's case, it's a matter of deleting/deactivating information already entered. In the sick person's case, it's a matter of having all that information re-entered into their own medical record. Is that a big deal?
The first part depends on the EMR system. I have seen 3 variations but all of them make it abundantly clear and other people are unlikely to read them:
1- The note is not displayed in the medical record unless someone sets preferences to "show notes marked in error". Even then the note is clearly marked with a red X.
2- When you try to open the note, a pop-up opens, saying "this note has been marked in error. Are you sure you want to view it?"
3- The note listing is red in color and when you open it, it has size 24 red lettering across the top: "In error"

The second part of your question is tricky. Getting the actual note into the other patient's chart will be a simple copy/paste thing. The tricky part is the "meaningful use" nonsense which is part of all EMRs these days (and the bane of our lives). A lot of data form entries are in registries and problem lists. This doesn't help the patient much and has a host of erroneous and useless, but potentially dangerous information almost uniformly. It is mainly used by insurance companies and medicare to reduce payments to physicians/ hospitals. I really doubt anyone will ever be able to completely sort that out in this particular case. 2-3 years down the road, your friend may be showing up in some erroneous insurance registry somewhere as a number and the physician's salary getting reduced because they didn't measure the "appropriate meaningful use outcomes data" for the patient. Also, depending on the diagnosis, 1-2 times a month, the physician may get a letter from the insurance company prompting them to do something for your friend which is based on the erroneous entry. I, and most other physicians simply don't act on those letters. They go straight to scrap after a scanning glance.
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Re: Medical record mix-up

Post by Pajamas » Fri Dec 30, 2016 3:39 pm

azurekep wrote:.My impression is that there could be pushback from Medical Records for making the actual data entry changes, but I could be wrong on that. But since medicine is a bureaucracy, it would be good to know the procedure for correcting things beforehand so it can be taken care of quickly.
The push from the medical records people should be to ensure that the records are accurate. They should have at least as much knowledge and concern about this error as the clinical people who are involved. If you want to know the bureaucratic procedure for correcting the record, ask the medical records people. At least in a hospital, they are the ones responsible for making sure that the records are complete, well-ordered, signed by the clinicians, etc. If the clinicians don't cooperate with the medical records people, their department head and then chief medical officer chew them out and then their privileges are eventually suspended.

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Re: Medical record mix-up

Post by samsoes » Fri Dec 30, 2016 4:11 pm

toofache32 wrote:I don't understand why this is such a big deal. The PCP should just make an addendum stating "an error was made and Mr. Smith has NOT been diagnosed with X Disease." Takes 60 seconds. What am I missing here?
Having worked for Mega Multi-State Hospital in the IS (Revenue Cycle) department, ICD codes are transmitted to multiple agencies for billing, and to a centralized state-based repository (at least here in CT). Corrections/deletions of codes were not transmitted to the state repository. Ever.

So, in the case of the OP's friend, I suspect it would be like being accidentally placed on the Master Death Index and trying to prove your still alive - an incredibly difficult process, since the data has already been disseminated. As the saying goes, you can't unring a bell.

To all the docs out there - stay on paper as long as you can.
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Re: Medical record mix-up

Post by dm200 » Fri Dec 30, 2016 8:01 pm

This can be a life insurance issue. It is often the case that a life insurance company will want to review all of your medicl records. One (of many) reasons to get this cleared up ASAP.

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Re: Medical record mix-up

Post by azurekep » Fri Dec 30, 2016 9:04 pm

samsoes wrote: Having worked for Mega Multi-State Hospital in the IS (Revenue Cycle) department, ICD codes are transmitted to multiple agencies for billing, and to a centralized state-based repository (at least here in CT). Corrections/deletions of codes were not transmitted to the state repository. Ever.
If my friend never receives an EOB that lists any office visits, procedures, lab tests or medications related to the erroneous disease, would it be safe to assume the error has been corrected, contained and not propagated?

Also, will going through HIPAA fully correct all errors locally and in the wider repositories?

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Re: Medical record mix-up

Post by toofache32 » Fri Dec 30, 2016 9:26 pm

azurekep wrote:
samsoes wrote: Having worked for Mega Multi-State Hospital in the IS (Revenue Cycle) department, ICD codes are transmitted to multiple agencies for billing, and to a centralized state-based repository (at least here in CT). Corrections/deletions of codes were not transmitted to the state repository. Ever.
If my friend never receives an EOB that lists any office visits, procedures, lab tests or medications related to the erroneous disease, would it be safe to assume the error has been corrected, contained and not propagated?

Also, will going through HIPAA fully correct all errors locally and in the wider repositories?
What do yo mean by "going through" HIPAA? This has ZERO to do with HIPAA. HIPAA is a security rule that tells us if and how information can be shared.

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Re: Medical record mix-up

Post by samsoes » Fri Dec 30, 2016 10:16 pm

azurekep wrote:
samsoes wrote: Having worked for Mega Multi-State Hospital in the IS (Revenue Cycle) department, ICD codes are transmitted to multiple agencies for billing, and to a centralized state-based repository (at least here in CT). Corrections/deletions of codes were not transmitted to the state repository. Ever.
If my friend never receives an EOB that lists any office visits, procedures, lab tests or medications related to the erroneous disease, would it be safe to assume the error has been corrected, contained and not propagated?

Also, will going through HIPAA fully correct all errors locally and in the wider repositories?
EOB's are derived from data sent to insurance companies. Insurance data may be corrected as necessary for billing purposes. For data transmitted to Connecticut's repository, however, we had no mechanism to correct codes. Who knows how this information is used. If bureaucrats claim unspecified "Public Health" purposes, it can be used as needed, whatever that means. Not to get all tinfoil-hat here, but that's not too comforting a prospect.

No conclusions can be drawn if an error never appears on an EOB. It depends on the timing/schedule of the transmission of data to the insurance company and the state repository. Of course, this applies to CT only. YMMV in other jurisdictions.
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Re: Medical record mix-up

Post by kiddoc » Fri Dec 30, 2016 11:17 pm

dm200 wrote:This can be a life insurance issue. It is often the case that a life insurance company will want to review all of your medicl records. One (of many) reasons to get this cleared up ASAP.
Less likely. As a specialist, I usually am asked for notes for review for life insurance, not problem lists or registry data. If the note is marked in error, it will not be sent/ considered.
azurekep wrote:If my friend never receives an EOB that lists any office visits, procedures, lab tests or medications related to the erroneous disease, would it be safe to assume the error has been corrected, contained and not propagated?

Also, will going through HIPAA fully correct all errors locally and in the wider repositories?
No and no. Again, what the medical practice can do at a maximum is change the note appropriately which should suffice for most future situations. They cannot do anything about the administrative data mining mess created by government/ insurance company mandates. Those systems were never designed to reflect medical data. They were designed to collect statistics for payment declining/ downgrading, without regard for medical accuracy.
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Re: Medical record mix-up

Post by toofache32 » Sat Dec 31, 2016 1:48 am

kiddoc wrote:
dm200 wrote:This can be a life insurance issue. It is often the case that a life insurance company will want to review all of your medicl records. One (of many) reasons to get this cleared up ASAP.
Less likely. As a specialist, I usually am asked for notes for review for life insurance, not problem lists or registry data. If the note is marked in error, it will not be sent/ considered.
azurekep wrote:If my friend never receives an EOB that lists any office visits, procedures, lab tests or medications related to the erroneous disease, would it be safe to assume the error has been corrected, contained and not propagated?

Also, will going through HIPAA fully correct all errors locally and in the wider repositories?
No and no. Again, what the medical practice can do at a maximum is change the note appropriately which should suffice for most future situations. They cannot do anything about the administrative data mining mess created by government/ insurance company mandates. Those systems were never designed to reflect medical data. They were designed to collect statistics for payment declining/ downgrading, without regard for medical accuracy.
Kiddoc brings up a good point. It is very difficult to "change" medical records for medicolegal reasons. We mainly just add "addendums" to the chart and nothing is actually erased. You can think the blood sucking attorneys for this. Thanks!!

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Re: Medical record mix-up

Post by leonard » Sat Dec 31, 2016 12:29 pm

At some point - you simply can't control what others put in a database somewhere about you.

Tell the doctor to remove it. Then, move on.
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Re: Medical record mix-up

Post by dm200 » Sat Dec 31, 2016 2:22 pm

kiddoc wrote:
dm200 wrote:This can be a life insurance issue. It is often the case that a life insurance company will want to review all of your medicl records. One (of many) reasons to get this cleared up ASAP.
Less likely. As a specialist, I usually am asked for notes for review for life insurance, not problem lists or registry data. If the note is marked in error, it will not be sent/ considered.
azurekep wrote:If my friend never receives an EOB that lists any office visits, procedures, lab tests or medications related to the erroneous disease, would it be safe to assume the error has been corrected, contained and not propagated?
Also, will going through HIPAA fully correct all errors locally and in the wider repositories?
No and no. Again, what the medical practice can do at a maximum is change the note appropriately which should suffice for most future situations. They cannot do anything about the administrative data mining mess created by government/ insurance company mandates. Those systems were never designed to reflect medical data. They were designed to collect statistics for payment declining/ downgrading, without regard for medical accuracy.
Let me give you my actual experience, although this goes back several decades and the rules may have changed. After getting married and having a small child, I sought to purchase term life insurance. I supplied the requested physician information. I was not aware of any meaningful health issues and a nurse came to my home and did a quick checkup. I was denied. When I queried the reason(s), I was told that there were abnormal liver tests in my medical history. I pressed the life insurance company and stated that I had never been told by any Physicians that there were any liver problems. We went round and round - the insurance company rep gave me a tutorial on the differences between "clinical" medicine and "actuarial" medicine. I consulted a Gastroenterologist to review my records, run any tests she thought reasonable and write a letter. I cannot remember the liver details, but the Gastroenterologist told me that (then) the only way to know 100% if there were actual liver problems would be to stick a needle into my liver - and that would be very unwise for an otherwise healthy man in his thirties. Fortunately, she wrote a letter (we worked on the wording together) and I received the insurance. Turned out to be a good deal for the insurance company since I am still alive after all these decades and they paid out NOTHING!

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Re: Medical record mix-up

Post by azurekep » Sat Dec 31, 2016 3:17 pm

toofache32 wrote:
Kiddoc brings up a good point. It is very difficult to "change" medical records for medicolegal reasons. We mainly just add "addendums" to the chart and nothing is actually erased. You can think the blood sucking attorneys for this. Thanks!!
On the HIPAA page, it mentions patients have the right to have their medical records corrected or amended. After reading this thread, it appears that language is ambiguous and no correctons per se are ever made (in the sense of text deletion), but amendments are "attached" to a record. And these amendments may or may not be read by future doctors since it involves some extra effort. Am I understanding this correctly?
From HIPAA page:

If you think the information in your medical or billing record is incorrect, you can request a change, or amendment, to your record. The health care provider or health plan must respond to your request. If it created the information, it must amend inaccurate or incomplete information.

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Re: Medical record mix-up

Post by azurekep » Sat Dec 31, 2016 3:24 pm

leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.

Tell the doctor to remove it. Then, move on.
The issue here is that my friend is worried that if he gets in a car accident or something similar and is taken to the ER, he may not get the correct treatment because doctors may be afraid to do what's necessary because of what's written on his chart. I don't want to go into the details of the "erroneous disease", but it would complicate the decisions of any medical personnel.

If a family member was at the hospital with him and could explain the situation, that's one thing, but in an emergency, decisions would have to be made before family contacts may be able to arrive on the scene.

Is this a legitimate worry? Or do emergency professonals not have access to medical records and simply treat the emergency in front of them -- whether it be a car accident, a poisoning, gunshot wound, etc. etc.

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Re: Medical record mix-up

Post by dm200 » Sat Dec 31, 2016 4:13 pm

azurekep wrote:
leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.
Tell the doctor to remove it. Then, move on.
The issue here is that my friend is worried that if he gets in a car accident or something similar and is taken to the ER, he may not get the correct treatment because doctors may be afraid to do what's necessary because of what's written on his chart. I don't want to go into the details of the "erroneous disease", but it would complicate the decisions of any medical personnel.
If a family member was at the hospital with him and could explain the situation, that's one thing, but in an emergency, decisions would have to be made before family contacts may be able to arrive on the scene.
Is this a legitimate worry? Or do emergency professonals not have access to medical records and simply treat the emergency in front of them -- whether it be a car accident, a poisoning, gunshot wound, etc. etc.
I think this is a legitimate worry - although in this case very remote. While access to a person's medical records in such cases is almost always a good thing, you cite a possible risk. I suspect most hospital emergency rooms do not have quick access to all of the injured person's records, there may be some that are part of a large network where this might be possible. In my case, for example, my Kaiser records are almost all accessible by any Kaiser provider. If I was take to a Kaiser affiliated emergency room, my guess is that (as soon as I was identified as a Kaiser participant) they could access my records.

Since I can see online most of my records with Kaiser, one thing I do regularly is review whatever I can see and if there are errors, I request that the errors be corrected. Earlier this year, for example, there was a minor error in the records about medications I was taking. When I noticed it, I requested my Primary care physician correct it. Curiously, she did not see the place I was looking and I had to send her a screen shot of what was wrong. Then, she could fix it.

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Re: Medical record mix-up

Post by azurekep » Sat Dec 31, 2016 5:24 pm

dm200 wrote:

In my case, for example, my Kaiser records are almost all accessible by any Kaiser provider. If I was take to a Kaiser affiliated emergency room, my guess is that (as soon as I was identified as a Kaiser participant) they could access my records.
That's a good point. In my friend's case, the healthcare providers don't have a "branded" hospital like Kaiser does. There are a couple of unaffiliated hospitals in the area, which is where an injured person would be transferred. So, it might be the case that the medical records wouldn't be available until after a delay.

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Re: Medical record mix-up

Post by leonard » Sun Jan 01, 2017 12:00 pm

dm200 wrote:
azurekep wrote:
leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.
Tell the doctor to remove it. Then, move on.
The issue here is that my friend is worried that if he gets in a car accident or something similar and is taken to the ER, he may not get the correct treatment because doctors may be afraid to do what's necessary because of what's written on his chart. I don't want to go into the details of the "erroneous disease", but it would complicate the decisions of any medical personnel.
If a family member was at the hospital with him and could explain the situation, that's one thing, but in an emergency, decisions would have to be made before family contacts may be able to arrive on the scene.
Is this a legitimate worry? Or do emergency professonals not have access to medical records and simply treat the emergency in front of them -- whether it be a car accident, a poisoning, gunshot wound, etc. etc.
I think this is a legitimate worry - although in this case very remote. While access to a person's medical records in such cases is almost always a good thing, you cite a possible risk. I suspect most hospital emergency rooms do not have quick access to all of the injured person's records, there may be some that are part of a large network where this might be possible. In my case, for example, my Kaiser records are almost all accessible by any Kaiser provider. If I was take to a Kaiser affiliated emergency room, my guess is that (as soon as I was identified as a Kaiser participant) they could access my records.

Since I can see online most of my records with Kaiser, one thing I do regularly is review whatever I can see and if there are errors, I request that the errors be corrected. Earlier this year, for example, there was a minor error in the records about medications I was taking. When I noticed it, I requested my Primary care physician correct it. Curiously, she did not see the place I was looking and I had to send her a screen shot of what was wrong. Then, she could fix it.
I do in fact agree that it is a practical worry. and, yes, it could have consequences.

But, the reality is that the most that can be done is to ask someone to do something. Unless we are medical professionals, I don't think there is any way to verify what is there. So, the only thing that can be done is to ask them to do it, then hope it gets done, cause you can't really verify it anyway.

Plus, purely pragmatically, there is no way for us to control what one of 7.5 billion people might store about us somewhere in an IT system. It's simply not practical to police it 24/7. So, I think it's a "do your best and move on" type of problem.
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mhalley
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Re: Medical record mix-up

Post by mhalley » Sun Jan 01, 2017 12:34 pm

In general, ers do not have access to office medical records. Er and hospital records ( for the er you are in) are instantly available on the computer. Records from other hospitals/ers are available after being requested, but this generally takes a long while. If you are in a big hospital system, the other hospitals/ers may be available on the computer.
Medical records can not have the possibility to delete records, as it would the be possible for someone change the medical record to cover up malpractice, medical errors, etc.

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azurekep
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Re: Medical record mix-up

Post by azurekep » Sun Jan 01, 2017 5:03 pm

leonard wrote:

I do in fact agree that it is a practical worry. and, yes, it could have consequences.

But, the reality is that the most that can be done is to ask someone to do something. Unless we are medical professionals, I don't think there is any way to verify what is there. So, the only thing that can be done is to ask them to do it, then hope it gets done, cause you can't really verify it anyway.

Plus, purely pragmatically, there is no way for us to control what one of 7.5 billion people might store about us somewhere in an IT system. It's simply not practical to police it 24/7. So, I think it's a "do your best and move on" type of problem.
I'm not entirely convinced of that, but I'm also not sure how radically things have changed in this new electronic era.

Some years ago, I asked for copies of my own medical records, more out of curiosity than anything. I paid a nominal fee and got hard copies of everything. If I had seen something amiss, I could have asked to have it changed then go through the whole process again, seeing actual hardcopy printouts of my records.

From what I'm hearing now, if one requests medical records after asking them to be altered, you'd actually see the same records as before, only with a notation saying that it's in error. But it seems the notations are not "stamped" on the record but are separate electronic files. So are they printed out separately and stapled to the original, erroneous records? That seems like a mess. So I'm not exactly sure what one would get if they asked for copies of their medical records these days. But in theory, one should be able to verify that the records have been changed.

Should my friend go through this process of getting hardcopy records verifying the changes? I would say yes since this all happened recently and he could just request the most recent records. I hope he wouldn't be asked to pay for the photocopies though. That would be kind of an insult.

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dm200
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Re: Medical record mix-up

Post by dm200 » Sun Jan 01, 2017 5:34 pm

I do not know what the future will bring, but the trend seems to be more electronic medical records and, for various reasons, more access to such records and more "sharing". If such records are accurate AND interpreted properly, that should be a good thing for our health and well being. On the other hand, inaccurate information or misinterpreted information might put us at more risk. So, in my opinion, even if our information is not available or shared now, it may be in the future.

This is a good reason for doing whatever we can to correct any errors.

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Re: Medical record mix-up

Post by azurekep » Sun Jan 01, 2017 6:35 pm

dm200 wrote:
Since I can see online most of my records with Kaiser, one thing I do regularly is review whatever I can see and if there are errors, I request that the errors be corrected. Earlier this year, for example, there was a minor error in the records about medications I was taking. When I noticed it, I requested my Primary care physician correct it. Curiously, she did not see the place I was looking and I had to send her a screen shot of what was wrong. Then, she could fix it.
When you went online after the correction, what did you see?

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azurekep
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Re: Medical record mix-up

Post by azurekep » Sun Jan 01, 2017 6:37 pm

mhalley wrote:In general, ers do not have access to office medical records. Er and hospital records ( for the er you are in) are instantly available on the computer. Records from other hospitals/ers are available after being requested, but this generally takes a long while. If you are in a big hospital system, the other hospitals/ers may be available on the computer.
Medical records can not have the possibility to delete records, as it would the be possible for someone change the medical record to cover up malpractice, medical errors, etc.
Thanks for the info. (I missed this post the first time around.)

I'm getting a clearer picture of how all this works.

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Re: Medical record mix-up

Post by inbox788 » Sun Jan 01, 2017 8:54 pm

AFAIK, there is no THE medical record, but various A medical record. A medical record at PCP. A medical record at specialist A. A medical record at specialist B. A medical record at local community hospital. Sometimes, because of agreements, some of these records get mixed or propagated. There is HIPAA protected medical information at various billing and payment providers, including insurance companies as well as some government agencies. And finally, there is the mysterious Medical Information Bureau that works like credit reporting agencies. Now some of any of this information may be disclosed to the patient, but there is always a hidden layer of information that doesn't get disclosed for one reason or another. It would be impossible to look at and correct all these records, so pretty much putting in a note at PCP and specialist A (and maybe specialist B) of the error is about all one can do. Trying to fix the rest of a crazy system is more likely to introduce problems, but if there are problems in the future, be sure to consider this misinformation as a potential source.

FWIW, there are misdiagnosis of diseases in a patient himself without involving other patients, and those are pretty much dealt with by the system, so this misdiagnosis shouldn't be much different, and hopefully doesn't have lasting effects.

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Re: Medical record mix-up

Post by kiddoc » Sun Jan 01, 2017 9:18 pm

leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.

Tell the doctor to remove it. Then, move on.
Short and sweet. As someone who works a lot in the ER, I can't agree more. The best thing for anyone is to have a small piece of paper in his/her wallet with their medical history, major allergies and medication list. If your friend shows up in our ER with that, we will be really grateful. If he is concerned, make an annotation on the wallet card, "Note: Diagnosis of Disease XYZ was entered in December 2016- THIS IS IN ERROR".

Don't bother about getting electronic repositories, USB drives, electronic bracelets, etc. The wallet card trumps all of them in the real world.
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Re: Medical record mix-up

Post by nisiprius » Sun Jan 01, 2017 9:26 pm

dm200 wrote:This can be a life insurance issue. It is often the case that a life insurance company will want to review all of your medicl records. One (of many) reasons to get this cleared up ASAP.
That reminds me. Have your friend get in contact with the so-called Medical Information Bureau or MIB immediately. Actually, they can take the first step, themselves, online, easily:

go to the MIB website and have them request a copy of their "MIB consumer file."

The "Medical Information Bureau" is a euphemistic name for a credit-agency-like organization that serves insurance companies. In Ye Olde Days they snooped on your medical records (you gave them permission in the fine print when you signed that piece of paper in the emergency room). Nowadays I think they only get information when you apply for insurance, so not everybody has a MIB record.

The point is, they might as well find out whether their medical record error has spread to the MIB yet. If so, then getting that corrected is one of the chores that needs to be done, as the MIB is the channel through which insurance companies get their information... I think.
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dm200
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Re: Medical record mix-up

Post by dm200 » Sun Jan 01, 2017 9:36 pm

kiddoc wrote:
leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.
Tell the doctor to remove it. Then, move on.
Short and sweet. As someone who works a lot in the ER, I can't agree more. The best thing for anyone is to have a small piece of paper in his/her wallet with their medical history, major allergies and medication list. If your friend shows up in our ER with that, we will be really grateful. If he is concerned, make an annotation on the wallet card, "Note: Diagnosis of Disease XYZ was entered in December 2016- THIS IS IN ERROR".
Don't bother about getting electronic repositories, USB drives, electronic bracelets, etc. The wallet card trumps all of them in the real world.
Especially when traveling, it would not be a bad idea for the travel companion to also be aware of the medical information being carried as well.

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azurekep
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Re: Medical record mix-up

Post by azurekep » Mon Jan 02, 2017 12:14 pm

kiddoc wrote:
leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.

Tell the doctor to remove it. Then, move on.
Short and sweet. As someone who works a lot in the ER, I can't agree more. The best thing for anyone is to have a small piece of paper in his/her wallet with their medical history, major allergies and medication list. If your friend shows up in our ER with that, we will be really grateful. If he is concerned, make an annotation on the wallet card, "Note: Diagnosis of Disease XYZ was entered in December 2016- THIS IS IN ERROR".
That sounds like a good, practical idea, but aren't there privacy issues with medical personnel accessing a patient's wallet without their permission? (I'm assuming the worst-case scenario where the patient is not in a position to speak coherently.)

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azurekep
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Re: Medical record mix-up

Post by azurekep » Mon Jan 02, 2017 12:35 pm

nisiprius wrote:
dm200 wrote:This can be a life insurance issue. It is often the case that a life insurance company will want to review all of your medicl records. One (of many) reasons to get this cleared up ASAP.
That reminds me. Have your friend get in contact with the so-called Medical Information Bureau or MIB immediately. Actually, they can take the first step, themselves, online, easily:

go to the MIB website and have them request a copy of their "MIB consumer file."

The "Medical Information Bureau" is a euphemistic name for a credit-agency-like organization that serves insurance companies. In Ye Olde Days they snooped on your medical records (you gave them permission in the fine print when you signed that piece of paper in the emergency room). Nowadays I think they only get information when you apply for insurance, so not everybody has a MIB record.

The point is, they might as well find out whether their medical record error has spread to the MIB yet. If so, then getting that corrected is one of the chores that needs to be done, as the MIB is the channel through which insurance companies get their information... I think.
We'll look into that, thanks.

I'm not as laid-back about this issue as some here because I'm looking at what might happen if ACA is repealed. Right now as I understand it, there are no issues with pre-existing conditions -- real ones or ones reported in error on a medical record. That is, there is no fear of being denied care or paying extra premiums. But if that changes, the error could be problematic.

The one piece of "amended" paper my friend has gotten on this whole thing is a document detailing the sick guy's diagnosis with my friend listed as the patient, along with his address, DOB, etc.. On page two, there is a tiny note saying this was issued in error. The only reason I would have seen the note was because I was looking for it. In an electronic format, it's already been explained in this thread how easy it would be to overlook the amendment as well.

The ideal way of doing this would be to keep the record intact (to ensure against fraud) but have an overlay displayed across the entire page (hardcopy and electronic) saying RETRACTED or something similar. That way it is apparent at first glance that it is an error.

I suppose since this error is still (hopefully) contained within the medical group, and perhaps they have their own rules/llatitude, something similar can be done.

In any case, we'll look into MIB and continue to work with the medical group.

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Re: Medical record mix-up

Post by toofache32 » Mon Jan 02, 2017 12:43 pm

azurekep wrote:
kiddoc wrote:
leonard wrote:At some point - you simply can't control what others put in a database somewhere about you.

Tell the doctor to remove it. Then, move on.
Short and sweet. As someone who works a lot in the ER, I can't agree more. The best thing for anyone is to have a small piece of paper in his/her wallet with their medical history, major allergies and medication list. If your friend shows up in our ER with that, we will be really grateful. If he is concerned, make an annotation on the wallet card, "Note: Diagnosis of Disease XYZ was entered in December 2016- THIS IS IN ERROR".
That sounds like a good, practical idea, but aren't there privacy issues with medical personnel accessing a patient's wallet without their permission? (I'm assuming the worst-case scenario where the patient is not in a position to speak coherently.)
Privacy issues? They're trying to figure out who you are and most people keep their ID in their wallet. Are you saying you want treatment but you want to remain anonymous? What is the privacy concern here? What are you trying to keep "private"?

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Re: Medical record mix-up

Post by azurekep » Mon Jan 02, 2017 12:58 pm

toofache32 wrote:

Privacy issues? They're trying to figure out who you are and most people keep their ID in their wallet. Are you saying you want treatment but you want to remain anonymous? What is the privacy concern here? What are you trying to keep "private"?
Nope. That's not what I'm saying.

Basically, I know very little about this area. My knowledge is limited to cop shows where wallets can be retrieved from dead bodies to establish identity. But in real-life, day-to-day situations, companies are very cautious about dealing with an individual unless the individual voluntarily discloses proof of their identity.

In between the cop-show/dead bodies and the real-life, day-to-day business situations is an area I'm not familiar with. If emergency personnel can look for and access people's wallets, I'm fine with that. I just figured there would be too much red tape preventing them from doing so.

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Re: Medical record mix-up

Post by leonard » Mon Jan 02, 2017 1:00 pm

azurekep wrote:
toofache32 wrote:

Privacy issues? They're trying to figure out who you are and most people keep their ID in their wallet. Are you saying you want treatment but you want to remain anonymous? What is the privacy concern here? What are you trying to keep "private"?
Nope. That's not what I'm saying.

Basically, I know very little about this area. My knowledge is limited to cop shows where wallets can be retrieved from dead bodies to establish identity. But in real-life, day-to-day situations, companies are very cautious about dealing with an individual unless the individual voluntarily discloses proof of their identity.

In between the cop-show/dead bodies and the real-life, day-to-day business situations is an area I'm not familiar with. If emergency personnel can look for and access people's wallets, I'm fine with that. I just figured there would be too much red tape preventing them from doing so.
I'd advise my friend to apply the 80/20 rule on this problem. Solve for the 80% likely case. Simply accept these edge cases as unlikely risks.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

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Re: Medical record mix-up

Post by azurekep » Mon Jan 02, 2017 1:13 pm

leonard wrote:

I'd advise my friend to apply the 80/20 rule on this problem. Solve for the 80% likely case. Simply accept these edge cases as unlikely risks.
It's tempting, but this is one of those rare occasions that a bureaucratic mix-up has been identified early. There's a chance to nip it in the bud.

I myself have had problems with erroneous information -- wrong info contained in public records, in my case. It's caused problems down the line as info from public records is often asked for authentication. There are few things worse in life than trying to fight a bureaucracy and tell them their records are wrong. :?

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Re: Medical record mix-up

Post by leonard » Mon Jan 02, 2017 1:16 pm

azurekep wrote:
leonard wrote:

I'd advise my friend to apply the 80/20 rule on this problem. Solve for the 80% likely case. Simply accept these edge cases as unlikely risks.
It's tempting, but this is one of those rare occasions that a bureaucratic mix-up has been identified early. There's a chance to nip it in the bud.

I myself have had problems with erroneous information -- wrong info contained in public records, in my case. It's caused problems down the line as info from public records is often asked for authentication. There are few things worse in life than trying to fight a bureaucracy and tell them their records are wrong. :?
Keep your eyes open then. At some point medical records may to turn to windmills and it may be easy to miss this transition.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

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Re: Medical record mix-up

Post by kiddoc » Mon Jan 02, 2017 11:52 pm

azurekep wrote:
kiddoc wrote:
Short and sweet. As someone who works a lot in the ER, I can't agree more. The best thing for anyone is to have a small piece of paper in his/her wallet with their medical history, major allergies and medication list. If your friend shows up in our ER with that, we will be really grateful. If he is concerned, make an annotation on the wallet card, "Note: Diagnosis of Disease XYZ was entered in December 2016- THIS IS IN ERROR".
That sounds like a good, practical idea, but aren't there privacy issues with medical personnel accessing a patient's wallet without their permission? (I'm assuming the worst-case scenario where the patient is not in a position to speak coherently.)
No, most people are happy to compromise on privacy when someone is trying to save their life. Medical professionals can't release this info without the patient's consent to anyone but are allowed to collect information needed "to do their job".
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